The transnasal route is an alternative delivery method that may be useful when
patients are no longer able to tolerate the oral route. Although several agents
are currently being studied, the only commercially available formulation is the
mixed agonist-antagonist drug butorphanol, which is rapidly taken up by the
vascular nasal mucosa. The major indication for its use is acute headache.
Although this formulation has general appeal by virtue of its potential for
rapid action, for the reasons noted above, this drug is not recommended for
routine use in cancer pain treatment.
Tolerance and Physical Dependence
Intravenous or Subcutaneous
Patient-Controlled Analgesia (PCA)