When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications

Ann Emerg Med. 2017 Aug;70(2):203-211. doi: 10.1016/j.annemergmed.2017.02.015. Epub 2017 Mar 30.


The intranasal route for medication administration is increasingly popular in the emergency department and out-of-hospital setting because such administration is simple and fast, and can be used for patients without intravenous access and in situations in which obtaining an intravenous line is difficult or time intensive (eg, for patients who are seizing or combative). Several small studies (mostly pediatric) have shown midazolam to be effective for procedural sedation, anxiolysis, and seizures. Intranasal fentanyl demonstrates both safety and efficacy for the management of acute pain. The intranasal route appears to be an effective alternative for naloxone in opioid overdose. The literature is less clear on roles for intranasal ketamine and dexmedetomidine.

Publication types

  • Review

MeSH terms

  • Administration, Intranasal
  • Analgesics, Opioid / administration & dosage*
  • Conscious Sedation / methods
  • Dexmedetomidine / administration & dosage
  • Drug Overdose / drug therapy*
  • Emergency Service, Hospital*
  • Fentanyl / administration & dosage
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Ketamine / administration & dosage
  • Midazolam / administration & dosage
  • Naloxone / administration & dosage
  • Patient Safety
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Wounds and Injuries / therapy*


  • Analgesics, Opioid
  • Hypnotics and Sedatives
  • Naloxone
  • Dexmedetomidine
  • Ketamine
  • Midazolam
  • Fentanyl