The nose has it: Opportunities and challenges for intranasal drug administration for neurologic conditions including seizure clusters

• Published in: Epilepsy & behavior reports 2023-01, Vol.21, p.100581-100581, Article 100581
• Main Authors: Chung, Steve, Peters, Jurriaan M., Detyniecki, Kamil, Tatum, William, Rabinowicz, Adrian L., Carrazana, Enrique
• Format: Article
• Language: English
• Subjects: Benzodiazepines; Epilepsy; Intranasal drug administration; Seizure cluster
• ISSN: 2589-9864; 2589-9864
• DOI: 10.1016/j.ebr.2022.100581

Nasal administration of treatments for neurologic conditions, including rescue therapies to treat seizure clusters among people with epilepsy, represents a meaningful advance in patient care. Nasal anatomy and physiology underpin the multiple advantages of nasal administration but also present challenges that must be addressed in any successful nasal formulation. Nasal cavity anatomy is complex, with a modest surface area for absorption that limits the dose volume of an intranasal formulation. The mucociliary clearance mechanism and natural barriers of the nasal epithelia must be overcome for adequate absorption. An extensive vasculature and the presence of olfactory nerves in the nasal cavity enable both systemic and direct-to-brain delivery of drugs targeting the central nervous system. Two intranasal benzodiazepine rescue therapies have been approved by the US Food and Drug Administration for seizure-cluster treatment, in addition to the traditional rectal formulation. Nasal sprays are easy to use and offer the potential for quick and consistent bioavailability. This review aims to increase the clinician’s understanding of nasal anatomy and physiology and of the formulation of intranasal rescue therapies and to facilitate patient education and incorporate intranasal rescue therapies for seizure clusters (also known as acute repetitive seizures) into their seizure action plans. •Intranasal neurologic drugs can advance ease of use and time to administration.•Nasal anatomy and physiology help to provide consistent bioavailability.•Intranasal formulations are designed specifically to optimize nasal absorption.•Two benzodiazepine nasal sprays are approved to treat seizure clusters in epilepsy.•Education on intranasal rescue therapies may increase patient comfort and care.