Routes of drug administration
Dr. Sirisa karki
Associate Professor
MBBS,MD
Department of Pharmacology
Path by which a drug, fluid or other
substance is brought into contact with the
body
Drugs can be applied at the site of action
(Local/ Topical route) or delivered to site
along with blood (Systemic route)
Classification
Routes
Local systemic
Oral
Rectal
Topical Deeper
Arterial Sublingual
-skin tissues
Or buccal
-mucous cutaneous
membrane
inhalational
Nasal
Parenteral
- SC/IM/IV
- intradermal
Local Routes
Used for localized lesions
Minimal or no systemic absorption
Minimal or no systemic side effects
Eg. topical routes, deeper tissues, arterial
supply
Topical Routes
A] Skin: Ointment, cream, lotion, powder
etc.
B] Mucous membrane
Applied to mucous membrane of mouth,
pharynx, larynx, ear, nose, eye, GIT,
vagina etc
As drops, ointment, aerosol, gargle, vaginal
tablets etc
Deeper tissues
Intra-articular injection
Drug is injected into the joint spaces
Eg. Hydrocortisone in case of RA
Intrathecal injecton
Injection of the drug into the subarachnoid
space of the spinal cord
Eg. Local anesthetics for spinal anesthesia
Arterial supply
Intra-arterial route:
Drug is injected directly into the artery
has specific indication for diagnosis and
treatment
Eg. Injection of drug into coronary artery
for coronary angiography
Systemic routes
Enteral routes
Enteral- drugs placed directly in the GI tract
Sublingual- placed under the tongue
Oral - swallowing
Rectum- absorption through the rectum
[Link]
Advantages
• Safe, more convenient and economical
• Assistance is not required
• Noninvasive and painless
• Sterilization of drug is not essential so is
cheaper
• Both solid as well as liquid dosage forms
can be administered
Disadvantages
• Onset of drug action is slower thus not
suitable for emergency
• Can not be used for uncooperative /
unconscious / vomiting patient
• Drugs likely to be destroyed by digestive
juices (Eg. Penicillin G, Insulin) or in
liver (Eg. Nitroglycerine, Testosterone)
can not be administered orally
2. Sublingual Route/Buccal
Advantages:
Rapid action
Escape first pass metabolism
Avoidance of degradation of the drug in stomach
Once the desired effect is obtained the remaining
drug can be spitted out to avoid unnecessary
effects.
Disadvantages:
Only lipid soluble and non-irritant drug can be
administered
Eg nitroglycerine, buprenorphine, clonidine
3. Rectal Route
Advantages:
Prevent the destruction of the drug by intestinal enzyme
or by low pH in the stomach
Gastric irritation is avoided
Used in patient having recurrent vomiting
Escape 1st pass metabolism to some extent
Disadvantages:
Inconvenient and embarrassing.
Rectal inflammation due to irritant drugs
Absorption is slower, irregular and unpredictable.
Eg. Indomethacin, Paracetamol, Diazepam etc.
Parenteral routes
Greek word : par:aside from
enteron:an intestine
i)Intravenous (i.v.)
ii)Intramuscular (i.m.)
iii)Subcutaneous (s.c.)
iv)Intradermal(i.d.)
Parenteral Routes
• Used for drugs poorly absorbed from
the GIT
• Used for drugs unstable in the GIT
• Used for treatment of unconscious
patients
• Used in circumstances that require
rapid onset of action
• Only sterile solutions can be injected
Advantages
Action is faster and accuracy of dose are ensured
Employed in an unconscious, uncooperative and
vomiting patient
No chance of interference by food or digestive juice
Escape first pass metabolism
Irritant to stomach and orally unabsorbed drug can
be administered.
Disadvantages:
Preparation has to be sterilized and is costlier
Painful, chances of local tissue injury and more risky
Self medication is not possible, assistance is required
1. Intravenous Route (IV)
Drug is given in one of the superficial vein as a bolus or
infused slowly over hours
Advantages:
Large volume of drugs can be infused (Eg. Normal saline,
dextrose etc.)
Drugs having short half life can be infused continuously to
maintain therapeutic conc. (Eg. Oxytocin)
Bioavailability is 100% (Smallest dose of drug required)
Disadvantages:
Local tissue injury, thrombophlebitis, air embolism
Costlier because drug has to be sterilized.
2. Intramuscular Route (IM)
Drug is injected in one of the large skeletal muscles-
deltoid, triceps, gluteus maximus etc.
Advantages:
Mildirritant drugs can be injected
Absorption is faster and onset of action is rapid
Depot preparation can be injected
Absorption is more predictable
Disadvantages:
Painat the site of injection, abscess formation
Chance of injury to underlying nerves
Volume should not exceed 10 ml
3. Subcutaneous (sc)
Injection is made into subcutaneous tissue under the skin which is
richly supplied by nerves but less vascular.
Advantages:
Self injection is possible
Depot preparation can be injected
Action is sustained and uniform
Disadvantages:
Suitablefor only small volumes of drugs(1ml)
Absorption is slower
Repeated injection at one site can cause lipoatrophy
Absorption by this route is unreliable in shock (vasoconstricted)
Eg. insulin, heparin
4. Intradermal Route
Drug is injected into the outer layers of
skin.
Amount of drug given is small and
absorption is slow
Utilized for special purpose
Eg. BCG vaccine, sensitivity testing
Other routes of drug administration
Cutaneous
Highly lipid soluble drug is applied over
skin for slow and long absorption
Transdermal patches
Adhesive matrix (patch) containing drug
is applied to chest, upper abdomen, pinna
etc
Delivers drug at constant rate into
systemic circulation
Advantages
Slow and sustained action with less
fluctuation
Less first pass metabolism & side effect
Disadvantages:
Expensive
Local irritation, erythema, itching
Patch may fall off unnoticed
e.g. Nitroglycerine, fentanyl, nicotine,
hyoscine etc
Inhalation
Inspiration of volatile liquid or gas through nose or
mouth
Absorption takes place from alveoli
Advantages :
Fast onset of action
Dose can be regulated
Disadv:
Irritant vapour(ether) cause inflammation and
increase secretion
Eg. Ether, halothane, Nitrous oxide, salbutamol,
ipratropium, inhalational steroids
Nasal
Instilled into nostril
Digestive juices and liver are bypassed
e.g. Gonadotropin releasing hormone
(GnRH) agonist, desmopressin
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