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Lipids in Health and Disease Nov 2019The oral route of drug administration is the most common and convenient route for dosing statin drugs, and, in fact, most medications, because of ease of drug delivery,... (Review)
Review
The oral route of drug administration is the most common and convenient route for dosing statin drugs, and, in fact, most medications, because of ease of drug delivery, patient compliance, and cost-effectiveness. However, the oral administration of statin drugs has disadvantages such as hepatic first-pass metabolism and degradation within the gastrointestinal tract that limit their overall bioavailability. This review introduces several diverse non-oral delivery methods for the administration of statins. These alternative delivery systems and routes of administration are varied and are capable of improving the bioavailability and therapeutic efficacy of statin drugs.
Topics: Administration, Buccal; Administration, Cutaneous; Administration, Intravenous; Drug Delivery Systems; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors
PubMed: 31690335
DOI: 10.1186/s12944-019-1139-8 -
Advanced Drug Delivery Reviews Sep 2021The woman's body presents a number of unique anatomical features that can constitute valuable routes for the administration of drugs, either for local or systemic... (Review)
Review
The woman's body presents a number of unique anatomical features that can constitute valuable routes for the administration of drugs, either for local or systemic action. These are associated with genitalia (vaginal, endocervical, intrauterine, intrafallopian and intraovarian routes), changes occurring during pregnancy (extra-amniotic, intra-amniotic and intraplacental routes) and the female breast (breast intraductal route). While the vaginal administration of drug products is common, other routes have limited clinical application and are fairly unknown even for scientists involved in drug delivery science. Understanding the possibilities and limitations of women-specific routes is of key importance for the development of new preventative, diagnostic and therapeutic strategies that will ultimately contribute to the advancement of women's health. This article provides an overview on women-specific routes for the administration of drugs, focusing on aspects such as biological features pertaining to drug delivery, relevance in current clinical practice, available drug dosage forms/delivery systems and administration techniques, as well as recent trends in the field.
Topics: Animals; Drug Administration Routes; Female; Genitalia, Female; Humans; Mammary Glands, Human; Pharmaceutical Preparations; Pregnancy; Sex Factors
PubMed: 34280514
DOI: 10.1016/j.addr.2021.113865 -
European Journal of Pediatrics May 2022Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire...
Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire survey in (i) parents of 0-5-year-old children and (ii) 6-17-year olds and their parents. We assessed (A) experienced drug-handling problems and (B) expectations for drug therapy. (i) Forty-six parents and (ii) 103 children and their parents participated in the study. Experienced drug-handling problems were described by (i) 100% of parents and (ii) 62% of children and 70% of parents. Problems concerned with the preparation of the drug, dosing, compliance with the time interval, and acceptance. (i) Sixty-five percent of parents preferred a peroral route of drug administration, while (ii) 74% of children and 86% of parents did so. Preferred characteristics of peroral drug formulations, e.g., liquid versus solid drug formulations or flavor, were highly heterogeneous. Preferences of 6-17-year-old children and their parents matched in 43 to 66%. Conclusion: Most children and their parents had already experienced drug-handling problems. Preferences concerning the ideal pediatric drug were highly heterogeneous and in about half of cases, preferences of children and their parents differed. Thus, the children should be approached directly. If information is solely gained from parents, the children's needs might remain unmet. What is Known: • Pediatric drug administration is complex and therefore error-prone. • Experiences and expectations of children and their parents should be considered. What is New: •Most pediatric patients and their parents have already experienced drug-handling problems. • Expectations concerning the ideal pediatric drug are highly heterogeneous. Parents are often insufficiently aware of those expectations in their children.
Topics: Administration, Oral; Adolescent; Child; Child, Preschool; Humans; Motivation; Parents; Patient Compliance; Surveys and Questionnaires
PubMed: 35199240
DOI: 10.1007/s00431-022-04419-6 -
The Patient Aug 2016Subcutaneous injections allow for self-administration, but consideration of patients' perspectives on treatment choice is important to ensure adherence. Previous... (Review)
Review
BACKGROUND
Subcutaneous injections allow for self-administration, but consideration of patients' perspectives on treatment choice is important to ensure adherence. Previous systematic reviews have been limited in their scope for assessing preferences in relation to other routes of administration.
OBJECTIVE
Our objective was to examine patients' perspectives on subcutaneously administered self-injectable medications when compared with other routes or methods of administration for the same medicines.
METHODS
Nine electronic databases were searched for publications since 2000 using terms pertaining to methods of administration, choice behavior, and adverse effects. Eligibility for inclusion was determined through reference to specific criteria by two independent reviewers. Results were described narratively.
RESULTS
Of the 1726 papers screened, 85 met the inclusion criteria. Studies were focused mainly on methods of insulin administration for diabetes but also included treatments for pediatric growth disorders, multiple sclerosis, HIV, and migraine. Pen devices and autoinjectors were favored over administration with needle and syringe, particularly with respect to ergonomics, convenience, and portability. Inhalation appeared to be more acceptable than subcutaneous injection (in the case of insulin), but how subcutaneous infusion, intramuscular injection, and needle-free injection devices compare with subcutaneous injections in terms of patient preference is less certain.
CONCLUSIONS
The review identified a number of studies showing the importance of the methods and routes of drug delivery on patient choice. However, studies were prone to bias, and further robust evidence based on methodologically sound approaches is required to demonstrate how patient choice might translate to improved adherence.
Topics: Choice Behavior; Drug Administration Routes; Humans; Injections, Subcutaneous; Patient Preference; Perception; Self Administration
PubMed: 26792584
DOI: 10.1007/s40271-015-0160-x -
Current Nutrition Reports Dec 2019While the delivery of medications through enteral tubes is common in critically ill patients, there are complications and a lack of unified practices between... (Review)
Review
PURPOSE OF REVIEW
While the delivery of medications through enteral tubes is common in critically ill patients, there are complications and a lack of unified practices between institutions. The purpose of this review is to evaluate current practices and literature evidence regarding this administration route. The effect of this administration on the medication's efficacy, safety, tolerability, and pharmacokinetics was examined, as well as other considerations to ensure that this route of delivery is both safe and effective for patients.
RECENT FINDINGS
Studies have found crushed oral tablets are the most frequent cause of obstructed feeding tubes. Complications such as this are primarily due to inadequate personnel training and failure to properly access medications before enteral administration. There are many factors that should be considered in order to effectively administer drugs via enteral tubes. Formal training and use of a multi-disciplinary approach that includes pharmacists and dieticians has been shown to reduce tube obstructions and administration errors.
Topics: Administration, Oral; Capsules; Critical Illness; Dosage Forms; Drug Administration Routes; Humans; Nutrients; Pharmaceutical Preparations; Pharmacists; Tablets
PubMed: 31606851
DOI: 10.1007/s13668-019-00290-4 -
Expert Opinion on Drug Delivery Oct 2013Pulmonary vaccination could be a promising alternative to vaccination by injection. Administration of a vaccine to the lungs does not require the use of needles, which... (Review)
Review
INTRODUCTION
Pulmonary vaccination could be a promising alternative to vaccination by injection. Administration of a vaccine to the lungs does not require the use of needles, which reduces the number of trained healthcare workers needed, the risk of needle-stick injuries and needle waste. Besides a systemic immune response, pulmonary vaccination may also induce a mucosal immune response. Such a local response may increase the effectiveness of vaccination against airborne pathogens. Although this route of administration has been studied for decades, no pulmonary vaccine is commercially available yet, due to various challenges mostly intrinsic to pulmonary drug delivery and vaccine formulation.
AREAS COVERED
This review discusses the inhalation devices and formulation strategies that may be suitable for the pulmonary administration of vaccines. In addition, critical parameters are addressed, such as the target population, to help assessing whether pulmonary administration of a specific vaccine may be feasible and beneficial or not.
EXPERT OPINION
A combined approach of inhalation device and vaccine formulation development is essential. This should result in a system that can effectively be used by the target population and can be produced at low costs. Only then, this challenging administration route can be successfully applied to large-scale vaccination programs.
Topics: Administration, Inhalation; Aerosols; Animals; Chemistry, Pharmaceutical; Drug Administration Routes; Drug Delivery Systems; Humans; Immunity, Mucosal; Lung; Nebulizers and Vaporizers; Respiratory Mucosa; Vaccination; Vaccines
PubMed: 23786408
DOI: 10.1517/17425247.2013.810622 -
Science Translational Medicine Jun 2017Failure of medical treatments can hamper responses to subsequent treatments. It has been suggested that changing the route of drug administration could reduce such...
Failure of medical treatments can hamper responses to subsequent treatments. It has been suggested that changing the route of drug administration could reduce such negative carry-over effects, but direct evidence for this approach is lacking. We therefore investigated in 211 healthy volunteers whether changes in drug administration route reduce such carry-over effects. A positive or negative treatment history with topical analgesic treatments was induced experimentally in a mock clinical trial setting. Subsequently, a different inert drug was introduced via the same (topical) or another (oral) route of administration and its analgesic efficacy was tested. Changing the route of drug administration induced expectations of positive treatment effects in the subjects but did not actually counteract the negative carry-over effects on treatment efficacy. These findings indicate that learned carry-over effects generalize over time and across routes of drug administration-independent of conscious expectations. Other strategies are needed to prevent negative carry-over effects of treatment failure from influencing the results of subsequent treatment attempts.
Topics: Adult; Analgesics; Drug Administration Routes; Female; Humans; Male; Treatment Failure; Young Adult
PubMed: 28592563
DOI: 10.1126/scitranslmed.aal2999 -
The Journal of Adolescent Health :... Feb 2014Little is known regarding cannabis administration routes for nonmedical use-that is, its delivery methods (e.g., joints, water pipe, food). Therefore, we examined the...
PURPOSE
Little is known regarding cannabis administration routes for nonmedical use-that is, its delivery methods (e.g., joints, water pipe, food). Therefore, we examined the prevalence rates of different cannabis delivery methods and assessed the relationship of the distinct administration routes with problematic drug use. Subgroups of cannabis users were also investigated (i.e., "pure" cannabis users, previously described as employing a harmless route of administration, and water pipe users, previously described as using a harmful route of administration).
METHODS
As part of the Cohort Study on Substance Use Risk Factors, 1,763 cannabis users answered questions concerning their drug use (i.e., routes of administration, problematic cannabis use, other illicit drug use). Descriptive statistics, latent class analysis, correlations and t-tests were assessed.
RESULTS
The main administration route was "joints with tobacco"; other routes of administration had prevalence rates from 23.99% to 38.23%. In addition, increasing the number of administration routes was associated with more problematic cannabis use, as well as heavier illicit drug use. Water pipes without tobacco were especially linked to heavy drug use patterns, whereas "pure" cannabis use seemed less harmful.
CONCLUSIONS
Our findings highlighted that diversification in routes of administration can be associated with heavier illicit drug use. This was especially true for water pipe users, whereas "pure" cannabis users, who did not mix cannabis with tobacco, were an exception. Indeed, these results may be useful for future preventive programs, which may need to focus on those who have diversified routes of administration for cannabis.
Topics: Cannabis; Cohort Studies; Drug Administration Routes; Eating; Humans; Male; Marijuana Abuse; Marijuana Smoking; Young Adult
PubMed: 24119417
DOI: 10.1016/j.jadohealth.2013.08.013 -
Drug Delivery and Translational Research Jul 2022Transdermal drug delivery is a viable and clinically proven route of administration. This route specifically requires overcoming the mechanical barrier provided by the... (Review)
Review
Transdermal drug delivery is a viable and clinically proven route of administration. This route specifically requires overcoming the mechanical barrier provided by the Stratum Corneum of epidermis and vascular and nervous networks within the dermis. First-generation Transdermal patches and second-generation iontophoretic patches have been translated into commercial clinical products successfully. The current review reports different studies that aim to enhance the transdermal delivery of biopharmaceutical using microneedles and their effect on drug delivery. Microneedles (MN) are the micron-scale hybrid between transdermal patches and hypodermic syringes. Microneedles are tested and proven to show better delivery of the drugs, overcoming the drawbacks of hypodermic syringes. Multiple microneedles designs have been fabricated i.e. solid, coated, hollow, and polymer microneedles. Hollow microneedles are shorter in length but similar to hypodermic needles and have pore for infusion of liquid formulation of the drug. Solid microneedles a patch is applied after creating a hole in the skin; Drugs are coated on the surface of Coated microneedles; Polymer microneedles can be of different types like dissolving, non-dissolving or hydrogel-forming made up of polymers. Various advantages and limitations associated with the use of these techniques are discussed. Delivery of peptide and protein molecules with microneedles represents a significant opportunity for a better clinical outcome and hence value creation compared to standard injectable routes of administration. The advancement in various formulation and microfabrication techniques are currently being focused to aid the delivery of protein drugs via microneedles. The most recent advances and limitations in Microneedles -mediated protein and peptide delivery were discussed.
Topics: Administration, Cutaneous; Drug Delivery Systems; Hydrogels; Microinjections; Needles; Peptides; Polymers; Skin
PubMed: 34564827
DOI: 10.1007/s13346-021-01056-8 -
Annals of the Rheumatic Diseases Jul 2009To review systematically the available literature on the optimal dosage and route of administration of methotrexate in patients with rheumatoid arthritis (RA), as an... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To review systematically the available literature on the optimal dosage and route of administration of methotrexate in patients with rheumatoid arthritis (RA), as an evidence base for generating clinical practice recommendations.
METHODS
A systematic literature search was carried out in MEDLINE, EMBASE, Cochrane Library and American College of Rheumatology/European League Against Rheumatism meeting abstracts, searching for randomised controlled trials evaluating various dosages or routes of administration of methotrexate in RA. Articles that fulfilled predefined inclusion criteria were systematically reviewed and the quality was appraised. Effect sizes and odds ratios for clinical, radiological and toxicity outcomes were calculated and directly or indirectly compared between study groups using methotrexate in different dosages or by different routes.
RESULTS
A total of 38 publications out of 1748 identified references was included in the review. Start doses of 25 mg/week or fast escalation with 5 mg/month to 25-30 mg/week were associated with higher clinical effect sizes and more (gastrointestinal) adverse events in comparison with doses of 5-15 mg/week or slow escalation. Starting with 15 mg/week subcutaneous versus oral methotrexate was associated with higher clinical efficacy but more withdrawal due to toxicity in early RA. In longstanding RA, after failure on 15-20 mg/week orally, a switch to 15 mg/week intramuscularly with subsequent dose escalation did not result in increased efficacy.
CONCLUSIONS
Starting on methotrexate 15 mg/week orally, escalating with 5 mg/month to 25-30 mg/week, or the highest tolerable dose, with a subsequent switch to subcutaneous administration in the case of an insufficient response, seems to be the optimal evidence-based dosing and routing recommendation for methotrexate in RA.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Drug Administration Routes; Drug Administration Schedule; Humans; Methotrexate; Randomized Controlled Trials as Topic
PubMed: 19033290
DOI: 10.1136/ard.2008.092668