Systemic absorption of epinephrine compared between the intranasal and intramuscular routes of administration in healthy adults
Issued Date
2025-09-01
Resource Type
ISSN
0125877X
eISSN
22288694
Scopus ID
2-s2.0-105020791875
Pubmed ID
35964243
Journal Title
Asian Pacific Journal of Allergy and Immunology
Volume
43
Issue
3
Start Page
640
End Page
647
Rights Holder(s)
SCOPUS
Bibliographic Citation
Asian Pacific Journal of Allergy and Immunology Vol.43 No.3 (2025) , 640-647
Suggested Citation
Srisawat C., Pipitpreecha R., Chandranipapongse W., Chatsiricharoenkul S., Pongnarin P., Kongpatanakul S., Laocharoenkiat A., Jirapongsananuruk O., Visitsuntorn N., Vichyanond P. Systemic absorption of epinephrine compared between the intranasal and intramuscular routes of administration in healthy adults. Asian Pacific Journal of Allergy and Immunology Vol.43 No.3 (2025) , 640-647. 647. doi:10.12932/ap-120821-1209 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113039
Title
Systemic absorption of epinephrine compared between the intranasal and intramuscular routes of administration in healthy adults
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Abstract
Background: Epinephrine 5 mg administered via the intranasal (IN) route was shown to be bioequivalent to epinephrine 0.3 mg administered via the intramuscular (IM) route in our preliminary study. Objective: To investigate the pharmacokinetics and pharmacodynamics of IN and IM epinephrine absorption in a larger group of healthy adults (n = 12). Methods: Each subject was administered IN saline, IN epinephrine (5 mg), and IM epinephrine (0.3 mg) on 3 separate days. Plasma epinephrine levels were determined using liquid chromatography-tandem mass spectrometry. Results: IN epinephrine administration showed significant systemic absorption compared to IN saline control with the areas under the curve (AUC<inf>0-180 min</inf>) of 4.4 (4.9) ± 4.0 and 0.2 (0.5) ± 0.3 ng.min/mL, respectively; the values are mean (median) ± standard deviation. IN epinephrine absorption was about 0.5-fold that of IM epinephrine (AUC<inf>0-180 min</inf> 10.0 (9.2) ± 8.6 ng.min/mL), but the difference was not statistically significant (p = 0.16). The mean peak epinephrine concentration and the time to reach it were also not significantly different between the IN and IM routes. The corresponding values were 120 pg/mL and 41 min for IN, and 209 pg/mL and 41 min for IM, respectively. Conclusion: The systemic absorption of IN epinephrine 5 mg was significantly different from the control IN saline and about 0.5-fold that of IM epinephrine 0.3 mg. Although epinephrine administration via the less invasive IN route is safe and feasible, further investigations are necessary to achieve an adequate and consistent systemic absorption comparable to that of the conventional IM injection.