Intranasal epinephrine in dogs: Pharmacokinetic and heart rate effects

Abstract

Epinephrine is the standard of care for the treatment of severe allergy and anaphylaxis. Epinephrine is most often administered through the intramuscular (IM) route via autoinjector. The current study aimed to evaluate an alternative method of epinephrine treatment through intranasal (IN) delivery in dogs. The pharmacokinetic (PK) parameters of maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), and area under the plasma concentration‐time curve from 0 to 90 minutes (AUC0–90) were observed after IN epinephrine (2, 3, 4, 5, 10, and 20 mg) and IM epinephrine via autoinjector (0.15 and 0.3 mg) for 90 minutes. Heart rate effects were measured after IN (2 and 5 mg) and IM (0.15 and 0.3 mg) epinephrine administration. IN epinephrine (5 mg) demonstrated significantly greater plasma epinephrine concentration at 1 minute as compared with IM epinephrine (0.3 mg) (1.68 ± 0.65 ng/mL vs 0.21 ± 0.08 ng/mL, P = .03). There were no significant differences in Cmax, Tmax, and AUC0–90 between 2‐mg IN and 0.15‐mg IM epinephrine or between 5‐mg IN and 0.3‐mg IM epinephrine. IN epinephrine reduced heart rate increases, as compared to IM epinephrine. IN and IM epinephrine were both well‐tolerated. Overall, IN epinephrine demonstrated advantages over IM epinephrine, including the rapid increase in plasma epinephrine and lack of increased heart rate over time.

Pharmacokinetics of intravenous, oral transmucosal, and intranasal buprenorphine in healthy male dogs

“…In addition, drugs administered by the nasal route can directly reach the central nervous system (CNS) via the trigeminal and olfactory nerves (Erdo et al, 2018). The IN route of administration in dogs has been investigated for midazolam, dexmedetomidine, epinephrine, naloxone, and ketamine (Bleske et al, 1992; Charalambous et al, 2017; Charalambous et al, 2019; Dretchen et al, 2020; Santangelo et al, 2019; Tuttle et al, 2020; Vlerick et al, 2020; Wahler et al, 2019). These studies reported the intranasal route of administration to be clinically effective and/or results in adequate plasma concentrations of the investigated drug.…”