SYSTEMIC ROUTES OF DRUG

ADMINISTRATION:
Hind B. Almufty
BS.c clinical pharmacy
• 1- Enteral Routes: It includes oral, sublingual and rectal
routes.
• A-Oral: It is the most common and acceptable route for drug
administration. Dosage forms are: tablet, capsule ,syrup,
mixture, etc.
ADVANTAGES
1. Safe.
2. Cheap.
3. Painless.
4. Convenient for repeated and prolonged use.
5. Can be self-administered.
• DISADVANTAGES:
• Not suitable for emergency as onset of action of most orally
administered drugs is slow.
• It is not suitable for/in:
 1. Unpalatable and highly irritant drugs.
 2. Un-absorbable drugs.
 3. Drugs that are destroyed by digestive juices.
 4. Drugs with extensive first-pass metabolism.
 5. Unconscious patients.
 6. Uncooperative and unreliable patients.
 7. Patients with severe vomiting and diarrhea.
• B-Sublingual and Buccal Route:
• Sublingaul route: Placement under the tongue allows
a drug to diffuse into the capillary network and enter
the systemic circulation directly, bypasses first-pass
metabolism e.g. nitroglycerin for acute anginal
attack.
• Buccal Route: The preparation is placed between
gums and cheek. The drug is absorbed through the
buccal mucous membrane and enters the systemic
circulation directly.
• C-Rectal Route: Drugs can be given in the form of
solid or liquid.
1. Suppository: It can be used for local (topical) effect
as well as systemic effect, e.g .indomethacin for
rheumatoid arthritis.
2. Enema: Retention enema can be used for local
effect as well as systemic effect. The drug is
absorbed through rectal mucous membrane and
produces systemic effect, e.g. diazepam for status
epilepticus in children.
• 2- Parenteral Routes: The term parenteral is derived from
Greek word Para means beside and entron meaning intestine is
together indicated something done outside of intestine and not
by the way of the elementary canal.
• It includes inhalation, injections and transdermal patches.

• Advantages:
 Onset of action of drugs is faster; hence it is suitable for
emergency.
 Useful for unconscious, uncooperative and unreliable patients.
 Useful for patients with vomiting and diarrhea.
• It is suitable for:
1. Irritant drugs.
2. Drugs with high first-pass metabolism.
3. Drugs not absorbed orally.
4. Drugs destroyed by digestive juices.
• Disadvantages:
1. Require aseptic conditions.
2. Preparations should be sterile and is
expensive.
3. Requires invasive techniques that are painful.
4. Cannot be usually self-administered.
5. Can cause local tissue injury to nerves,
vessels, etc.
• A-Inhalation: Volatile liquids and gases are given by
inhalation for systemic effects, e.g. general anaesthetics.
• B-Injections:
1-Subcutaneous (s.c): The drug is injected into the
subcutaneous tissues of the thigh, abdomen and arm, e.g.
insulin.
2-Intramuscular (i.m) : Drugs are injected into large muscles,A
volume of 5–10 mL can be given at a time.
3-Intradermal: The drug is injected into the layers of the skin
e.g. BCG vaccination and drug sensitivity tests. It is painful and
only a small amount of the drug can be administered.
4-Intravenous (i.v): Drugs are injected directly into the
blood stream through a vein. Drugs are administered
as:
 Bolus: Single, relatively large dose of a drug injected
rapidly or slowly as a single unit into a vein .
 Slow intravenous injection: For example, i.v.
morphine in myocardial infarction.
 Intravenous infusion: For example, dopamine
infusion in cardiogenic shock.
• ADVANTAGES:
 Bioavailability is 100%.
 Quick onset of action; therefore, it is the route of choice in
emergency, e.g. intravenous diazepam to control convulsions
in status epilepticus.
 Large volume of fluid can be administered, e.g. intravenous
fluids in patients with severe dehydration .
 Highly irritant drugs, e.g. anticancer drugs can be given
because they get diluted in blood.
 By i.v. infusion, a constant plasma level of the drug can be
maintained.
• DISADVANTAGES:
 Once the drug is injected, its action cannot be
halted.
 Local irritation may cause phlebitis.
 Self-medication is not possible.
 Strict aseptic conditions are needed.
 Extravasation of some drugs can cause injury and
necrosis.
 Depot preparations cannot be given by i.v. route.
• C-Transdermal route: The drug is administered in the form of a patch or
ointment that delivers the drug into the circulation for systemic effect
For example nitroglycerin patch/ointment for angina.

• Advantages:
1. Self-administration is possible and Patient compliance is better.
2. Duration of action is prolonged.
3. Systemic side effects are reduced.
4. Provides a constant plasma concentration of the drug.
• Disadvantages:
1. Expensive and local irritation may cause dermatitis and itching.
2. Patch may fall-off unnoticed.