The Institute for Safe Medication Practices recently alerted practitioners that although many nasal sprays are intended to be administered in both nostrils, there are some medications meant to be sprayed into just one nostril. These include calcitonin salmon, butorphanol, desmopressin, sumatriptan and zolmitriptan. If a patient misunderstands the directions and sprays the prescribed amount of one of these drugs into each nostril, he or she could be getting a two-fold overdose. Patient error may be only a part of the problem. Some electronic prescribing systems are preprogrammed to print directions saying “spray in each nostril” whenever a nasal spray is prescribed. ISMP says that for nasal sprays intended for one nostril, the patient needs explicit verbal directions and written instructions in order to prevent “double spraying. ” Additional Information: ISMP Medication Safety Alert — One or Both Nostrils? June 29, 2006. www. ismp. org