The Scottish Medicines Consortium (SMC) has accepted fentanyl single dose nasal spray (Instanyl®) for use within NHS Scotland for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain.  Its use is restricted to patients who are unsuitable for other short-acting oral opioids (e.g. oral morphine) as an alternative to other buccal and sublingual fentanyl preparations. 

The product update (see link below) notes that this single dose fentanyl nasal spray presentation has been shown in a pharmacokinetic study to be bioequivalent to the multi-dose nasal spray presentation and is available at equivalent cost per dose.