Suppository
From Wikipedia, the free encyclopedia
A suppository is a drug delivery system that is inserted either into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository) where it dissolves.
They are used to deliver both systemically-acting and locally-acting medications.
The alternative term for delivery of medicine via such routes is pharmaceutical pessary.
The general principle is that the suppository is inserted as a solid, and will dissolve inside the body to deliver the medicine.
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[edit] Rectal suppositories
Rectal suppositories are commonly used for:
- laxative purposes, with chemicals such as glycerin or bisacodyl
- treatment of hemorrhoids by delivering a moisturizer or vasoconstrictor
- delivery of many other systemically-acting medications, such as promethazine or aspirin
- general medical administration purposes: the substance crosses the rectal mucosa into the bloodstream; examples include paracetamol (acetaminophen), diclofenac, opiates, and eucalyptol suppositories.
[edit] Mode of insertion
In 1991, Abd-El-Maeboud and his colleagues published a study in The Lancet,[1] based upon their investigation into whether there was some hidden and forgotten knowledge behind the traditional shape of a rectal suppository.
Their research very clearly demonstrated that there was, indeed, a very good reason for the traditional "torpedo" shape; namely, that the shape had a strong influence on the extent to which the rectal suppository traveled internally — and, thus, upon its increased efficiency.
They (counter-intuitively) found that the ideal mode of insertion was to insert suppositories "blunt"-end first, rather than the generally used mode of inserting the "pointy"-end first. This conclusion was based on the greater distance of internal travel of the suppository once inserted, which was entirely a mechanical consequence of the natural actions of the bowel's muscular structure and the rectal configuration.
As a consequence, and in order to guarantee the maximum optimal efficiency, they recommended that all rectal suppositories be inserted "blunt"-end first. The findings of this single study have been challenged as insufficient evidence on which to base clinical practice.[2]
[edit] Non-laxative rectal suppositories
Non-laxative rectal suppositories are to be used after defecation, so as not to be expelled before they are fully dissolved and the substance is absorbed. The use of a examination glove or a finger cot can ease insertion by protecting the rectal wall and the fingernail(s) from each other.
[edit] Vaginal suppositories
Vaginal suppositories are commonly used to treat gynecological ailments, including vaginal infections such as candidiasis.
[edit] Urethral suppositories
Alprostadil pellets are urethral suppositories used for the treatment of severe erectile dysfunction. They are marketed under the name Muse in the United States.[3] Its use has diminished since the development of oral impotence medications, but is still on the market.
[edit] Constituents
Some suppositories are made from a greasy base, such as cocoa butter, in which the active ingredient and other excipients are dissolved; this grease will melt at body temperature (this may be a source of discomfort for the patient, as the melted grease may pass through the anus during flatulences). Other suppositories are made from a water soluble base, such as polyethylene glycol. Suppositories made from polyethylene glycol are commonly used in vaginal and urethral suppositories. Glycerin suppositories are made of glycerol and gelatin.
[edit] Indications
Suppositories may be used for patients in the event it may be easier to administer than tablets or syrups.
Suppositories may also be used when a patient has a vomiting tendency, as oral medication can be vomited out.
Drugs which often cause stomach upset, for example diclofenac sodium (Voltaren) are better tolerated in suppository form.
[edit] "Liquid suppository"
The phrase "liquid suppository" is also sometimes applied to the activity of injecting a liquid, typically a laxative, with a small syringe, into the rectum.
[edit] See also
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[edit] Notes and references
- ^ Abd-El-Maeboud, K. H.; T. El-Naggar, E. M. M. El-Hawi, S. A. R. Mahmoud and S. Abd-El-Hay (28 September 1991). "Rectal suppository: commonsense and mode of insertion". The Lancet (Elsevier Science) 338 (8770): 798–800. doi:.
- ^ Bradshaw, Ann; Lynda Price (20 December 2006). "Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice". Journal of Clinical Nursing (Blackwell Publishing) 16 (1): 98–103. doi:.
- ^ DrugDigest: Muse overview. Retrieved July 10, 2007.
- Doyle, D., "Per Rectum: A History of Enemata", Journal of the Royal College of Physicians of Edinburgh, Vol.35, No.4, (December 2005), pp.367-370.
- Payer, L., "How Medical Practice Reflects National Culture", The Sciences, Vol.30, No.4, (July-August 1990), pp.38-42.
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