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HOME / ... / DRUG ADMINISTRATION

Drug Administration
By Jennifer Le, PharmD, MAS, BCPS-ID, FIDSA, FCCP,
FCSHP, Skaggs School of Pharmacy and
Pharmaceutical Sciences, University of California San
Diego

Last full review/revision Oct 2020| Content last

modified Oct 2020

CLICK HERE FOR THE PROFESSIONAL

VERSION

Drugs are introduced into the body by several

routes. They may be

Taken by mouth (orally)

Given by injection into a vein (intravenously,
IV), into a muscle (intramuscularly, IM), into
the space around the spinal cord
(intrathecally), or beneath the skin
(subcutaneously, sc)
Placed under the tongue (sublingually) or
between the gums and cheek (buccally)
Inserted in the rectum (rectally) or vagina
(vaginally)
Placed in the eye (by the ocular route) or the
ear (by the otic route)
Sprayed into the nose and absorbed through
the nasal membranes (nasally)
Breathed into the lungs, usually through the
mouth (by inhalation) or mouth and nose (by
nebulization)
Applied to the skin (cutaneously) for a local
(topical) or bodywide (systemic) effect
Delivered through the skin by a patch
(transdermally) for a systemic effect
Each route has specific purposes, advantages, and
disadvantages.

(See also Introduction to Administration and

Kinetics of Drugs.)

Oral route

Many drugs can be administered orally as liquids,

capsules, tablets, or chewable tablets. Because
the oral route is the most convenient and usually
the safest and least expensive, it is the one most
often used. However, it has limitations because of
the way a drug typically moves through the
digestive tract. For drugs administered orally,
absorption may begin in the mouth and stomach.
However, most drugs are usually absorbed from
the small intestine. The drug passes through the
intestinal wall and travels to the liver before being
transported via the bloodstream to its target site.
The intestinal wall and liver chemically alter
(metabolize) many drugs, decreasing the amount
of drug reaching the bloodstream. Consequently,
these drugs are often given in smaller doses when
injected intravenously to produce the same effect.

When a drug is taken orally, food and other drugs

in the digestive tract may affect how much of and
how fast the drug is absorbed. Thus, some drugs
should be taken on an empty stomach, others
should be taken with food, others should not be
taken with certain other drugs, and still others
cannot be taken orally at all.

Some orally administered drugs irritate the

digestive tract. For example, aspirin and most
other nonsteroidal anti-inflammatory drugs
(NSAIDs) can harm the lining of the stomach and
small intestine to potentially cause or aggravate
preexisting ulcers. Other drugs are absorbed
poorly or erratically in the digestive tract or are
destroyed by the acid and digestive enzymes in
the stomach.

Other routes of administration are required when

the oral route cannot be used, for example:

When a person cannot take anything by

mouth
When a drug must be administered rapidly
or in a precise or very high dose
When a drug is poorly or erratically
absorbed from the digestive tract

Injection routes

Administration by injection (parenteral

administration) includes the following routes:

Subcutaneous (under the skin)

Intramuscular (in a muscle)
Intravenous (in a vein)
Intrathecal (around the spinal cord)
A drug product can be prepared or manufactured
in ways that prolong drug absorption from the
injection site for hours, days, or longer. Such
products do not need to be administered as often
as drug products with more rapid absorption.

Through the Skin

Sometimes a drug is given through the skin—

by needle (subcutaneous, intramuscular, or
intravenous route), by patch (transdermal
route), or by implantation.

For the subcutaneous route, a needle is inserted

into fatty tissue just beneath the skin. After a drug
is injected, it then moves into small blood vessels
(capillaries) and is carried away by the
bloodstream. Alternatively, a drug reaches the
bloodstream through the lymphatic vessels (see
figure Lymphatic System: Helping Defend Against
Infection). Protein drugs that are large in size,
such as insulin, usually reach the bloodstream
through the lymphatic vessels because these
drugs move slowly from the tissues into
capillaries. The subcutaneous route is used for
many protein drugs because such drugs would be
destroyed in the digestive tract if they were taken
orally.

Certain drugs (such as progestins used for

hormonal birth control) may be given by inserting
plastic capsules under the skin (implantation).
Although this route of administration is rarely
used, its main advantage is to provide a long-term
therapeutic effect (for example, etonogestrel that
is implanted for contraception may last up to 3
years).

The intramuscular route is preferred to the

subcutaneous route when larger volumes of a
drug product are needed. Because the muscles lie
below the skin and fatty tissues, a longer needle is
used. Drugs are usually injected into the muscle
of the upper arm, thigh, or buttock. How quickly
the drug is absorbed into the bloodstream
depends, in part, on the blood supply to the
muscle: The sparser the blood supply, the longer
it takes for the drug to be absorbed.

For the intravenous route, a needle is inserted

directly into a vein. A solution containing the drug
may be given in a single dose or by continuous
infusion. For infusion, the solution is moved by
gravity (from a collapsible plastic bag) or, more
commonly, by an infusion pump through thin
flexible tubing to a tube (catheter) inserted in a
vein, usually in the forearm. Intravenous
administration is the best way to deliver a precise
dose quickly and in a well-controlled manner
throughout the body. It is also used for irritating
solutions, which would cause pain and damage
tissues if given by subcutaneous or intramuscular
injection. An intravenous injection can be more
difficult to administer than a subcutaneous or
intramuscular injection because inserting a
needle or catheter into a vein may be difficult,
especially if the person is obese.

When given intravenously, a drug is delivered

immediately to the bloodstream and tends to take
effect more quickly than when given by any other
route. Consequently, health care practitioners
closely monitor people who receive an
intravenous injection for signs that the drug is
working or is causing undesired side effects. Also,
the effect of a drug given by this route tends to
last for a shorter time. Therefore, some drugs
must be given by continuous infusion to keep
their effect constant.

For the intrathecal route, a needle is inserted

between two vertebrae in the lower spine and
into the space around the spinal cord. The drug is
then injected into the spinal canal. A small
amount of local anesthetic is often used to numb
the injection site. This route is used when a drug
is needed to produce rapid or local effects on the
brain, spinal cord, or the layers of tissue covering
them (meninges)—for example, to treat infections
of these structures. Anesthetics and analgesics
(such as morphine) are sometimes given this way.

Sublingual and buccal routes

A few drugs are placed under the tongue (taken

sublingually) or between the gums and teeth
(buccally) so that they can dissolve and be
absorbed directly into the small blood vessels that
lie beneath the tongue. These drugs are not
swallowed. The sublingual route is especially good
for nitroglycerin, which is used to relieve angina,
because absorption is rapid and the drug
immediately enters the bloodstream without first
passing through the intestinal wall and liver.
However, most drugs cannot be taken this way
because they may be absorbed incompletely or
erratically.

Rectal route

Many drugs that are administered orally can also

be administered rectally as a suppository. In this
form, a drug is mixed with a waxy substance that
dissolves or liquefies after it is inserted into the
rectum. Because the rectum’s wall is thin and its
blood supply rich, the drug is readily absorbed. A
suppository is prescribed for people who cannot
take a drug orally because they have nausea,
cannot swallow, or have restrictions on eating, as
is required before and after many surgical
operations. Drugs that can be administered
rectally include acetaminophen (for fever),
diazepam (for seizures), and laxatives (for
constipation). Drugs that are irritating in
suppository form may have to be given by
injection.

Vaginal route

Some drugs may be administered vaginally to

women as a solution, tablet, cream, gel,
suppository, or ring. The drug is slowly absorbed
through the vaginal wall. This route is often used
to give estrogen to women during menopause to
relieve vaginal symptoms such as dryness,
soreness, and redness.

Ocular route

Drugs used to treat eye disorders (such as

glaucoma, conjunctivitis, and injuries) can be
mixed with inactive substances to make a liquid,
gel, or ointment so that they can be applied to the
eye. Liquid eye drops are relatively easy to use
but may run off the eye too quickly to be
absorbed well. Gel and ointment formulations
keep the drug in contact with the eye surface
longer, but they may blur vision. Solid inserts,
which release the drug continuously and slowly,
are also available, but they may be hard to put in
and keep in place.

Ocular drugs are almost always used for their

local effects. For example, artificial tears are used
to relieve dry eyes. Other drugs (for example,
those used to treat glaucoma [see table Drugs
Used to Treat Glaucoma], such as acetazolamide
and betaxolol, and those used to dilate pupils,
such as phenylephrine and tropicamide) produce
a local effect (acting directly on the eyes) after
they are absorbed through the cornea and
conjunctiva. Some of these drugs then enter the
bloodstream and may cause unwanted side
effects on other parts of the body.

Otic route

Drugs used to treat ear inflammation and

infection can be applied directly to the affected
ears. Ear drops containing solutions or
suspensions are typically applied only to the outer
ear canal. Before applying ear drops, people
should thoroughly clean the ear with a moist cloth
and dry it. Unless the drugs are used for a long
time or used too much, little of the drugs enter
the bloodstream, so bodywide side effects are
absent or minimal. Drugs that can be given by the
otic route include hydrocortisone (to relieve
inflammation), ciprofloxacin (to treat infection),
and benzocaine (to numb the ear).

Nasal route

If a drug is to be breathed in and absorbed

through the thin mucous membrane that lines the
nasal passages, it must be transformed into tiny
droplets in air (atomized). Once absorbed, the
drug enters the bloodstream. Drugs administered
by this route generally work quickly. Some of
them irritate the nasal passages. Drugs that can
be administered by the nasal route include
nicotine (for smoking cessation), calcitonin (for
osteoporosis), sumatriptan (for migraine
headaches), and corticosteroids (for allergies).

Inhalation route

Drugs administered by inhalation through the

mouth must be atomized into smaller droplets
than those administered by the nasal route, so
that the drugs can pass through the windpipe
(trachea) and into the lungs. How deeply into the
lungs they go depends on the size of the droplets.
Smaller droplets go deeper, which increases the
amount of drug absorbed. Inside the lungs, they
are absorbed into the bloodstream.

Inhalers

VIDEO

Drug Administration by Inhalation

PHOTO COURTESY OF JUSTIN KAPLAN, MD.

Relatively few drugs are administered this way

because inhalation must be carefully monitored
to ensure that a person receives the right amount
of drug within a specified time. In addition,
specialized equipment may be needed to give the
drug by this route. Usually, this method is used to
administer drugs that act specifically on the lungs,
such as aerosolized antiasthmatic drugs in
metered-dose containers (called inhalers), and to
administer gases used for general anesthesia.

Nebulization route

Similar to the inhalation route, drugs given by

nebulization must be aerosolized into small
particles to reach the lungs. Nebulization requires
the use of special devices, most commonly
ultrasonic or jet nebulizer systems. Using the
devices properly helps maximize the amount of
drug delivered to the lungs. Drugs that are
nebulized include tobramycin (for cystic fibrosis),
pentamidine (for pneumonia caused by
Pneumocystis jirovecii), and albuterol (for asthma
attacks).

Side effects can include those that occur when the

drug is deposited directly in the lungs (such as
cough, wheezing, shortness of breath, and lung
irritation), spread of the drug into the
environment (possibly affecting people other than
the one taking the drug), and contamination of
the device used for nebulization (particularly
when the device is reused and inadequately
cleaned). Using the device properly helps prevent
side effects.

Cutaneous route

Drugs applied to the skin are usually used for

their local effects and thus are most commonly
used to treat superficial skin disorders, such as
psoriasis, eczema, skin infections (viral, bacterial,
and fungal), itching, and dry skin. The drug is
mixed with inactive substances. Depending on the
consistency of the inactive substances, the
formulation may be an ointment, cream, lotion,
solution, powder, or gel (see Topical
Preparations).

Transdermal route

Some drugs are delivered bodywide through a

patch on the skin. These drugs are sometimes
mixed with a chemical (such as alcohol) that
enhances penetration through the skin into the
bloodstream without any injection. Through a
patch, the drug can be delivered slowly and
continuously for many hours or days or even
longer. As a result, levels of a drug in the blood
can be kept relatively constant. Patches are
particularly useful for drugs that are quickly
eliminated from the body because such drugs, if
taken in other forms, would have to be taken
frequently. However, patches may irritate the skin
of some people. In addition, patches are limited
by how quickly the drug can penetrate the skin.
Only drugs to be given in relatively small daily
doses can be given through patches. Examples of
such drugs include nitroglycerin (for chest pain),
scopolamine (for motion sickness), nicotine (for
smoking cessation), clonidine (for high blood
pressure), and fentanyl (for pain relief).

CLICK HERE FOR THE PROFESSIONAL

VERSION

Introduction to Administration and

Kinetics of Drugs

Drug Absorption

OTHER TOPICS IN THIS CHAPTER

Administration and Kinetics of Drugs

Introduction to Administration and

Kinetics of Drugs
Drug Administration
Drug Absorption

Drug Distribution

Drug Metabolism

Drug Elimination

Others Also Read

Drug Interactions

• • •

TEST YOUR KNOWLEDGE

Severity of Adverse Drug

Reactions

Which of the following statements about

severity of adverse drug reactions is NOT
correct?

A. Doctors always stop administering

drugs that produce severe adverse
reactions

B. Mild or moderate adverse drug

reactions do not necessarily mean a
person must stop taking the drug causing
the reaction

C. Often, additional drugs are used to

control adverse drug reactions

D. Severe adverse drug reactions are

often life-threatening

AM I CORRECT?

Also Of Interest

NEWS VIEW ALL

Health Tip: Take Over-the-Counter

Medication Wisely

Health Tip: Acetaminophen Safety

Health Tip: How to Remember to Take

Your Medications

VIDEOS VIEW ALL

Inhalers

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