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A suppository is a drug delivery system that is inserted into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository), where it dissolves or melts and is absorbed into the blood stream. They are used to deliver both systemically and locally acting medications.
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.
Shape and insertion
In 1991, Abd-El-Maeboud and his colleagues published a study on suppository insertion in The Lancet, explaining that the "torpedo" shape, when introduced to the patient blunt end first, helps the device to travel internally, increasing its efficacy. The findings of this single study have been challenged as insufficient evidence on which to base clinical practice.
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 an examination glove or a finger cot can ease insertion by protecting the rectal wall from fingernail(s).
Vaginal suppositories are meant for introduction into the vagina. These are generally conical, rod shaped or wedge shaped and are larger than Rectal suppositories (4-8 g). Commonly used for local actions in the treatment of gynecological ailments, including vaginal infections such as candidiasis.
Alprostadil pellets are urethral suppositories used for the treatment of severe erectile dysfunction. They are marketed under the name Muse in the United States. Its use has diminished since the development of oral impotence medications.
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 flatus). 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.
Suppositories may be a more convenient and safer substitute to injections, especially for post-operative hospitalized patients, while administrating commonly used drugs like paracetamol or acetaminophen.
Suppositories may also be used when a patient has a vomiting tendency, as oral medication can be vomited out.
Liquid suppository involves injecting a liquid, typically a laxative, with a small syringe, into the rectum.
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- 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:10.1016/0140-6736(91)90676-G. PMID 1681170.
- 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:10.1111/j.1365-2702.2005.01519.x.
- "Muse Suppository - Facts and Comparisons". Drugs.com. Retrieved 4 January 2013.
- 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.