117 - Intranasal

Intranasal

116 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Inhaled Loxapine is the only antipsychotic licensed as an inhalation powder. It is indicated for adults with mild to moderate agitation associated with schizophrenia and bipolar disorder in the hospital setting. It was licensed in Europe and the USA in 2013 but has since been discontinued in the UK. Inhaled loxapine remains available in the EU and USA but use is restricted. Onset of tranquillising effect is around 10  minutes. Administration requires co-­operation with the patient, which may not be possible in medically unwell patients. It is not clear if repeated administration of inhaled loxapine has an antipsychotic effect. Intranasal There are no commercially available preparations designed for intranasal and clinical investigations in humans are limited.1 Nanotechnology delivery systems have been developed for intranasal delivery of various antipsychotics, but this system remains clinically untested.2–4 One small study compared the pharmacokinetics of intranasal and intramuscular haloperidol in healthy volunteers.5 Using a compounded nasal spray, intranasal Table 1.26  (Continued) Drug name and route Dosing information Manufacturer Notes Transdermal Asenapine transdermal patch (Secuado) Starting dose 3.8mg/24 hr, may increase to 5.7mg/24 hr or 7.6mg/24 hr after 1 week Noven Pharmaceuticals Inc (USA) ■ ■Licensed in the USA ■ ■Can be applied to upper arm, upper back, abdomen and hip ■ ■Patients may shower with the patch on. Avoid bathing or swimming. Blonanserin transdermal patch (Lonasen) Starting dose 40mg/24 hr up to 80mg/24 hr Sumitomo Pharma ■ ■Licensed in China, Japan and South Korea ■ ■Can be applied to upper arm, upper back, abdomen and hip ■ ■Patients may shower with the patch on. However, avoid bathing or swimming. Rectal Chlorpromazine rectal 100mg every 6–8 hr Special order ■ ■25mg and 100mg suppositories available. Limited information about this route for the treatment of psychosis. Olanzapine rectal 2.5–10mg suppositories used Suppositories have been manufactured by pharmacies ■ ■Has been used for delirium, nausea and vomiting in terminally ill patients rather than for psychosis Prochlorperazine rectal 25mg every 12 hr Suppositories available in some countries ■ ■Case report only