Transmucosal Valium?

[becksdad]

Has anyone ever heard of using valium intranasally via an atomizer device? We use versed intranasally, and I've heard of narcan used this way also. My understanding is that valium is too viscous for proper atomization and absorption. But we inherited a patient a while ago from another agency that administered valium intranasally (and it wasn't very effective). They insist they have a protocol for this drug/route, but I have been unable to locate any information supporting this. Just curious....

[chbare]

Becksdad, the question should be, "why would we want to consider doing this when we can give it IV?" Unless this is yet another way of allowing non ALS providers to administer medications "non invasive."

Take care,

chbare.

[becksdad]

CH - Good point. Of course IV is always the preferred route, but we have recently used intranasal versed for seizures when IV access has been unsuccessful (usually on peds). It is pretty effective, with faster onset than rectal valium. Then again, I suppose the argument could be made that this could encourage mediocre IV skills. For some it may, but its a nice rescue tool when used judiciously.

As for valium used this way, I have found nothing in any literature to indicate intranasal administration. There has been quite a bit of discussion among several of us involved with this particular call, and when my partner and I discovered the drug this patient received, and the route of administration, it was kind of a WTF? moment.

[chbare]

Becksdad, with the proliferation of IO access devices, I am not sure that this is really needed.

Take care,

chbare.

[AZCEP]

Valium can be absorbed by the nasal mucosa, but it will take so long to have an effect it would be senseless to use it this way. Versed and Narcan work because they are water soluble drugs. They cross the membrane much faster, and more reliably. If you don't like rectal Valium, get good at your IV's on the seizing patient. IO is a consideration, but difficult vascular access remains.

[Medic26]

Good point. Of course IV is always the preferred route, but we have recently used intranasal versed for seizures when IV access has been unsuccessful (usually on peds). It is pretty effective, with faster onset than rectal valium. Then again, I suppose the argument could be made that this could encourage mediocre IV skills. For some it may, but its a nice rescue tool when used judiciously.

I agree here, we just recently started using versed intranasal route when IV cannot be obtained and have had good luck so far. We were told by our medical director that valuim was not to be given this route under any circumstance!!

[becksdad]

AZCEP, chbare, thank you both. Your comments pretty much supported our argument/questioning of why Valium (of all things) was given intranasally. This particular patient wasn't even seizing!

[kevkei]

Well that depends, there are forms of Valium that are water based/water soluble on the market now. So not all is oil based. Having said that, Versed would be a much better choice from a pharmacological perspective.

[CoyoteMedic]

I've given both Narcan and Versed IN in the field.

Where I work, there are alot of current and former IVDA people. While some are smart enough to "save a vein", alot don't. True you can go Versed IM, but you also need to look at the absorbtion time for IM injections. IN narcan works 75-90% faster I read somewhere then it does IM. I do applogize for not having that artical to back up that stat.

As for IN versed. Lacking IV skills or not, it still takes time to get a bag and a dripset out, or even just to set up a saline lock. As your partners getting O2 on the pt, you can already be drawing up your versed for IN admin, and you can have the first dose onboard at about the same time you would be dropping your line. When you have the IN option, and to wait to get a IV to give the versed, it could easily be looked at as withholding treatment.

[Awolfa]

I am accually looking to try this in our protocols. I think this route would be helpful in pedi cases plus those od pts that are either combative (Narcan) or one of our constant siezure pts that will rip out your iv and throw his blood arms all around when he wakes up. Anyone know where I can find more info on this so I can go to med control more prepared?? Thx