Parenteral routes:

Parenteral administration is used for drugs that are poorly absorbed from the gastrointestinal (GI) tract, and for agents such as insulin that are unstable in the GI tract. Parenteral administration is also used for treatment of unconscious patients and under circumstances that require a rapid onset of action. The three major parenteral routes are- Intravascular (intravenous or intra-arterial) - Intramuscular- Subcutaneous

Intravascular:
Intravenous (IV) injection is the most common parenteral route. For drugs that are not absorbed orally, there is often no other choice.- Rapid onset of action because the drug is injected directly into the bloodstream - Useful in emergencies and in patients that are unconscious - The drug avoids the GI tract andfirst-pass metabolism by the liver - Smaller doses generally are required than the other routes but cost is high.

Greater risk of adverse effects as:

a. High concentration attained rapidly b. That are injected cannot be recalled by strategies such as emesis or binding to activated charcoal c. Risk of embolism (obstruction of blood vessel)

d. May introduce bacteria through contamination, induce e. Pain at application f. No self administration facility Capillary: brings the blood into intimate relationship with the tissue cell Artery Arterioles Capillary Venules Veins

hemolysis site

Intra-artery
Similar properties, advantages and disadvantages of intravascular route. Intra-artery route is specially used when high drug concentration in specific tissue is required than other tissue: - diagnostic purpose and - for chemotherapy

Intramuscular
Drugs administered intramuscularly can be aqueous solutions or specialized depot preparationsoften a suspension of drug in a non-aqueous vehicle, such as ethylene glycol or peanut oil. Absorption of drugs in aqueous solution is fast,whereas that from depot preparations is slow. Drug passes through capillary walls to enter the blood stream.-Pain at injection sites for certain drugs - This parenteral route may be used when an immediate effect is not required but a prompt effect isdesirable- Absorption from an intramuscular depot is more predictable and uniform than from a subcutaneous site

Subcutaneous
Drug is injected beneath the skin and permeates capillary walls to enter blood stream. Absorption from the site of injection is dependent on local blood flow. Concurrent administration of vasoconstrictor will slow absorption. For example, minute amount ofepinephrine is sometime used in combination with a drug to restrict its area of action. Epinephrine acts as alocal vasoconstrictor and decreases removal of a drug, such as lidocaine (local anesthetic), from the site of administration. Examples of drugs given by this route areinsulin and sodium heparin, neither of which is absorbed orally, and both of which should be absorbed slowly over many hours.