ROUTES OF DRUG

ADMINISTRATION

Mr.Manikanta
 Drug can be defined by as “any substance or product that is
used or intended to be used to modify or explore
physiological systems or pathological states for the benefit
of the recipient”.

 It’s a active principle present in medicine.

 Drugs can administered by various methods.

 Routes of drug administration

Systemic
Local

Topical Deeper Arterial Oral Buccal Rectal

Cutaneous Inhalation Nasal Parenteral

• The choice of the route in a given patient depends on the
properties of the drug and pt’s requirements.

• A knowledge of the advantages and disadvantages of the

different routes of administration is essential.
I) Local routes- Merits
• Less systemic absorption.
• High drug conc. at desired site of action.
• Less systemic toxicity / S.E.
• GTN ointment- Systemic absorption.
1.Topical:-
• Refers to external application.
• More convenient & encouraging.
E.g. Lotion, oint, cream, powder, paints, drops, spray,
lozenges, suppositories or pesseries.
• Non-absorbable drugs given orally- sucralfate /vancomycin
• Inhalational drugs- Salbutamol.
2.Deeper tissues:-

Intra- articular inj-Hydrocortisone acetate,

Infiltration. A or Intrathecal inj- Lidocaine.

Retro bulbar injection-Hydrocortisone acetate.

3.Arterial supply:

• Intra-arterial injection- contrast media in angiography

• Anticancer drugs- femoral or brachial artery-Rx of limb

malignancies.
Intraarticular Intra-arterial
II) Systemic routes-
1.Oral:
 Merits :-
• Oldest & commonest mode of drug adm.
• Safer & convenient,
• Does not need assistance,
• Noninvasive & painless,
• Medicament need not be sterile,
• Cheaper.
• Solid & liquid dosage forms- given orally.
• Drug given orally to provide local effect-
e.g., antacids, streptomycin, pectin, norfloxacin.
 Demerits:-
• Drug action is slower.
• Not suitable for emergencies.
• Unpalatable drugs (chloramphenicol) .
• May cause nausea &vomiting.
• Can’t be used for uncooperative /unconscious/ vomiting pt.
• Drug absorption- variable & certain drugs are not absorbed
(streptomycin)
• Drugs can be destroyed by
- digestive juices- PnG, insulin
- liver -GTN, testosterone, lidocaine.
 Enteric coated tablets-
 Tablets are coated with cellulose acetate, gluten etc. Which
are not digested by gastric acid but dissolved in alkaline PH.
 Provides high concentration in small intestine.
 Absorption is slow and duration is prolonged.
 Similarly SR/CR tablets are also designed to prolong the
rate of absorption & duration of action too.
 This is useful for short acting drugs.
Adv-
 Frequency of drug adm can be reduced.
 Drug plasma conc. are maintained for longer periods.
2.Sublingual or Buccal:-
• Tablet is placed under the tongue or crushed in the mouth &
spread over the buccal mucosa.
• Lipid soluble & non-irritating drugs can be adm.
• Rapid absorption & quick onset of action.
• Drug can be spit after desired effect has been obtained.
• Bypasses the 1st pass metabolism .
• Directly absorbed into the systemic circulation.
• E.g. GTN, buprenorphine, desamino oxytocin.
First-pass Effect
1.Sublingual drug is placed or direct spray between the
underside of the tongue and the floor of the oral cavity.

1 2

Buccal tablets are placed between the patient’s

cheek and gum.
3.Rectal:-

• Irritant & unpleasant drugs can be put in rectum.

• Suppositories or retention enema for systemic effect.

• Suitable for vomiting or unconscious patient.

• Absorption is slower, irregular & unpredictable.

• Drug absorbed into EHV (about 50%) bypasses liver.

• Rectal inflammation can result from irritant drugs.

e.g., Diazepam, Indomethacin, paraldehyde, ergotamine .

EHV- external haemorrhoidal veins

Rectal administration-
4.Cutaneous:-
• Drugs in ointment - applied over specified area of skin.

• Highly lipid soluble drugs can be applied over the skin.

• Absorption is slow & prolonged.

• Bypasses 1st pass metabolism.

• Absorption- rubbing the preparation /oily base/ occlusive

dressing.
Transdermal therapeutic systems:-
• Adhesive patches of various shapes & sizes.
• Drug delivers at a constant rate into systemic circulation via
the stratum corneum.
E.g., GTN, Fentanyl, Nicotine, Estradiol, Isosorbide , Hyoscine, Clonidine.

• Drug delivers constantly, predictable rate irrespective of site

of application.
• Drug plasma concentrations- without fluctuations.
• Drug is subjected to little 1st pass metabolism & S/E.
• Pt compliance is better.
• Local irritation & erythema occur in some pt’s.
• Discontinuation has been necessary in 2-7% cases.
Site of application TDPs - chest, mastoid region, abdomen, upper arm,
lower back, buttock
5.Inhalation:-
• Volatile liquids & gases - systemic action. e.g. G.A’s.
• Rapid absorption-alveoli.
• Drug is rapidly eliminated in exhale air.
• Dose can be adjusted/controlled.
• Dis -adv- inflammation of respiratory tract & secretion.
6.Nasal:-
• Drugs readily absorb from nasal mucous membrane .
• Digestive juices & liver are bypassed.
e.g., GnRH agonists & Desmopressin.
• Spray or Nebulizer can be used by this route.
Nasal Medication Administration
7.Parenteral:- (par – beyond, enteral – intestine)
 Merits-
• Drugs are administered through injection.
• Drug directly enters into tissue fluid or blood.
• Limitations of oral administration are overcome.
• Drug action is faster & surer (valuable in emergencies).
• Less gastric irritation & vomiting .
• Unconscious, uncooperative or vomiting patient.
• No interactions with food or digestive juices.
• Liver is bypassed.
 Demerits-
• Sterilized preparations has to be used.
• Costlier.
• Technique is invasive & painful.
• Needed assistance.
• Self injection is possible e.g. insulin by diabetics.
• Local tissue injury & more risky than oral.
.
i ) Subcutaneous (S/C)
• Drug deposited into S/C tissue.
• It’s richly supplied by nerves- irritant drugs cant be injected.
• It is less vascular.
• Absorption S.C < I.M.
• Only small volumes can be injected.
• Self injection is possible - deep penetration is not needed.
• Avoid in shock pt’s- absorption will be delayed.
• Depot injections (aqueous) - prolonged action.
E.g., Insulin
Subcutaneous Injection
• Given at a 45-degree angle
– 25- or 26-gauge needle, 3/8 to 5/8 inch length
• No more then 1.5 ml should be injected into the site-
– to avoid pressure on sensory nerves causing pain and discomfort.
 Some special forms of S/C route are:
a) Dermojet –Needless injection.
• A high velocity jet of drug soln is projected from a microfine
orifice using a gun like device.
• Painless & mass inoculations can be given.
b) Pellet implantation:-
• Drug pellet is introduced with a trochar &cannula
• Drug release over wks & months, e.g. DOCA, testosterone.
C) Sialistic and biodegradable implants:-
• Drug is packed in tubes /capsule are implanted under skin.
E.g., hormones & contraceptives. (NORPLANT)
Dermojet Implants
CSII
(ii) Intramuscular:-
• Drug injected into-deltoid, triceps, gluteus maximus, rectus
femoris muscles.
• Its less richly supplied with sensory nerves -
- mild irritants can be inj.
• Highly vascular.
• It is less painful.
• Self injection is not advised.
• Depot injection (oil & aqu) can be given. 23- to 25-gauge
½- to 1-inch needle.
• Avoid in anticoagulant pt’s- local hematoma.
E.g., Procaine Penicillin
(iii) Intravenous:
 Merits
• Given as I.V bolus / slow infusion - superficial veins.
• Drug directly enters into systemic circulation.
• Effects are produced immediately (value in emergency).
• Bioavailability is 100%.
• Large volumes can be infused.
• T.intima is insensitive-irritant drugs can be inj.
• Response is accurately measurable (e.g. BP).
• Titration of dose with response is possible.
 Demerits
• Requires strict aseptic conditions .
• Thrombophlebitis, necrosis &
extravasation occurs.
• Only aqueous soln (not suspensions)
can be injected.
• Depot preparations can’t be used.
• Vital organs exposed to high conc.
• Complications can be by diluting the
drug or injecting it into a running i.v. line.
IV injections are administered at a 15- to 20-degree angle
21 Gauge needle.

E.g., I.V bolus- Furosemide, Thiopentone .Na.

I.V infusion- Dopamine, Aminophylline, Cisplatin
(v) Intradermal injection- tuberculin syringes.
• Drug injected into the skin raising a bleb (e.g. BCG vaccine,
sensitivity testing) or multiple puncture of the epidermis .

• 26-Gauge needle
vi) Intrathecal:
Site of admin is into the subarachnoid space.
Merits: Drug is diffuses from lumbar sac into subarachnoid
space.
•Bypasses BBB & Blood-CSF.
•Drugs directly act on meninges & CNS.
•Strict aseptic conditions & expertise in needed.
Ex:
1.Radio opaque contrast media for myelography.
2.Xylocaine - spinal anesthesia- local effects.
3.Antibiotics- Rx infectious meningitis- systemic effects.
iv) Intra peritoneal:
Site of admin is into peritoneal space.
Merits: Rapid absorption
due to L.S.A
E.g., Anti rabies inj.
•Peritoneal dialysis-poisoning
•Renal failure.
•Lab animals
Intra medullary administration-
 Site: Injection into the tibial or sacral bone marrow.
Merits- Quick on set of action as the vascular spaces of bone
marrow directly communicate with large veins.
E.g., Bone marrow transplantation.
- Blood transfusion- children's.
• Mainly provides systemic effects.
Intracardiac injection-
• Injection is given by a long needle into heart muscle
through the left 4th intercostal space close to sternum.
E.g., Adrenaline injection to restart the heart beat in cases of
sudden cardiac arrest.
Draw up the
medication. Prepare the site.
Insert the needle at a Insert the needle, bevel up at
90-degree angle. a 10 to 15-degree angle.

I.M
© Scott Metcalfe Intradermal
 Remove the needle and
cover the puncture site with Monitor the patient.
an adhesive bandage.

I.V Inj
Glass Syringes
Plastic Syringes
 Dosage forms

Solid
semisolid Liquid

Capsules
Tablets Ointment
Paste Mixture
Gels Syrups
Emulsions
Uncoated- PCM, Aspirin, Elixirs
Enteric coated- Aspirin, Valproic acid Tincture
Sustained release – Diclofenac, Etophylline Extracts
Sublingual – GTN Solutions
Lozenges- Strepsils, Vicks Spirits
Chewable- Antacids
Dispersible- Aspirin, Acyclovir, Fluconazole
Controlled release-
Retard – Nifedipine, KCl Soft gelatin- Vit.E,
Hard/soft tablets- Aspirin, Erythromycin Hard gelatin-T.C’s
Sugar coated- B.complex, chloroquine, Metronidazole Spansules – Iron & Folic acid.
Film coated – Dilitazam, Cefuroxime
Thank you