CHAPTER 12
SUPPOSITORIES, INSERTS, AND STICKS
Suppositories generally have been employed for three
reasons, to
1. promote defecation
2. introduce drugs into the body
3. treat anorectal diseases
SUPPOSITORIES (​Cocoa butter as base = 2g)
- solid dosage forms intended for insertion into body
orifices where they melt, soften, or dissolve and
exert local or systemic effects.
- from the Latin supponere, meaning “to place
under,” as derived from sub (under) and ponere (to
place)
- usually about 32 mm (1.5 inch) long, are cylindrical,
and have one or both ends tapered.
- Some rectal suppositories are shaped like a bullet, a
torpedo, or the little finger. Depending on the
density of the base and the medicaments in the
suppository, the weight may vary.
- Rectal suppositories for use by infants and children
are about half the weight and size of the adult
suppositories and assume a more pencil-like shape.
5 TYPES:
(1) Rectal (2) Vaginal (3) Urethral
(4) Nasal [Burginarium] (5) Aural [Ear Cones]
INSERT
- a solid dosage form that is inserted into a naturally
occurring (nonsurgical) body cavity other than the
mouth or rectum, including the vagina and urethra.
- Vaginal inserts (​pessaries​) are usually globular,
oviform, or cone shaped
- cocoa butter as base = 5g
- Urethral inserts (​bougies​) are pencil-shaped
suppositories intended for insertion into the male
or female urethra. Male urethral suppositories may
be 3 to 6 mm in diameter and approximately 140
mm long, although this may vary. Female urethral
suppositories are about half the length and weight
of the male urethral suppository.
- Cocoa butter as base = 4g
STICKS
- a convenient form for administering ​topical​ drugs.
- their development involves the history of
cosmetics, which parallels human history
- it js cylindrical in shape and generally range from 5
to 25 g.
- They are generally packaged in an applicator tube
for topical administration
The advantages of rectal administration:
1. Avoiding, at least partially, the first-pass effect
that may result in higher blood levels for those
drugs subject to extensive first-pass metabolism
upon oral administration.
2. Drug stability: Avoiding the breakdown of certain
drugs that are susceptible to gastric degradation.
3. Ability to administer somewhat larger doses of
drugs than using oral administration.
4. Ability to administer drugs that may have an
irritating effect on the oral or gastrointestinal
mucosa when administered orally.
5. Ability to administer unpleasant tasting or
smelling drugs whose oral administration is
limited.
6. In children, the rectal route is especially useful.
An ill child may refuse oral medication and may
fear injections.
7. In patients experiencing nausea and vomiting or
when the patient is unconscious.
8. The presence of disease of the upper
gastrointestinal tract that may interfere with
drug absorption.
9. Objectionable taste or odor of a drug (especially
important in children).
10. Achievement of a rapid drug effect systemically
(as an alternate to injection).
Disadvantages of suppositories:
1. A perceived lack of flexibility regarding dosage of
suppositories results in underuse and a lack of
availability.
2. If suppositories are made on demand, they may
be expensive.
3. Suppositories as a dosage form are safe, but they
exhibit variable effectiveness, including the
pathology of the anorectal lesions.
 4. Different formulations of a drug with a narrow
therapeutic margin, such as aminophylline,
cannot be interchanged without risk of toxicity.
5. The “bullet-shaped” suppository after insertion
can leave the anorectal site and ascend to the
rectosigmoid and descending colon. Hence, one
may consider that suppositories with this shape
possibly should not be used at bedtime.
6. Defecation may interrupt the absorption process
of the drug; this may especially occur if the drug
is irritating.
7. The absorbing surface area of the rectum is much
smaller than that of the small intestine.
8. The fluid content of the rectum is much less than
that of the small intestine, which may affect
dissolution rate, etc.
9. There is the possibility of degradation of some
drugs by the microflora present in the rectum.
10. The dose of a drug required for rectal
administration may be greater than or less than
the dose of the same drug given orally. This can
be dependent upon such factors as the
constitution and condition of the patient, the
physicochemical nature of the drug, and its ability
to traverse the physiologic barriers to absorption.
11. The factors that affect the rectal absorption of a
drug administered in the form of a suppository
may be divided into two main groups:
(a) anatomic and physiologic factors and (b)
physicochemical factors of the drug and the base.
Local Action
- Rectal ​suppositories intended for local action are
most frequently used to relieve constipation or the
pain, irritation, itching, and inflammation associated
with hemorrhoids or other anorectal conditions.
- glycerin ​suppositories are a popular laxative where it
promotes laxation by local irritation of the mucous
membranes, probably by the dehydrating effect of
the glycerin on those membranes.
- Vaginal ​suppositories ​or ​inserts intended for local
effects are employed mainly as contraceptives, as
antiseptics in feminine hygiene, and as specific
agents to combat an invading pathogen.
- Urethral ​suppositories may be antibacterial or a
local anesthetic preparative for a urethral
examination.
- Sticks are commonly used for local effect and
include hydration/emollient, antibacterial,
sunscreen, antipruritic, and other uses.
Systemic Action
- the mucous membranes of the rectum and vagina
permit the absorption of many soluble drugs,
although the rectum is more frequently used.
- Examples of drugs administered rectally in the form
of suppositories for their systemic effects include
(a) ​prochlorperazine ​and ​chlorpromazine for the
relief of nausea and vomiting and as a tranquilizer;
(b) ​morphine​ ​and​ ​oxymorphone​ for opioid analgesia;
(c) ​ergotamine ​tartrate for the relief of migraine
syndrome;
(d) ​indomethacin​, a nonsteroidal anti-inflammatory
analgesic and antipyretic; and
(e) ​ondansetron for the relief of nausea and
vomiting
Physiological Factors and Drug Effect that affect drug
absorption from the rectum:
1. Circulation Route
- drugs absorbed rectally can bypass the portal
circulation during their first pass into the general
circulation. This enables drugs that are otherwise
destroyed in the liver to exert systemic effects.
- Lymphatic circulation also assists in the absorption
of rectally administered drugs.
2. pH and Lack of Buffering Capacity of the Rectal
Fluids
- Rectal fluid pH ranges 7.2 to 7.4, in which the drug
administered will not generally be chemically
changed by the rectal environment; therefore, the
pH of the medium may be determined by the
characteristics of the drug
- The rectum contains three types of hemorrhoidal
veins:
• superior hemorrhoidal vein
• middle hemorrhoidal vein
• inferior hemorrhoidal vein
- These veins act by transporting the active
principle absorbed in the rectum to the blood
system either directly by means of iliac veins and
the vena cava or indirectly by means of the portal
vein and the liver
- it is generally accepted that at least 50% to 70%
of the active ingredients administered rectally
 take the direct pathway, thus bypassing the liver Cocoa butter base​ (theobroma oil)
and avoiding the first-pass effect. ✔ Fulfills the requirements of an ideal suppository
- The pH of the Vagina ranges 4-4.5 base
3. Colonic Content ✔ superior base when irritation or inflammation is
- greater absorption may be expected from a to be relieved
rectum that is void (absence of fecal matter) than x it is immiscible with body fluids
from one that is distended with fecal matter - fat-soluble drugs tend to remain in the oil and
- Other conditions such as diarrhea, colonic have little tendency to enter the aqueous
obstruction due to tumorous growths, and tissue physiologic fluids ​where the drug can release
dehydration can all influence the rate and degree its effect.
of drug absorption from the rectal site. - For water-soluble drugs in cocoa butter, the
reverse is usually true and results in good
Physicochemical Factors and Drug Effect release.
Physicochemical​ ​- relating to physics and chemistry
- Fat-soluble drugs seem to be released more
❖ Effects on Drug
readily from bases of glycerinated gelatin or
> Relative solubility of the drug in lipid and in
polyethylene glycol, both of which dissolve
water
slowly in body fluids.
> Particle size of the dispersed drug
Remarks​:
❖ Effects on Suppository base
Cocoa butter melts quickly and non-irritatingly at
> Ability to melt, soften, and dissolve at body
body temperature and maintains solidity at room
temperature
temperature. In the treatment of anorectal disorders,
> Ability to release the drug substance
cocoa butter appears to be the superior base because of
> Its hydrophilic or hydrophobic character
its emollient or soothing, spreading action.
- The lipid–water partition coefficient of a
However, because of its triglyceride content,
drug is an important consideration in the
cocoa butter exhibits marked polymorphism or existence
selection of the suppository base and in
in several crystalline forms. Because of this, when cocoa
anticipating drug release from that base.
butter is hastily or carelessly melted at a temperature
▪ Lipid-water solubility
greatly exceeding the minimum required temperature
- A lipophilic drug distributed in a fatty
and is then quickly chilled, the result is a metastable
suppository base in low
crystalline form (alpha crystals) with a melting point
concentration has lesser tendency to
much lower than that of the original cocoa butter.
escape to the surrounding aqueous
fluids than a hydrophilic substance in
Nature of the Base
a fatty base.
Base - ​must be capable of ​melting, softening or
▪ Particle size
dissolving ​to release its drug for absorption.
- The smaller, the readily the
dissolution and chance for rapid
If base ​interacts with drug ​to inhibit its release, drug
absorption
absorption will be ​impaired​ or even​ prevented​.
- It is preferable to avoid a too fine
If base​ irritates mucous membranes of rectum, ​it may
particle size because of the high
initiate a ​colonic response ​and ​prompt bowel
increase of the viscosity of the
movement, ​eliminating prospect of complete drug
melted excipient that can result from
release and absorption.
the use of excessively small particles
and possible difficulties in flow
Morphine Sulfate in Slow-Release Supp. - ​prepared in a
during production.
base that includes a material such as ​alginic acid, ​which
> Influences released and dissolved amount in
will prolong release of drug over several hours.
absorption
CLASSIFICATION OF BASES
It is convenient to classify suppository bases according to
their physical characteristics into ​2 main categories and a
3rd miscellaneous group:
a. Fatty or Oleaginous Bases
b. Water-soluble or Water-miscible Bases
c. Miscellaneous Bases ( ​Combinations of Lipophilic
and Hydrophilic Substances)
Suppository Bases - ​should be physically and chemically
stable, nonirritating, nonsensitizing, nontoxic,
chemically and physiologically inert, compatible with a
variety of drugs, stable during storage, esthetically
acceptable (​free from objectionable odor and a pleasing
appearance)
Fatty or Oleaginous Bases
- the​ most frequently employed ​suppository bases
- cocoa butter​ is a member of this group of
substances
- among the other fatty or oleaginous materials
used in suppository bases are many
hydrogenated fatty acids of vegetable oils​, such
as ​palm kernel oil​ and ​cottonseed oil
- fat-based compounds containing compounds of
glycerin with the higher–molecular-weight fatty
acids, such as ​palmitic and stearic acids​, may be
found in fatty bases
- Such compounds, such as ​glyceryl monostearate
and glyceryl monopalmitate​, are examples of
this type of agent.
- in many commercial products, they employ
varied combinations of these types of materials
to achieve the ​desired hardness ​under conditions
of shipment and storage and the ​desired quality
of submitting to the temperature of the body to
release their medicaments
- some bases are prepared with the ​fatty materials
emulsified or with an emulsifying agent
Cocoa Butter, NF, - ​fat obtained from the roasted seed of
Theobroma cacao.
- At room temperature, it is a yellowish-white solid
having a faint, agreeable chocolate-like odor
- Chemically, it is a triglyceride (combination of
glycerin and one or different fatty acids) primarily
of ​oleopalmitostearin and oleodistearin​.
- because of its triglyceride content, cocoa butter
exhibits marked ​polymorphism​ or existence in
several crystalline forms.
- Consequently, if suppositories that have been
prepared by melting cocoa butter for the base do
not harden soon after molding, they will be
useless to the patient and a loss of time,
materials, and prestige to the pharmacist.
- Substances such as phenol and chloral hydrate
have a tendency to lower the melting point of
cocoa butter.
- If the melting point is low enough that it is not
feasible to prepare a solid suppository using
cocoa butter alone as the base, solidifying agents
like cetyl esters wax (about 20%) or beeswax
(about 4%) may be melted with the cocoa butter
to compensate for the softening effect of the
added substance
- the addition of hardening agents must not be so
excessive as to prevent the base from melting in
the body, nor must the waxy material interfere
with the therapeutic agent in any way so as to
alter the efficacy of the product.
- Other bases in this category include commercial
products such as Fattibase (triglycerides from
palm, palm kernel, and coconut oils with
self-emulsifying glyceryl monostearate and
polyoxyl stearate), the Wecobee bases
(triglycerides derived from coconut oil), and
Witepsol bases (triglycerides of saturated fatty
acids C12–C18 with varied portions of the
corresponding partial glycerides)
​Water-Soluble and Water-Miscible Bases
- The main members of this group are glycerinated
gelatin and polyethylene glycols
Glycerinated gelatin suppositories ​may be prepared by
dissolving granular gelatin (20%) in glycerin (70%) and
adding water or a solution or suspension of the
medication (10%)
-It is most frequently used in the preparation of
vaginal suppositories, with which prolonged local action
of the medicinal agent is usually desired
- It is slower to soften and mix with the
physiologic fluids than is cocoa butter and therefore
provides a slower release
- Because glycerinated gelatin–based
suppositories have a tendency to absorb moisture as a
result of the hygroscopic nature of glycerin, they must be
protected from atmospheric moisture if they are to
maintain their shape and consistency
- Also as a result of the hygroscopicity of the
glycerin, the suppository may have a dehydrating effect
and irritate the tissues upon insertion. The water in the
formula for the suppositories minimizes this action;
however, if necessary, the suppositories may be
moistened with water prior to insertion to reduce the
initial tendency of the base to draw water from the
mucous membranes and irritate the tissues.
Urethral suppositories​ may be prepared from a
glycerinated gelatin base of a formula somewhat
different from the one indicated earlier
- For urethral suppositories, the gelatin
constitutes about 60% of the weight of
the formula, the glycerin about 20%, and
the medicated aqueous portion about
20%
- Urethral suppositories of glycerinated
gelatin are much more easily inserted
than those with a cocoa butter base
owing to the brittleness of cocoa butter
and its rapid softening at body
temperature
- Various combinations of these
polyethylene glycols may be combined by
fusion, using two or more of the various
types to achieve a suppository base of
the desired consistency and
characteristics
- Polyethylene glycols having average
molecular weights of 300, 400, and 600
are clear, colorless liquids. Those having
average molecular weights of greater
than 1,000 are waxlike white solids
whose hardness increases with an
increase in the molecular weight
- Melting ranges, for example,
polyethylene glycols, are PEG 300 (−15°C
to 18°C), PEG 1000 (37°C to 40°C), PEG
3350 (54°C to 58°C), and PEG 8000 (60°C
to 63°C)
- Pharmacists have been called on in
recent years to prepare progesterone
vaginal suppositories extemporaneously.
- These suppositories, used in
premenstrual syndrome, are commonly
molded with either a polyethylene glycol
base or a fatty acid base.
- Polyethylene glycol suppositories do not
melt at body temperature but rather
dissolve slowly in the body’s fluids.
Therefore, the base need not be
formulated to melt at body temperature.
Thus, it is possible, in fact routine, to
prepare suppositories from polyethylene
glycol mixtures having melting points
considerably higher than body
temperature.
-This property permits a slower
release of the medication from the base
once the suppository has been inserted
and permits convenient storage of these
suppositories without need for
refrigeration and without danger of their
softening excessively in warm weather. -
Further, their solid nature permits slow
insertion without fear that they will melt
in the fingertips (as cocoa butter
suppositories sometimes do). Because
they do not melt at body temperature
but mix with mucous secretions upon
dissolution, polyethylene glycol–based
suppositories do not leak from the
orifice, as do many cocoa butter–based
suppositories
-Polyethylene glycol
suppositories that do not contain at least
20% water should be dipped in water just
before use to avoid irritation of the
mucous membranes after insertion. This
procedure prevents moisture being
drawn from the tissues after insertion
and the stinging sensation.
- ​Poloxamers​ (Pluronics) are
water-soluble, block copolymers with a
wide range of uses. Pluronics L44, L62,
L64, and F68 are potential suppository
bases.
-The poloxamers have practically
no odor or taste. An example of an
aspirin suppository using a poloxamer
base uses the following formula:
​ Pluronic F68 - 6 ​ .00 g
​Pluronic L44​ - 7.00 mL
 ​Aspirin​ - 1.02 g
Formulation Variables
- Formulation variables that are generally
considered include
(a) the nature and form of the active principle
(esters, salts, complexes, etc.), (b) the physical
state, particle dimensions, and the specific
surface of the product,
© the solubility of the drug in various bases,
(d) the presence or absence of adjuvants added
to the active principle,
(e) the nature and type of dosage form in which
the active principle is incorporated, and
:(f) pharmaceutical procedures used in the
preparation of the dosage form.
- Active drugs have a number of physical
characteristics. In suppositories, those of interest
involve the drug’s physical state, including
physical state, particle size, solubility, dielectric
constant, and bulk density.
Physical State
- An active drug can be a solid, liquid, or semisolid
in nature.
- For ​solids​, the drug’s particle size may be very
important, especially if the drug is not very water
soluble; the increase in surface area resulting
from decreased particle size can serve to
enhance its activity.
- For ​liquids​, it is necessary to take up the liquid
into the suppository base using one of several
techniques such as forming an emulsion, adding a
drying powder, or adding a suitable thickening
agent when the liquid is mixed with the
suppository base.
- For the ​semisolids​ or paste-type drugs, it can be
either mixed with a solid that will serve to thicken
the drug prior to mixing with the base or mixed
with the base to which a thickener is added.
Particle Size
- If a drug is readily soluble, the influence of
particle size may be minimal
- For highly water-soluble drugs, the tendency will
be to dissolve and migrate to the rectal barrier.
- For poorly water-soluble drugs, the dissolution
rate will be slower, and a reduction in particle
size may increase the rate of dissolution by
exposing a greater surface area. This can also be
affected by the nature of the suppository base.
Solubility
- Increased solubility of the active in the base can
improve product homogeneity; however, it may
also delay the release of the active if there is too
great an affinity of the drug for the suppository
vehicle
- If the active ingredient is insoluble in the base,
as is the case when a “suspension” or “emulsion”
is formed, this poses different problems.
- It is necessary to maintain homogeneity of the
total mixture; this can usually be obtained by
constant agitation of the mixture during
processing and filling.
- Oftentimes, it is best to select a temperature
just above the melting point of the suppository
mixture where the mixture is thick but still
pourable. ​Viscosity
- Viscosity considerations are also important in
the preparation of the suppositories and the
release of the drug.
- If the viscosity of a base is low, it may be
necessary to add a suspending agent such as
silica gel to ensure that the drug is uniformly
dispersed until solidification occurs.
- When preparing the suppository, the
pharmacist should stir the melt constantly and
keep it at the lowest possible temperature to
maintain a high viscosity.
- After the suppository has been administered,
the release rate of the drug may be slowed if the
viscosity of the base is very high. This is because
the viscosity causes the drug to diffuse more
slowly through the base to reach the mucosal
membrane for absorption.
Brittleness
- ​Brittle suppositories can be difficult to
handle, wrap, and use. Cocoa butter
suppositories are usually not brittle
unless the percentage of solids present is
high.
- In general, brittleness results when the
percentage of nonbase materials exceeds
about 30%.
- Synthetic fat bases with high stearate
concentrations or those that are highly
hydrogenated are typically more brittle.
 - S​ hock cooling​ also causes fat and cocoa
butter suppositories to crack. This
condition can be prevented by ensuring
that the temperature of the mold is as
close to the temperature of the melted
base as possible.
- Suppositories should not be placed in a
freezer, which also causes shock cooling.
Volume Contraction
- ​Bases, excipients, and active ingredients
generally occupy less space at lower
temperatures than at higher
temperature.
- During the cooling process, the melt has
a tendency to contract in size. This makes
it easier to release the suppository from
the mold, but it may also produce a
cavity at the back, or open end, of the
mold.
- Such a cavity is undesirable and can be
prevented if the melt is permitted to
approach its congealing temperature
immediately before it is poured into the
mold.
- It is advisable to pour a small amount of
excess melt at the open end of the mold
to allow for the slight contraction during
cooling.
- Scraping with a blade or spatula dipped
in warm water will remove the excess
after solidification, but care must be
taken not to remove the metal from the
mold. The heated instrument can also be
used to smooth out the back of the
suppository
Drug Release Rates
​General approximate drug release rates as they
relate to the drug and base characteristics are
summarized as follows:
Drug:Base Characteristics Approximate Drug
Release Rate
Oil-soluble drug: Oily base Slow release; poor
escaping tendency
Water-soluble drug: Oily Rapid release
base
Oil-soluble drug: Moderate release
Water-miscible base
Water-miscible drug: Moderate release; based
Water-miscible base on diffusion; all water
soluble
Methods of preparing suppositories.
1. Hand molding/rolling/shaping
> a historic part of the art of the pharmacist
> useful when preparing a small number of
suppositories
> no heating required
2. Compression molding
> skips the task of hand rolling
> more elegant than hand rolled preparation
> air entrapment may take place, weight
variation, drug may then be oxidized into this
air
> compression methods comes with difficulties
particularly to the required homogeneity of
the dosage from and its achievement of
appropriate fracture strength.
> compression methods are less suitable for
fluid active ingredients
a. Cold Compression
b. Compression in a tablet press
- occasionally, vaginal suppositories, such as
Metronidazol tablets, are prepared by
compression in a tableting machine
3. Molding from a melt/Fusion method
> large or small-scale
> manufactured suppositories are generally
prepared by this method
Preparation by molding
1) Melting of the base​: preferably in water or steam
bath to avoid local overheating
2) Incorporating the required medicament​: either
emulsified or suspend
3) Pouring the melt into the cooled metal mold​:
4) Allowing the melt to cool and congeal thoroughly
into suppositories: using refrigerator in a small
scale or refrigerated air on a larger scale
5) Removing the formed suppositories from the
mold
Remarks​: - the pharmacist calculates the amounts of
Molds in common use today are made from stainless materials needed for the preparation of one or
steel, aluminum, brass, or plastic.
two more suppositories than the number
Along with Cocoa butter, glycerinated gelatin,
polyethylene glycol, and most other bases are suitable for prescribed to compensate for the inevitable
preparation by molding. loss of some material and to ensure having
enough material.
Lubrication of the Mold
- the pharmacist must be certain that the
● Suppository molds may require lubrication before
required amount of drug is provided in each
the melt is poured to facilitate clean and easy
suppository.
removal of the molded suppositories.
- Because the volume of the mold is known (from
● Cocoa butter or polyethylene glycol as base –
the determined volume of the melted
lubrication is seldom necessary as these materials
suppositories formed from the base), the volume
contract sufficiently on cooling to separate from
of the drug substances subtracted from the
the inner surfaces and allow easy removal
total volume of the mold will give the volume of
● Lubrication is necessary in Glycerinated gelatin
base required. If the added amounts of
suppositories - a thin coating of mineral oil
medicaments are slight, they may be considered
applied with the finger to the molding surfaces
to be negligible, and no deduction from the total
usually suffices
volume of base may be deemed necessary.
Calibration of the Mold
However, if considerable quantities of other
- The pharmacist should calibrate each suppository
substances are to be used, the volumes of these
mold for the usual base (generally cocoa butter and a
materials are important and should be used to
polyethylene glycol base) so as to prepare medicated
calculate the amount of base actually required to
suppositories each having the proper quantity of
fill the mold.
medicaments
Glycerin suppositories
METHOD FOR DETERMINATION ON THE AMOUNT OF
● Glycerin, a hygroscopic material, contributes to
BASE:
the laxative effect of the suppository by drawing
● The total volume of these materials is
water from the intestine and from its irritant
subtracted from the volume of the mold, and
action on the mucous lining.
the appropriate amount of base is added.
● promote laxation by local irritation of the mucous
Because the bases are solid at room temperature,
membranes, probably by the dehydrating effect
the volume of base may be converted to weight
of the glycerin on those membranes.
from the density of the material.
Determination of the Amount of Base Required
● The weight of the active ingredients subtracted
- the prescribing physician indicates the amount
from the weight of the suppository yields the
of medicinal substance desired in each
weight of the base. This amount of base
suppository but leaves the amount of base to
multiplied by the number of suppositories to be
the discretion of the pharmacist.
 prepared in the mold is the total amount of base
required.
● Third method is to place all of the required
medicaments for the preparation of the total
number of suppositories (including one extra) in a
calibrated beaker, add a portion of the melted
base, and incorporate the drug substances. Then
add sufficient melted base to reach the required
volume of mixture based on the original
calibration of the volume of the mold.
Info. patients need to know about suppositories
● If they must be stored in the refrigerator,
suppositories should be allowed to warm to room
temperature before insertion.
● Rub cocoa butter suppositories gently with the
fingers to melt the surface to provide lubrication
for insertion. Glycerinated gelatin or
polyethylene glycol suppositories should be
moistened with water to enhance lubrication.
● Bullet-shaped rectal suppositories should be
inserted point-end first.
● When using one-half suppository, the patient
should be told to cut the suppository in half
lengthwise with a clean razor blade.
● Most suppositories are dispensed in paper, foil,
or plastic wrappings, and the patient must be
instructed to completely remove the wrapping
before insertion.
- stored at controlled room temperature (20°C to
25°C or 68°F to 77°F)
● Suppositories prepared from a cocoa butter base
- usually individually wrapped or otherwise
separated in compartmentalized boxes to
prevent contact and adhesion.
- stored below 30°C (86°F) and preferably in a
refrigerator (2°C to 8°C or 36°F to 46°F)
● Suppositories containing light sensitive drugs
- individually wrapped in an opaque material such
as metallic foil.
❖ Suppositories made from a base of polyethylene glycol
may be stored at usual room temperatures.
❖ Suppositories are also commonly packaged in slide
boxes or in plastic boxes.
Suppositories stored in high humidity may absorb
moisture and tend to become spongy, whereas
suppositories stored in places of extreme dryness may
lose moisture and become brittle.

Packaging and Storage

● Glycerin suppositories and glycerinated gelatin
suppositories
- packaged in tightly closed glass containers to
prevent a moisture change in the content of
the suppositories.
Other examples of suppositories given for
systemic results include diazepam, metronidazole, progesterone, aminophylline, morphine, prochlorperazine,
chlorpromazine, thiethylperazine, indomethacin, diclofenac, ketoprofen, naproxen, and ondansetron