ROUTES OF DRUG

ADMINISTRATION
Dr. Jeevan Jacob
Junior Resident
Dept. Of Pharmacology
Definition:
A route of administration is the path by which a drug,
fluid, poison or other substance is brought into contact
with the body.
Factors Governing Choice of Route
• Physical and chemical properties of the drug
• Site of desired action
• Rate and extent of drug absorption
• Effect of digestion and first pass metabolism
• Rapidity of response desired
• Accuracy of dosage required
• Condition Of patient
 Major routes

Enteral Parenteral Topical

Injections Conjunctival,Nas
Oral
al,Auditory

Sublingual, Inhalation Vaginal and

Buccal Urethral

Transderm
Rectal Dermal
al
 ORAL ROUTE
ADVANTAGES DISADVANTAGES

•Safe •Slow absorption

•Convenient •Slow action
•Economical •Irritable and
•Can be self unpalatable drugs
administered •Un co-operative and
•Painless unconscious patients
•Some drugs
destroyed
•First-pass effect
First-pass Effect
The first-pass effect is the term used for the
hepatic metabolism of a pharmacological
agent when it is absorbed from the gut and
delivered to the liver via the portal
circulation. The greater the first-pass effect,
the less the agent will reach the systemic
circulation when the agent is administered
orally
First pass effect:
Examples - Oral
• Solid-Tablet,Capsule,Powder

• Liquid-Syrup,Elixir,Mixture
Sublingual and Buccal
Sublingual: Beneath the tongue
Buccal: Crushed and spread over
buccal mucosa
 SUBLINGUAL ROUTE
ADVANTAGES DISADVANTAGES

•Economical •Unpalatable &

•Drug absorption is bitter drugs
quick •Irritation of oral
•First-pass avoided mucosa
•Quick termination- •Large quantities
Spit off not given
•Can be self
administered
Example
Systemic use

• Isosorbide dinitrate
• Nitroglycerine
• Nifedipine

Local
• Antispetic lozenge
 RECTAL ROUTE
ADVANTAGES DISADVANTAGES

Used in children Embarrassing

Little first pass effect Inconvenient
Used in Absorption is
vomiting/unconscious slow and erratic
Higher concentrations Irritation or
rapidly achieved inflammation of
Can use gastric irritants rectal mucosa can
occur
Example
Local Effects
• Dulcolax, Glycerine suppository ,enema, ointment

Systemic Effects
• Aminophylline, Indomethacin suppositories
Gastric Tube Administration
• Gastric tubes provide access
directly to the GI system.
Parenteral Routes
Routes other
than enteral
are called
parenteral
Administration of drugs by
the parenteral route
Intradermal
• Amount of drug small, slow absorption
• Example: BCG vaccine, diagnostic tests,
allergic sensation testing
Subcutaneous administration
Site: Injection under skin

ADVANTAGES DISADVANTAGES

• Smooth but slow • small volume(1 ml)

absorption • irritant drugs-
• depot sloughing and
injections/implants necrosis
• Examples • not suitable in shock
• Local effect- Local
anaesthetic
• Systemic-Insulin
Intramuscular Injections

• Site-Deltoid muscle, Gluteus, Vastus

 Intramusular route
ADVANTAGES DISADVANTAGES

•Absorption •Only upto 10ml drug

reasonably uniform given
•Rapid onset of •Local pain and
action abscess
•Mild irritants can •Expensive
be given •Nerve damage
•First pass avoided
•Gastric factors can
be avoided
 Intravenous Administration
ADVANTAGES
• Bypass first pass
metabolism(100%)
• Quick onset of action
• In uncooperative and
unconscious patients
• those with nausea and
vomiting
• hypertonic solutions and
irritants
• large volumes
• amount of drug can be
controlled accurately
DISADVANTAGES
• Antiseptic conditions
• Depend on others
• Painful and risky
• Embolism
• Suspensions/oily
drugs/depots cant be
given
• Venous thrombosis and
phlebitis
• Necrosis due to
extravasation
Examples
• IV infusion-Ringer,Dextrose
5%,DNS,Dopamine

• IV bolus-Diazepam,Adenosine,Insulin
Intraarterial
• Site: Lumen of artery
• ADVANTAGE: Greater concentration of
the drug can be delivered
• DISADVANTAGE: Expertise and
asepsis
• Examples: Radiopaque contrast for
coronary angiography and cerebral
angiography
Intraperitoneal
• Site-Peritoneal space

• ADVANTAGE -Rapid absorption-large

surface area

• DISADVANTAGE -
Painful,Risky,Adhesions,Peritonitis
• Example: Dialyzing fluid-poisoning and
renal failure
• In lab animals
Intrathecal (Intraspinal)
• Site: Subarachanoid space

• ADVANTAGE: Bypass blood brain

barrier and blood CSF barrier-acts
directly on meninges and spinal cord

• DISADVANTAGE-Asepsis, Expertise,
Painful,Risky
• Example: Radioopaque contrast media,
Xylocaine injection
Epidural
• Through vertebral interspace
between dura and lining of spinal
canal
• Example: Xylocaine injection
Intramedullary
Site:Tibial or Sternal bone marrow

ADVANTAGE: onset of action very fast

DISADVANTAGE: Strict aseptic

conditions, expertise and skill required
Painful and risky
Examples: Bone Marrow transplantation
Intraarticular
• Site: Injection directly into the joint space
• ADVANTAGE: High concentration in
localised area
• DISADVANTAGE: Asepsis, Joint
damage, Pain
• Examples: Hydrocortisone, Gold chloride
for rheumatoid arthritis
Intracardiac injection
• Left fourth intercostal space into
heart muscle
• Eg Adrenaline injection-cardiac
arrest
Inhalation
• Site: Inspiration nose/mouth
• ADVANTAGE: fast, quick-large
surface area, self

• DISADVANTAGE: increased
bronchial and salivary secretions
• Examples: Salbutamol ,Na
cromoglycate –Metered dose inhalers
 Intranasal
•Drugs directly into the nose.
•Desmopressin is administered
intranasally in the treatment of
diabetes insipidus
•Salmon calcitonin- osteoporosis
•GnRH aanalogues
 Topical
• Conjunctival, Nasal ,Auditory Mucosal
• drops, sprays
• Vaginal and urethral
• Solutions, ointment ,emulsions, suppositories, pessary
• Inunction and dermal
• Rubbing into skin
• Dust/spray
Transdermal therapeutic system
• Drug in solution or bound to a polymer is held in reservoir
between occlusive backing film and rate controlling micro
pore membrane under surface of which is smeared with an
adhesive impregnated with priming dose of drug.

• Adhesive layer protected with film which is peeled off just

before application

• To provide smooth plasma concentration without fluctuations

• More convenient, patient compliance is better