Routes of Administration

Introduction

 A route of administration is the path by which a drug, fluid,

poison or other substance is brought into contact with the
body.
-Jonas: Mosby's Dictionary of Complementary and lternative
Medicine, 2005, Elsevier.

 No single method of drug administration is ideal for all

drugs in all circumstances
 Choosing particular route of drug
administration

 DRUG RELATED FACTORS

 Physical and Chemical properties
 Compared bioavailability for different routes
 PATIENT RELATED FACTORS
 Condition of the patient
 Site of desired action
 Effect of digestive juice,
 first pass metabolism
 Urgency for response
 Accuracy of dosing
 FACTORS GOVERNING CHOICE
OF ROUTE

 Physical & chemical properties of drug solid/liquid/gas; solubility,

stability, PH, irritancy
 Site of desired action- localized and approachable or generalized
and non approachable
 Rate & extent of absorption from various routes
 Effect of digestive juices & first pass effect
 Rapidity of the desired response- emergency/routine
 Accuracy of dosage
 Condition of the patient- unconscious, vomiting
 Routes of administration

Systemic
Local Application
i) Oral
ii) Sublingual
Enternal Parenteral
iii) Enema
i) Oral i) Inhalation
ii) Sublingual
iii) Enema ii) Injection

iii) Transdermal • Intradermal

• Subcutaneous
• Intramuscular
• Intravenous
• Intra-arterial
• Intrarathecal
• Intramedullary
• Intraarticular
 Oral Route
 Drug administered may be solid or liquid form
 Drug is placed in mouth cavity & is swallowed along with drinks like
water, milk, etc
 Sometimes drug is chewed and then swallowed by mouth cavity
 After administration of drug by this route absorption takes place in
intestine
 Eg: Paracetamol tablets, Calcium Tablets, etc
 100% absorption of drug is not possible as drug is degraded or destroyed
by hepatic enzymes
Eg: testosterone are destroyed in liver cells
 Drugs which undergo degradation due to gastric enzymes or digestive
enzymes cannot be administered through this route
Eg: Insulin undergoes degradation in GIT
 Advantages:
 Most common route of drug administration
 Safe, convenient and economical route
 Self medication possible
 Drugs administered by this route does not require complicated
process like sterilization

 Disadvantages:
 Very slow onset of action (3-4 hrs after adm.)
 Cannot be used in emergency conditions
 Cannot be used in case of unconscious & in cooperative patients
 Irritant, unpalatable drugs cannot be administered through this route
 In patients with symptoms of vomiting and diarrhoea this route of
drug administration is not effective
 High doses are effective
 Sublingual route
 Tablet of medicament is placed below the tongue & allowed to
dissolve in buccal cavity
 Hence the active medicament get absorbs through buccal
mucous membrane
 The absorbed material directly passes into systemic circulation
 Eg: i) Ephedrine hydrchloride and Isoprenaline tablets used in
asthma
ii) Nitroglycerine & Isosorbitrate used in Anginapectoris
 Advantages :
 Quick onset of action
 Quick termination of action or side effects
 Overdose can be avoided
 1oo % absorption is possible

 Disadvantages :
 Drugs having direct/toxic effects on heart should be
administered with utmost care to avoid any side effects.
 Enema/Enemata
 Involves aadministration of liquid medicament into rectum
 Types: Evacuant and Retension Enema
 Evacuant Enema :
 Employed to remove fecal matter & also flatulence
 Max. quantity administered at a time: 600ml
Eg: Soap water enema
 This type of enema is utilised before operations, delivery &
investigation of GIT by X rays, etc.
 Retension Enema :
 Here administered fluid contains medicament which is
retained in rectum
 the medicaments act locally Eg: prednisolone enema in
ulcerative colitis
 Sometimes drug act systemically br absorption through
mucous membrane Eg: Paraldehyde enema for production of
basal anesthesia
 Advantages
 Gastric irritation is avoided
 Useful in old and terminally ill patients

Disadvantages
 Tedious to administer
 Require help of other person/technical person.
 Disadvantages:

 It's a costly route

 Aseptic technique is required
 It is inconvenient
 Self-medication is not possible
 Once administered, action cannot be halted and hence
risky route.
 Skilled person required
 Chances of inflammation and abscess formation at site of
injection
 Pain may be produced by injection
 Intradermal Route
 Drug injected into the layers of skin(dermis ) raising a bleb
 Painful
 Small quantity administered (not more than 1ml)
APPLICATIONS :
 Mainly used for testing sensitivity to drugs
 e.g. penicillin, ATS (anti tetanus serum)
 Diagnostic tests: Schick test(Diphtheria),
Dick test (Scarlet fever),Tuberculin test
 Local anesthetics are sometimes injected by
this route
 INOCULATION :administration of
vaccine (like small pox vaccine ), BCG(Bacilli
Calmette Guerin)
 Subcutaneous route

 Drug is injected under the skin into loose connective tissue.

 Absorption is evenly &slow, so action is prolonged.
 Usually soluble drugs and non irritant substances are injected
 Quantity of drug injected is upto 2ml
 Site of injection: outer surface of upper arm or front of the
thigh
 E.g. Insulin (protamine in zincInsulin),
Heparin, Adrenaline in oil
 Advantages :
 Reliable
 Patients can be trained for self-administration
Disadvantages
 Irritant drugs can cause severe pain- due to rich nerve supply
 Less vascular tissue – slows absorption + if vasoconstriction is
there then further decreases absorption
 Repeated injections at same site leads to lipoatrophy & hence
decreased absorption
 Intramuscular route
 Drug is injected deep into muscle
tissue
 Volume upto 10ml can be injected.,
2ml in deltoid muscle (at shoulder joint)
and large volume in gluteal muscle
mass (hip joint)
 Longer & heavier needle is used which will penetrate into muscle
tissue.
 Soluble substances, Irritants, suspensions & colloids are
administered by this route
 Drugs administered by this route form depots and slowly release
the drug & hence forms persistent action
 Advantages
 More reliable
 Highly vascular so ↑ absorption
 Irritants, depot preparations, suspensions, colloids & injections
with oily bases can be injected
 Ensures uniform & slow absorption
 First pass avoided
 Gastric factors can be avoided
 Disadvantages
 Painful
 Expensive
 Nerve liable to injury or irritation
 Local infection with necrosis
 Some drugs have decreased absorption by IM ( diazepam,
phenytoin, digoxin).These drugs take more time for absorption
when given I/M as compared to their oral adm.
 Some drugs should be avoided (heparin)
 Only upto 10 ml of drug is given
 Intravenous route
Drug is directly introduced
into the lumen of the vein
(cubital vein)
 This route of injection
bypasses all barriers of drug
absorption hence 100%
absorption and desired blood
concentration is obtained at definite dose
 Rapid onset of action hence useful in emergency conditions
 Useful for administration of irritant and hypertonic solution
 Drugs which are never administered by this route:
Insoluble drugs,
oily substances,
drugs in suspensions,
markedly acidic or alkaline salts incompatible with blood
 Advantages:
 Rapid onset of action as drug (15 sec) enters blood circulation in
active form
 Decreased blood concentration can be obtained
 Useful in emergency cases
 Useful in unconscious patients and patients showing symptoms
like vomitting & diarrhoea
 Large quantity of drugs can be administered by this route
 Disadvantages:
 Drugs which precipitate blood constituents cannot be
administered
 Irritation of veins cause thrombophlebitis
 Extravasations of drug can cause irritation
 Only aqueous soln can given IV
 Technical expert required for administration
 Expensive
 Untoward reactions if occur are immediate
 Withdrawl of drug is not possible
 Intrathecal route
 Drug is injected in the subarachnoid space for CNS action
e.g. Spinal anaesthetics
 Minimise systemic adverse effect
 Advantages:
 Used for long duration surgeries to prevent complications from
general anaesthesia
 Direct and Rapid Action
 Strict aseptic conditions are required.

Disadvantages :
 Skilled person required
 Costly
 Intra-articular route
 Involves administration of
drugs directly into joint
 Used in local treatment where
high concentration of drug can be
achieved locally.
 injections of antibiotics and corticosteroids are administered in
inflammed joined cavities by experts.
 example: hydrocortisone in rheumatoid arthritis
 Intraperitoneal route

 Drugs are injected into peritoneal cavity

 Provides large absorbing surface
 Primarily used on lab animals
 Rarely used in clinical practice
 Used to give fluids like glucose saline solution to
infants

 Limitations:
 First pass effect
 Vast danger of adhesions, infection, injury in employing this route
 Hypodermoclysis
 Special processes of injecting
large amount of drugs through
subcutaneous tissues of the body
 Used when vein puncture is difficult
 Site for hypodermoclysis : thighs,buttocks,abdomen,lower back
 used where a slow rate of fluid uptake is required compared to
intravenous infusion
 Eg: In paedriatic practice normal saline solution is given by this
route
 Advantages:
 Safer route than I/V route : No thrombophlebitis,
thrombosoed catheter or veins,septicemia
 Reduced Distress for patients, especially the cognitive impaired
 Less discomfort with insertion and maintenance
 Less complicated,easier to maintain than IVF administartion
 Night infusion allow for day time mobility
 Cost saving
 Disadvantages:
 Limited volume of administration
 Localized oedema is created
 Isotonic or nearly isotonic (no medicaments) can be
administered.
 Hypospray
 This method is needleless and is
subcutaneous done by applying
pressure over the skin.
 The drug solution is retained under
 pressure in a container called ‘gun’.
 It is held with nozzle against the skin.
 Pressure on the nozzle allows a fine jet of solution to emerge
with great force.
 The solution can penetrate the skin and subcutaneous tissue
to a variable depth as determined by the pressure.
 Mass inoculation is possible but the method is expensive,
definite skills are required and cuts might result.
 Inhalation:
 • Inhalation may be the route of choice to avoid the
 systemic effects. In this way drugs can pass directly to
 the lungs.
 • Drugs used involve volatile drugs and gases.
 • Examples include aerosols like salbutamol; steam
 inhalations include tincture and Benzoin
 Advantages:
 • Rapid absorption
 • Rapid onset of action
 • This route has minimum side effects.
 • No first pass effect
 • This method is easy.
 • Fewer doses is required.
 Disadvantages:
 • Special apparatus is required.
 • Irritation of the respiratory tract may take place.
 • Cooperation of the patient is required.