Suppository

  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 known as a 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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Vaginal suppositories

Vaginal suppositoriesare commonly used to treat gynaecological ailments, including vaginal infections such as candidiasis.

Rectal suppositories

 Rectal suppositories are commonly used for:

• For laxative purposes, with chemicals such as glycerin or bisacodyl.
• To treat a hemorrhoid by delivering a moisturizer or vasoconstrictor.
• Delivery of many other systemically-acting medications, such as promethazine or aspirin.
• For 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 very important 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.

Furthermore, based on the extent 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 — they (counter-intuitively) found that the ideal mode of insertion was to insert suppositories narrow, "blunt"-end first, rather than the generally used mode of inserting the thick, "pointy"-end first.

As a consequence, and in order to guarantee the maximum optimal efficacy, they recommended that all rectal suppositories be inserted narrow, "blunt"-end first.

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.

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.^[1] Its use has diminished since the development of oral impotence medications, but is still on the market.

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^{[citation needed]}, as the melted grease may pass 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 vomitted out.

Drugs which often cause stomach upset, for example diclofenac sodium (Voltaren) are better tolerated in suppository form.

"Liquid suppositories"

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.

See also

• Artesunate suppositories
• Clyster
• Enema
• Pessary

Notes

1. ^ DrugDigest: Muse overview. Retrieved July 10, 2007.

References

• Abd-El-Maeboud, K.H., El-Naggar, T., El-Hawi, E.M.M., Mahmoud, S.A.R. & Abd-El-Hay, S., "Rectal Suppository: Commonsense and Mode of Insertion", The Lancet, Vol.338, No.8770, (28 September, 1991), pp.798–800.
• 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.