Intranasal Epinephrine

Aka: Intranasal Epinephrine, Neffy

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II. Indications

  1. Anaphylaxis
    1. FDA approved in U.S. in Augist 2024 for adults and children (weight >= 30 kg or 66 lb)

III. Medications

  1. See Epinephrine Home Injectable Devices
  2. Intranasal Epinephrine (Neffy)
    1. Nasal spray formulation of Epinephrine
    2. Very expensive (cost for two doses is >$700 in 2026)

IV. Pharmacokinetics

  1. Shelf-Life: 30 months
  2. Can withstand Temperatures up to 50 C (122 F)

V. Dosing

  1. Weight >= 30 kg (66 lb): 2 mg nasal Inhaler
  2. Weight 15 to 30 kg (33 to 66 lb): 1 mg nasal Inhaler

VI. Technique

  1. Hold device with thumb on underside plunger and a finger on either side of nozzle
  2. Insert nozzle completely into 1 nostril and fully depress the plunger to spray
  3. Each spray delivers 2 mg Epinephrine
  4. May give a second dose in the same nostril in 5 minutes if needed

VII. Adverse Effects (adults)

  1. Nasal discomfort (10-13%)
  2. Headache (6-18%)
  3. Rhinorrhea
  4. Nausea or Vomiting

VIII. Efficacy

  1. Appears to reach similar serum levels of Epinephrine with similar onset as for injectables
    1. However, absorption may be impacted by prior nasal surgery or Nasal Polyps
    2. Testing was done in healthy subjects, and efficacy may be reduced in Anaphylaxis
    3. Injectables are still preferred as first line agents

IX. References

  1. (2024) Presc Lett 31(10): 56
  2. LoVecchio (2024) Crit Dec Emerg Med 38(10): 35
  3. Wolf (2026) Am Fam Physician 113(3): 270-2 [PubMed]

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