Vaginal drug administration

Alexander, N.J., et al. 2004. Why consider vaginal drug administration Fertil Steril 82 1. 

Today, there are a number of methods that can be used to introduce a drug into the body. Because of its convenience, the most common delivery system is the oral route. However, sometimes the oral route is not the most appropriate. In addition to the oral route, some of the alternative routes of drug administration with the oldest history include, not surprisingly, inhalation, and, surprisingly, rectal and vaginal, as illustrated by the following examples. 

Although results found in the literature related to women s preferences toward the vaginal route of drug administration may vary significantly, particularly when different locations and cultures are considered, some general statements can be... 

Kafka, D., and Gold, R. B. (1983), Food and Drug Administration approves vaginal sponge, Fam. Plann. Perspect., 15,146-148. 

One of the key pieces to development of a successful drug product is the ability to deliver the drug to the site of action with minimal discomfort or inconvenience to the patient. For small molecule therapeutics, there is a wide range of options available for drug administration. Delivery via injection (IV, IM, and SC), oral, nasal, ocular, transmucosal (buccal, vaginal, and rectal), and transdermal routes is possible with small molecule drugs. However, the size of proteins and the complexity of their structures severely limit the routes of administration available to proteins. 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

Das Neves J, Santos B, Teixeira B, Dias G, Cunha T, Brochado J (2008) Vaginal drug administration in the hospital setting. Am J Health-Syst Pharm 65 254—259... 

Oxytocin is contraindicated in patients with known hypersensitivity to the drug, cephalopelvic disproportion, unfavorable fetal position or presentation, in obstetric emergencies, situations of fetal distress when delivery is not imminent, severe toxemia (preeclampsia, eclampsia), hypertonic uterus, during pregnancy (intranasal administration), when there is total placenta previa, or to induce labor when vaginal delivery is contraindicated. Oxytocin is not expected to be a risk to the fetus when administered as indicated. When oxytocin is administered with vasopressors, severe hypertension may occur. 

Suppositories and pessaries— These are preparations intended for either rectal or vaginal administration of drugs. They are formulated with a suitable base that melts at body temperature. 

Sustained- and controlled-release devices for drug delivery in the vaginal and uterine areas are most often for the delivery of contraceptive steroid hormones. The advantages in administration by this route—prolonged release, minimal systemic side effects, and an increase in bioavailability—allow for less total drug than with an oral dose. First-pass metabolism that inactivates many steroid hormones can be avoided [183,184],... 

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