Route of administration Pharmaceuticle Dosage Form
In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body.
Obviously, a substance must be transported from the site of entry to the part of the body where its action is desired to take place (even if this only means penetration through the stratum corneum into the skin). However, using the body's transport mechanisms for this purpose can be far from trivial. The pharmacokinetic properties of a drug (that is, those related to processes of uptake, distribution, and elimination) are critically influenced by the route of administration.
topical: local effect, substance is applied directly where its action is desired
enteral: desired effect is systemic (non-local), substance is given via the digestive tract
parenteral: desired effect is systemic, substance is given by other routes than the digestive tract
The U.S. Food and Drug Administration recognizes 111 distinct routes of administration. The following is a brief list of some routes of administration. also see pharmaceutical validation
Topical
epicutaneous (application onto the skin), e.g. allergy testing, typical local anesthesia
inhalational, e.g. asthma medications
enema, e.g. contrast media for imaging of the bowel
eye drops (onto the conjunctiva), e.g. antibiotics for conjunctivitis
ear drops - such as antibiotics and corticosteroids for otitis externa
intranasal route (into the nose), e.g. decongestant nasal sprays
vaginal, e.g. topical estrogens, antibacterials
Enteral
Enteral is any form of administration that involves any part of the gastrointestinal tract:
by mouth (orally), many drugs as tablets, capsules, or drops
by gastric feeding tube, duodenal feeding tube, or gastrostomy, many drugs and enteral nutrition
rectally, various drugs in suppository or enema form
Parenteral by injection or infusion , also see pharma process validation
intravenous (into a vein), e.g. many drugs, total parenteral nutrition
intraarterial (into an artery), e.g. vasodilator drugs in the treatment of vasospasm and thrombolytic drugs for treatment of embolism
intramuscular (into a muscle), e.g. many vaccines, antibiotics, and long-term psychoactive agents
intracardiac (into the heart), e.g. adrenaline during cardiopulmonary resuscitation (no longer commonly performed)
subcutaneous (under the skin), e.g. insulin
intraosseous infusion (into the bone marrow) is, in effect, an indirect intravenous access because the bone marrow drains directly into the venous system. This route is occasionally used for drugs and fluids in emergency medicine and paediatrics when intravenous access is difficult.
intradermal, (into the skin itself) is used for skin testing some allergens, and also for tattoos
intrathecal (into the spinal canal) is most commonly used for spinal anesthesia and chemotherapy
intraperitoneal, (infusion or injection into the peritoneum) e.g. peritoneal dialysis
Other parenteral
transdermal (diffusion through the intact skin), e.g. transdermal opioid patches in pain therapy, nicotine patches for treatment of addiction
transmucosal (diffusion through a mucous membrane), e.g. insufflation (snorting) of cocaine, sublingual nitroglycerine, buccal (absorbed through cheek near gumline), vaginal suppositories
inhalational, e.g. inhalational anesthetics , also see process validation in pharma
Other
epidural (synonym: peridural) (injection or infusion into the epidural space), e.g. epidural anesthesia
intravitreal
Advantages and disadvantages
There are advantages and disadvantages to each route of administration
Inhalation
Advantages
Fastest method, 7-10 seconds for the drug to reach the brain
User can titrate (regulate the amount of drug they are receiving)
Disadvantages
Most addictive route of administration because it hits the brain so quickly
Difficulties in regulating the exact amount of dosage
Patient having difficulties in giving themselves a drug by inhaler
Injection
Injection incompasses intravenous (IV), intramuscular (IM), and subcutaneous (subcu)
Advantages
Fast: 15-30 seconds for IV, 3-5 minutes for IM and subcutaneous
One injection can be formulated to last days or even months, ex. Depo-Provera is a birth control shot that works for three months
IV can deliver continuous medication, ex. Morphine for patients in continuous pain, or saline drip for people needing fluids
Disadvantages
Because it's fast, there is more risk of addiction when it comes to injecting drugs of abuse
If needles are shared, there is risk of HIV and other infectious diseases
It is the most dangerous route of administration because it bypasses most of the body's natural defenses, exposing the user to health problems such as hepatitis, abscesses, infections, and undissolved particles or additives
If not done properly, air boluses (bubbles) can occur and can be fatal
Need of strict asepsis
Uses
Some routes can be used for topical as well as systemic purposes, depending on the circumstances. For example, inhalation of asthma drugs is targeted at the airways (topical effect), whereas inhalation of volatile anesthetics is targeted at the brain (systemic effect).
----Ad--pharma guideline
On the other hand, identical drugs can produce different results depending on the route of administration. For example, some drugs are not significantly absorbed into the bloodstream from the gastrointestinal tract and their action after enteral administration is therefore different from that after parenteral administration. This can be illustrated by the action of naloxone (Narcan), an antagonist of opiates such as morphine. Naloxone counteracts opiate action in the central nervous system when given intravenously and is therefore used in the treatment of opiate overdose. The same drug, when swallowed, acts exclusively on the bowels; it is here used to treat constipation under opiate pain therapy and does not affect the pain-reducing effect of the opiate.
Enteral routes are generally the most convenient for the patient, as no punctures or sterile procedures are necessary. Enteral medications are therefore often preferred in the treatment of chronic disease. However, some drugs can not be used enterally because their absorption in the digestive tract is low or unpredictable. Transdermal administration is a comfortable alternative; there are, however, only a few drug preparations are suitable for transdermal administration. Validation
In acute situations, in emergency medicine and intensive care medicine, drugs are most often given intravenously. This is the most reliable route, as in acutely ill patients the absorption of substances from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or bowel motility.
Technorati Profile
In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body.
Obviously, a substance must be transported from the site of entry to the part of the body where its action is desired to take place (even if this only means penetration through the stratum corneum into the skin). However, using the body's transport mechanisms for this purpose can be far from trivial. The pharmacokinetic properties of a drug (that is, those related to processes of uptake, distribution, and elimination) are critically influenced by the route of administration.
Classification
Routes of administration can broadly be divided into:topical: local effect, substance is applied directly where its action is desired
enteral: desired effect is systemic (non-local), substance is given via the digestive tract
parenteral: desired effect is systemic, substance is given by other routes than the digestive tract
The U.S. Food and Drug Administration recognizes 111 distinct routes of administration. The following is a brief list of some routes of administration. also see pharmaceutical validation
Topical
epicutaneous (application onto the skin), e.g. allergy testing, typical local anesthesia
inhalational, e.g. asthma medications
enema, e.g. contrast media for imaging of the bowel
eye drops (onto the conjunctiva), e.g. antibiotics for conjunctivitis
ear drops - such as antibiotics and corticosteroids for otitis externa
intranasal route (into the nose), e.g. decongestant nasal sprays
vaginal, e.g. topical estrogens, antibacterials
Enteral
Enteral is any form of administration that involves any part of the gastrointestinal tract:
by mouth (orally), many drugs as tablets, capsules, or drops
by gastric feeding tube, duodenal feeding tube, or gastrostomy, many drugs and enteral nutrition
rectally, various drugs in suppository or enema form
Parenteral by injection or infusion , also see pharma process validation
intravenous (into a vein), e.g. many drugs, total parenteral nutrition
intraarterial (into an artery), e.g. vasodilator drugs in the treatment of vasospasm and thrombolytic drugs for treatment of embolism
intramuscular (into a muscle), e.g. many vaccines, antibiotics, and long-term psychoactive agents
intracardiac (into the heart), e.g. adrenaline during cardiopulmonary resuscitation (no longer commonly performed)
subcutaneous (under the skin), e.g. insulin
intraosseous infusion (into the bone marrow) is, in effect, an indirect intravenous access because the bone marrow drains directly into the venous system. This route is occasionally used for drugs and fluids in emergency medicine and paediatrics when intravenous access is difficult.
intradermal, (into the skin itself) is used for skin testing some allergens, and also for tattoos
intrathecal (into the spinal canal) is most commonly used for spinal anesthesia and chemotherapy
intraperitoneal, (infusion or injection into the peritoneum) e.g. peritoneal dialysis
Other parenteral
transdermal (diffusion through the intact skin), e.g. transdermal opioid patches in pain therapy, nicotine patches for treatment of addiction
transmucosal (diffusion through a mucous membrane), e.g. insufflation (snorting) of cocaine, sublingual nitroglycerine, buccal (absorbed through cheek near gumline), vaginal suppositories
inhalational, e.g. inhalational anesthetics , also see process validation in pharma
Other
epidural (synonym: peridural) (injection or infusion into the epidural space), e.g. epidural anesthesia
intravitreal
Advantages and disadvantages
There are advantages and disadvantages to each route of administration
Inhalation
Advantages
Fastest method, 7-10 seconds for the drug to reach the brain
User can titrate (regulate the amount of drug they are receiving)
Disadvantages
Most addictive route of administration because it hits the brain so quickly
Difficulties in regulating the exact amount of dosage
Patient having difficulties in giving themselves a drug by inhaler
Injection
Injection incompasses intravenous (IV), intramuscular (IM), and subcutaneous (subcu)
Advantages
Fast: 15-30 seconds for IV, 3-5 minutes for IM and subcutaneous
One injection can be formulated to last days or even months, ex. Depo-Provera is a birth control shot that works for three months
IV can deliver continuous medication, ex. Morphine for patients in continuous pain, or saline drip for people needing fluids
Disadvantages
Because it's fast, there is more risk of addiction when it comes to injecting drugs of abuse
If needles are shared, there is risk of HIV and other infectious diseases
It is the most dangerous route of administration because it bypasses most of the body's natural defenses, exposing the user to health problems such as hepatitis, abscesses, infections, and undissolved particles or additives
If not done properly, air boluses (bubbles) can occur and can be fatal
Need of strict asepsis
Uses
Some routes can be used for topical as well as systemic purposes, depending on the circumstances. For example, inhalation of asthma drugs is targeted at the airways (topical effect), whereas inhalation of volatile anesthetics is targeted at the brain (systemic effect).
----Ad--pharma guideline
On the other hand, identical drugs can produce different results depending on the route of administration. For example, some drugs are not significantly absorbed into the bloodstream from the gastrointestinal tract and their action after enteral administration is therefore different from that after parenteral administration. This can be illustrated by the action of naloxone (Narcan), an antagonist of opiates such as morphine. Naloxone counteracts opiate action in the central nervous system when given intravenously and is therefore used in the treatment of opiate overdose. The same drug, when swallowed, acts exclusively on the bowels; it is here used to treat constipation under opiate pain therapy and does not affect the pain-reducing effect of the opiate.
Enteral routes are generally the most convenient for the patient, as no punctures or sterile procedures are necessary. Enteral medications are therefore often preferred in the treatment of chronic disease. However, some drugs can not be used enterally because their absorption in the digestive tract is low or unpredictable. Transdermal administration is a comfortable alternative; there are, however, only a few drug preparations are suitable for transdermal administration. Validation
In acute situations, in emergency medicine and intensive care medicine, drugs are most often given intravenously. This is the most reliable route, as in acutely ill patients the absorption of substances from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or bowel motility.
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