New Drug
Lauren Howell, PharmD
The first needle-free dosage form of epinephrine was approved by FDA in August 2024. neffy (epinephrine nasal spray–ARS Pharmaceuticals) is a pocket-sized nasal spray approved for emergency treatment of type 1 allergic reactions, including anaphylaxis, in adult and pediatric patients who weigh 30 kg (66 lbs) or greater.
According to ARS Pharmaceuticals, neffy uses Intravail technology to temporarily loosen the spaces between nasal cells, allowing epinephrine to be rapidly absorbed into the body and reverse an allergic reaction.
Recommended dosage and administration
The recommended dosage of neffy is one spray, or 2 mg of epinephrine, administered into one nostril. After 5 minutes if no clinical improvement is seen, or symptoms worsen, a second dose of neffy can be administered into the same nostril as the first spray. Patients should be prescribed and have immediate access to two neffy sprays. The manufacturer produces a compact carrying case that holds two doses and can be ordered online.
As soon as symptoms of a serious allergic reaction are identified, neffy should be administered. The first step is to remove neffy from the packaging. The device should then be held with the thumb on the bottom of the plunger and a finger on either side of the nozzle. The plunger should not be pulled or pushed. No priming or test spray is necessary, as each device only contains one spray.
The nozzle should be inserted in a nostril until the fingers touch the nose. The nozzle should be pointed straight into the nose and toward the forehead. It is important not to angle the nozzle toward the nasal septum or outer walls of the nose.
Once positioned correctly, the plunger should be pressed firmly until it snaps up and sprays liquid in the nostril. Patients should not sniff during or after the dose is given. If any liquid is observed dripping out of the nose, a second dose of neffy may be required.
neffy should not be sprayed into the eyes or mouth. It is recommended that right-handed individuals administer the dose in the right nostril and that left-handed individuals administer the dose in the left nostril. The patient can be in any position when the dose is administered. Emergency medical help should be received after the dose is administered. neffy has been found to remain stable for 30 months at room temperature. Patients should check the expiration date periodically and replace their neffy device before the expiration date occurs.
Adverse effects, warnings, and precautions
Since neffy is administered nasally, the absorption of epinephrine may be affected by underlying structural and anatomical nasal conditions. In patients with heart disease, neffy may aggravate angina pectoris or produce ventricular arrhythmias.
Although a sulfite is present in neffy, this should not deter use in individuals with a sulfite allergy.
Nasal mucosa may be altered after neffy administration for up to 2 weeks, and this could increase systemic absorption of nasal products, including neffy. Patients taking cardiac glycosides, diuretics, or anti-arrhythmics should be observed for cardiac arrhythmias after neffy administration.
Certain medications such as TCAs, MAOIs, levothyroxine sodium, certain antihistamines, and catechol-O-methyl transferase inhibitors may potentiate the effects of epinephrine. b-adrenergic drugs can antagonize the cardiostimulating and bronchodilating effects of epinephrine. a-adrenergic blocking drugs may antagonize the vasoconstricting and hypertensive effects of epinephrine. Ergot alkaloids may reverse the pressor effects of epinephrine.
The most common adverse reactions following administration of neffy are throat irritation, intranasal paresthesia, headache, nasal discomfort, feeling jittery, paresthesia, fatigue, tremor, rhinorrhea, nasal pruritus, sneezing, abdominal pain, gingival pain, oral hypoesthesia, nasal congestion, dizziness, nausea, and vomiting. The risk of developing these adverse reactions is greater in older adults. ■