Opioid (Fentanyl) Nasal Spray

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 19 June, 2011


During the last years since 2008, approximately 2 billion dollars have been invested worldwide on research and production of drugs in the form of a nasal spray. Such drugs are calcitonin for osteoporosis, desmopressin for enuresis and triptanes for migraine.

A new pharmaceutical product has circulated in Greece lately. It is administered transnasally to treat paroxysmal pain of adults who are already in chronic cancer pain treatment with slow-release and long-acting opioids.


“Paroxysmal pain” is a sudden attack of moderate to severe pain in a patient who has chronic pain that is under control during the 24-hour day. Characteristic elements of paroxysmal pain are: moderate to strong intensity, rapid peaking (2-3 minutes) and short duration (60 minutes on average). It may be provoked by some movement or activity and is spontaneous and unpredictable. The untreated paroxysmal pain has a highly negative effect on the patient’s psychology as it causes anxiety, stress, fear and reduces quality of life.

According to various studies, approximately 95% of patients with cancer pain experience paroxysmal pain daily. 2/3 of these patients do not receive any satisfactory treatment. The mean value of episodes occurring is 3-4 attacks per day. About 87% of patients have stated that paroxysmal pain affects negatively their life, sleep and ability to walk and communicate with other people.


The drug administered to treat paroxysmal pain is an opioid called fentanyl (instanyl). It has recently become available in the Greek market, in the form of an oral lozenge (lollipop).

It is delivered with a special dose metering pump, in the form of a nasal spray. The dose metering pump is the VP7D model manufactured by Valois Pharma’s, the company that manufactures spray pumps used worldwide for systematic and local drug administration. The VP7D pump delivers predetermined fentanyl doses with accuracy and safety (50, 100, 200 mcg/dose).


Up to four episodes of paroxysmal pain can be treated daily, each one with no more than two separate dosages. The second dose is delivered 10 minutes after the first one in case the pain persists. There has to be an inbetween interval of at least 4 hours before treating the next paroxysmal pain attack.

The initial dose selected is 50mcg and is repeated after 10 minutes, if necessary.  If there is no satisfactory pain relief, the right next available higher dose of 100mcg is chosen for the next episode.

The advantage of this new drug is its rapid action. Immediately after nasal spraying, there is fast absorption by the systematic circulation and nasal mucosa. A further advantage is that it can be easily used by patients. So, today there is a powerful and functional weapon available for fighting against attacks of paroxysmal pain.


This drug is prescribed by specialist physicians who have experience in patients’ treatment with opioids. A special prescription for narcotic substances is needed.

The drug is contra-indicated for patients who already take opioids of stable release, patients with severe respiratory failure, severe obstructive pulmonary disease, repeated epistaxis and those receiving radiation on the face.