Routes of Drug Administration

Classification
1. Enteral Routes

2. Parenteral Routes

3. Topical Routes

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 Contd….
1. Enteral routes:

i) Oral

ii) Sublingual

iii) Rectal
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 Contd….
2. Parenteral routes:
A) Injections:
i) Intravenous
ii) Intramuscular
iii) Intraperitoneal
iv) Intrathecal
v) Intramedullary
vi) Intraarterial
vii) Intraarticular
viii) Subcutaneous
ix) Intracardiac
B) Inhalational administration 4
C) Transdermal administration
 Contd….
3. Topical routes

i) Conjunctival, Nasal, Auditory mucosal

ii) Vaginal & Urethral

iii) Inunction & Dermal

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 Routes of Drug Delivery
Parenteral Inhaled
(IV)
Oral

Transdermal
Parenteral
Topical (SC, IM)

Rectal 6
 Dosage forms
 SOLID DOSAGE FORMS
 Powders
 Tablets
 Pills
 Capsules
 Lozenges
 Suppositories
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 LIQUID DOSAGE FORMS
 Aqueous solutions
 Suspensions
 Elixirs
 Drops
 Lotions
 injections
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 SEMI SOLID DOSAGE FORMS
 Ointments
 Pastes
 Gels

 INHALATIONS

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 ORAL ROUTE
 Oldest & commonest route of administration

 Advantages
– Safe
– Convenient
– Painless
– Low cost
– Does not require assistance for administration

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 Oral Route contd
 Disadvantages

– Slow action (not suitable for emergency)

– Unpalatable drugs can’t be given-

may cause nausea, gastric irritation

– Cannot be given in unconscious, vomiting,

uncooperative patients

– Some drugs are not absorbed (e.g. streptomycin) 11

 Oral Route contd
 Disadvantages contd

– Some drugs are destroyed by gastric juices

e.g. Penicillin G, Insulin

– Some drugs are metabolized in liver during

their first passage (First Pass Metabolism)
e.g. Nitroglycerine, Testosterone, Lignocaine
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 Sublingual route
 Beneath the tongue, over the
buccal mucosa

Advantages
Examples
Quick onset of action Nitroglycerine
Isoprenaline
bypass first pass effect Clonidine
can be Spit out 13
 Sublingual route

Disadvantages

 Distasteful drugs – cannot be given

 High molecular wt drugs – cannot be given

 Only lipid soluble, non irritating drugs can be

given 14
 Rectal Route
 Given as suppositories or retention enema
for systemic effect

Advantages
 pts with nausea and vomiting
 gastric irritant drugs- can be given
 Unconscious patients & children
 Easy to terminate exposure 15
 Rectal Route…
Disadvantages
– Inconvenient & embarrassing
– Absorption is slow, irregular & unpredictable
– Rectal inflammation can occur as a side effect from irritant
drugs
Examples
– Aminophylline,diazepam, ergotamine

Ext. Hemorrhoidal vein

Systemic
Intra-rectal drug Circulation
Int. Hemorrhoidal vein Liver

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 Parenteral Routes
 Par – beyond, enteral – intestinal
 Administration of drug by injection, directly into
the tissue fluid or blood
i) Intravenous
ii) Intramuscular
iii) Intraperitoneal
iv) Intrathecal
v) Intramedullary
vi) Intraarterial
vii) Intraarticular
viii) Subcutaneous ix) Intracardiac 17
 Parenteral Route
 Advantages

– Fast onset
– Accurate
– No gastric irritation/vomiting
– Can be given to unconscious /
uncooperative / vomiting patient
– No interference by food / digestive juices
– Liver is bypassed
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 Parenteral Route
Disadvantages
– Has to be sterile
– Costly
– Invasive and painful
– Assistance of trained person required
– Chances of local tissue injury
– More risky 19
 Intramuscular route
 Drug injected in skeletal muscle
– deltoid, triceps, gluteus maximus,
rectus femoris etc.
Merits:
1. absorption is more predictable
2. depot injections can be given
3. less painful
4. Less nerve supply (mild irritant can
be given)
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21
 Intramuscular route
Demerits:
1. perfect aspetic conditions are required
2. chances of abscess and hematoma
formation
3. large volumes cannot be administered
4. self injection – impracticable

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23
 Intravenous route
 Through lumen of veins,mainly antecubital
veins
Merits:
1. quick onset of action as first pass effect is bypassed
2. unconscious, irritable patients, patients with nausea,
vomiting and diarrhoea.
3. GIT irritant drugs can be given
4. large volumes of fluids can be infused
5. amount of drug can be controlled with accuracy
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25
 Intravenous route
Demerits:
1. risky route, as vital organs are exposed to high conc
2. strict aseptic conditions are required
3. painful
4. chances of air embolism
5. oily drugs cannot be administerd
6. venous thrombosis and thrombophlebitis of the injected
vein
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 Subcutaneous
subcutaneous tissue
Merits:
1. smooth but slower absorption
2. depot injections can be given

Demerits:
1. Avoided in shock patients
2. only small volumes can be given
3. irritant drugs cannot be given
4.can result in sloughing and necrosis of the skin27
 Subcutaneous
Eg:
1. Dermojet
2. Pellet implantation: testosterone
3. biodegradable implants: norplant –
contraceptives
4. intra dermal – BCG vaccination

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 Intraperitoneal
peritoneal space
Merits:
rapid absorption due to large surface area

Demerits:
painful, risky,aseptic conditions required

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 Intrathecal and intraspinal
Given into the sub arachnoid space
Merits:
significant CSF levels are achieved

Demerits: strict aseptic conditions are required,

painful and risk of infections

Eg: Xylocaine – spinal anaesthesia, antibiotics for

infectious meningitis, radioopaque contrast
media 30
 intramedullary
tibial or sternal bone marrow

Merits:
quick onset of action at the desired site
Demerits:
painful, risky, skill is required

Eg; Bone marrow transplantation – specially in

children 31
 intra-arterial
lumen of desired artery
Merits:
quick onset at the desired site
Demerits:
requires greater expertise and aseptic conditions

Eg: radio opaque contrast media for coronary and

Cerebral angiography, nitrogen mustard – anti
cancer drug
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 Intra articular
directly into joint space
Merits:
quicker onset at the desired site
Demerits:
1. strict aseptic conditions
2. repeated administrations are required
3. painful procedure

Eg: hydrocortisone, gold chloride for RA 33

 intracardiac
Through left 4th intercostal space

Eg: adrenaline – cardiac arrest

Epidural
Through vertebral interspace

Eg: xylocaine injection – epidural block

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 inhalational
Merits:
faster absorption, desired site, quick onset of
action, self administration is possible
Demerits:
inflammation of the respiratory tract

Eg: GA, oxygen, metered aerosol preparations of

salbutamol and isoprenaline
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 Transdermal
adhesive patches
Sites:
chest, abdomen, upper arm, lower back, buttocks &
mastoid region
Merits: slow and sustained release, constant
release
Demerits: irritation, erythema

Eg: GTN, fentanyl, nicotine, estadiol Isosorbide

dinitrate, hyoscine and clonidine 36
 Topical routes
Conjuctival
sulfacetamide, gentamycin, ciprofloxacin

Vaginal and urethral

sulfa drugs, antifungal and metronidazole

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 inunction
rubbing the drug preparation on the surface of the skin
Merits:
safe and convenient
Demerits:
1. difficult to ascertain the amount of the drug absorbed
2. systemic absorption can take place if skin is abraided

Eg: antifungal ointments, antibiotic ointments,

powders,solutions, various lotions, linments and
ointments for analgesic, anti pruritic and antiseptic
actions. 38