Suppository

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. 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 or melt inside the body to deliver the medicine pseudo received by the many blood vessels that follow the larger intestine.

Rectal suppositories

Glycerin suppositories (laxative)

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.

Mode of insertion

In 1991, Abd-El-Maeboud and his colleagues published a study in The Lancet, 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 tapered 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.

Non-laxative rectal suppositories

Four 500 mg paracetamol 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).

Hemorrhoid suppositories (aka rectal rockets)

The "rectal rocket" is a special suppository design for hemorrhoids that rivals traditional suppositories in three ways:

• It does not get lost in the rectum, but remains at the point of insertion.
• It treats internal and external hemorrhoids simultaneously.
• The patient can expel gas without losing the suppository.

Vaginal suppositories

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.

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. Its use has diminished since the development of oral impotence medications.as per the jntuk

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.

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.

Liquid suppository

Liquid suppository involves injecting a liquid, typically a laxative, with a small syringe, into the rectum.

In humor

File:PrepH Bullets.jpg

Rectal suppositories featured on a humorous image.

Suppositories are sometimes featured on joke images because of their shape ranging from gun bullets (rectal), rifle bullets (vaginal), and even rockets (hemorrhoids).

See also

• Artesunate suppositories
• Enema
• Pessary

References

• 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.