Parenteral delivery routes

Parenteral administration is not perceived as a problem in the context of drugs which are administered infrequently, or as a once-off dose to a patient. However, in the case of products administered frequently/daily (e.g. insulin to diabetics), non-parenteral delivery routes would be preferred. Such routes would be more convenient, less invasive, less painful and generally would achieve better patient compliance. Alternative potential delivery routes include oral, nasal, transmucosal, transdermal or pulmonary routes. Although such routes have proven possible in the context of many drugs, routine administration of biopharmaceuticals by such means has proven to be technically challenging. Obstacles encountered include their high molecular mass, their susceptibility to enzymatic inactivation and their potential to aggregate. 

Parenteral delivery routes are those that do not give rise to drug absorption into the splanchnic circulation. Thus, they avoid the possibility of hepatic first-pass metabolism. It should be noted that some parenteral routes do not avoid other first-pass metabolism effects (e.g., pleural metabolism for some inhaled drugs). Some major parenteral drug delivery routes are intraarterial, intrathecal, intravenous, intramuscular, trans-dermal, intranasal, buccal, inhalation, intraperitoneal, vaginal, and rectal. 

Virtually all therapeutic proteins must enter the blood in order to promote a therapeutic effect. Such products must usually be administered parenterally. However, research continues on the development of non-parenteral routes which may prove more convenient, less costly and obtain improved patient compliance. Alternative potential delivery routes include transdermal, nasal, oral and bucal approaches, although most progress to date has been recorded with pulmonary-based delivery systems (Chapter 4). An inhaled insulin product ( Exubera , Chapters 4 and 11) was approved in 2006 for the treatment of type I and II diabetes. 

Pulmonary delivery currently represents the most promising alternative to parenteral delivery systems for biopharmaceuticals. Delivery via the pulmonary route moved from concept to reality in 2006 with the approval of Exubera, an inhalable insulin product (Chapter 11). Although the lung is not particularly permeable to solutes of low molecular mass (e.g. sucrose or urea), macromolecules can be absorbed into the blood via the lungs surprisingly well. In fact, pulmonary... 

Almost 30 routes exist for administration of drugs to patients, but only a handfbl of these are commonly used in preclinical safety studies (Gad, 1994). The most common deviation from what is to be done in clinical trials is the use of parenteral (injected) routes such as IV (intravenous) and SC (subcutaneous) deliveries. Such injections are loosely characterized as bolus (all at once or over a very short period, such as five minutes) and infusion (over a protracted period of hours, days, or even months). The term continuous infusion implies a steady rate over a protracted period, requiring some form of setup such as an implanted venous catheter or infusion port. 

Many drugs can now be delivered rectally instead of by parenteral injection (intravenous route) or oral administration. Generally, the rectal delivery route is particularly suitable for pediatric and elderly patients who experience difficulty ingesting medication or who are unconscious. However, rectal bioavailabilities tend to be lower than the corresponding values of oral administration. The nature of the drug formulation has been shown to be an essential determinant of the rectal absorption profiles. The development of novel absorption enhancers with potential efficacy without mucosal irritation (low toxicity) is very important. The delivery of peptide and protein drugs by the rectal route is currently being explored and seems to be feasible. 

Although examples of delivery systems using the parenteral and oral (solid) routes are presented in this chapter, application of dissolution controlled release matrix and coated systems concepts can extended easily (and has been) used for many other delivery routes. 

Parenteral delivery systems involve the use of needles. This is painful for the patient, as well as generally requiring the intervention of medical professionals. The oral route, which involves merely swallowing a tablet, liquid or capsule, thus represents a much more convenient and attractive route for drag delivery. Transdermal patches are also well accepted by patients and convenient. Some other dosage forms, for example nebulizers, pessaries and suppositories, may meet with more limited patient compliance. 

Treatment of pernicious anaemia has traditionally involved the parenteral delivery of vitamin B12 to ensure absorption. Oral replacement is now an accepted route, using large doses of vitamin B12, 1-2mg daily. 

The choice of solubilization method will depend upon how efficiently the drug can be solubilized, stability in the system, and upon the biocompatibility of the vehicle for a given delivery route. For solid dosage forms, it may be possible to alter the solid phase to enhance dissolution. For parenterals, the four most commonly used techniques for solubilization are pH adjustment cosolvent addition micelle inclusion through surfactant addition and complexation. The following chapter is designed to summarize the theoretical as well as practical use of each of the above techniques. More extensive discussion on techniques for drug solubilization can be found in books dedicated to the subject. ... 

The success of vaccination depends primarily on the method of presenting the antigen to the host immune system. Antigens have usually been delivered by parenteral (such as intravenous, intramuscular, intraperito-neal, intradermal, and subcutaneous) administration, but recent studies have shown that other routes of delivery such as intranasal, oral, and transdermal delivery have also been effective. In some cases, vaccination through mucosal routes resulted in better responses in IgA production. Because non-parenteral vaccine delivery presents many obvious advantages, numerous attempts have been made on the development of non-parenteral delivery of vaccines. 

Emulsions have been widely used as vehicles for oral, topical, and parenteral delivery of medications. Although the product attributes of an emulsion dosage form are dependent on the route of administration, a common concern is the physical stability of the system, in particular the coalescence of its dispersed phase and the consequent alteration in its particle-size distribution and phase separation. The stabilization mechanism(s) for an emulsion is mainly dependent on the chemical composition of the surfactant used. Electrostatic stabilization as described by DLVO theory plays an important role in emulsions (0/W) containing ionic surfactants. For 0/W emulsions with low electrolyte content in the aqueous phase, a zeta potential of 30 mV is found to be sufficient to establish an energy maximum (energy barrier) to ensure emulsion stability. For emulsions containing... 

Parenteral Administration Parenteral dosage forms include a wide variety of delivery routes, including injections, implants, and liposomes. The advantages of parenteral delivery systems is that they avoid first-pass effects, oral metabolism, and the harsh chemical environment of the stomach s gastric juices. The disadvantage is that the delivery mechanism is invasive. 

Particle design applied to pharmaceutical processing has the potential to improve the efficacy of current medications as well as to open the way to the use of alternative delivery routes. An example is the administration of drugs, such as insulin, that are subject to extensive gastrointestinal breakdown and thus cannot be administered orally. The alternative is parenteral administration, which has major side effects, especially in long-term or chronic conditions. 

Parenteral is defined as situated or occurring outside the intestine, and especially introduced otherwise than by way of the intestines —pertaining to essentially any administration route other than enteral. This field is obviously too broad for an adequate focus in one book, let alone one chapter. Many have nonetheless used the term synonymously with injectable drug delivery. We restrict ourselves to this latter usage. This would thus include intravenous, intramuscular, subcutaneous, intrathecal, and subdural injection. In this chapter we discuss the theoretical and practical aspects of solubilizing small molecules for injectable formulation development and will examine the role of surfactants and other excipients in more recent parenteral delivery systems such as liposomes, solid-drug nanoparticles and particulate carriers. 

The most important requirement is that the salt possesses sufficient solubility at physiologically compatible pH values to permit incorporation into the dosage form. Buffering the solution to an appropriate pH can often enhance solubility. Salts may also be prepared in situ in the formulation. This is particularly useful when the main route of administration utilizes the parent drug form. Where the aqueous solubility of the salt is not sufficiently high, co-solvents may need to be added to enhance solubility (e.g. propylene glycol is used as the vehicle in phe-nobarbitone sodium injection). Parenteral solutions based on co-solvent vehicles normally cannot be directly injected intravenously because there is the risk of precipitation at the injection site. Therefore, such products are diluted with isotonic saline or 5%w/v dextrose solution to produce a lower concentration that remains soluble and can be safely administered by infusion. Alternative delivery routes are by subcutaneous or intramuscular administration by which, in... 

If it is found necessary to investigate the more complex systems such as (4) and (5) above, the anticipated route of administration must be considered as most of these chemical modifications or formulation types can be degraded to some extent in the gastrointestinal tract. They are primarily intended for parenteral delivery. 

Polymeric multivalent structures will have high molecular weights and as such will not likely to be orally active and would require other routes of administration such as parenteral delivery. Also, high molecular weight materials tend to be mixtures that are difficult to characterize and to control in manufacturing. 

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