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One or Both Nostrils?

From the June 29, 2006 issue

One or both nostrils? Although many nasal sprays are intended to be administered in each nostril for a single dose, there are notable exceptions. For example, some medications are meant to be delivered via the nasal passage but NOT sprayed into each nostril. Calcitonin salmon (FORTICAL, MICALCIN) is a prime example. Patients should administer a single spray (200 international units) into one nostril daily, using alternate nostrils each day. Other examples in metered-dose or unit-dose nasal spray containers include butorphanol, desmopressin (DDAVP), sumatriptan (IMITREX), and zolmitriptan (ZOMIG). Some pharmacy and/or physician electronic prescribing systems have been preprogrammed to print directions that default to "spray in each nostril" when nasal sprays are selected. For the previously mentioned drugs, this would result in the administration of a double dose of medication.

One facility recently reported that about 50 patients, who had been prescribed medications intended to be given into one nostril, had prescription container labels that instructed the patient to administer the spray into both nostrils. Some physicians might anticipate patients’ confusion and write the prescription for "half" doses in each nostril. Even if instructed to use the spray in one nostril, patients who administer other nasal medications in both nostrils may spray these medications into both nostrils without thinking. Explicit verbal directions and written instructions that emphasize administration via one nostril only are critical to avoid an overdose.


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