Pessary

Progesterone. Progesterone (1) is not orally active. Although seldom used clinically, it can be adrninistered as an intramuscular injection, pessaries, or suppositories in the treatment of menstmal disorders and habitual abortion (121). Progesterone can be recrystaUized from dilute alcohol and exists in two crystalline forms (122). It is soluble in chloroform and ethanol sparingly soluble in acetone, dioxane, ether, and fixed oils and practically insoluble in water (121). Two syntheses of progesterone (1) are described in Figure 3. 

Formulation(s) cream 3.42 % pessaries 1-72.5 mg (in comb, with sulfacetamide, sulfabenzamide) ... 

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. 

Daneshmend [104] measured the serum concentration of miconazole in 11 healthy adult females for 72 h following a single 1200 mg vaginal pessary. The mean peak serum miconazole concentration was 10.4 pg/L and the mean elimination half-life was 56.8 h. The mean area under the serum concentration-time curve was 967 pg/L/h. The calculated mean systemic bioavailability of the vaginal pessary was 1.4%. There was large intersubject variation in serum miconazole pharmacokinetics. This formulation may provide effective single dose treatment for vaginal candidiasis. 

Conventional vaginal delivery systems include tablets, foams gels, suspensions, and pessaries. Mucoadhesive gel formulations based on polycarbophil have been reported to remain 3 to 4 days at the vaginal tissue, providing an excellent vehicle for the delivery of progesterone and nonoxynol-9 [66]. 

The benzyl ester of hyaluronic acid (HYAFF 11) is a highly mucoadhesive polymer which can be processed into microspheres. Such microspheres containing salmon calcitonin were intravaginally administered to rats as a dosage form for the prevention of ovariectomy osteopenia [65]. In recent studies, HYAFF 11-salmon calcitonin microspheres were formulated as single-dose pessaries, resulting in sustained plasma concentrations of calcitonin [67]. 

Vaginal Local or systemic effects (hormones) No first-pass metabolism Inconvenient Erratic absorption Irritation Creams, ointments, foams, tablets, pessaries... 

TRADITIONAL MEDICINAL USES Algeria. Hot water extract of the seed, mixed with Euphorbia species and a beetle, is taken orally to facilitate childbirth° °. Arabic countries. The dried seeds are used as an abortifacient in the form of a pessary in Unani medicine° . 

Pessary. An instrument placed in the vagina to support the uterus or rectum or as a contraceptive device a medicated vaginal suppository. 

Drugs may also be administered locally in the form of bougies, jellies for urethra, pessaries, vaginal tablets, creams and douches for vagina and suppositories for rectal administration. 

Solid dosage form includes capsules, granules, effervescent granules, powders, tablets, insufflations, suppositories (pessaries, bougies and ear cone) etc. 

Pessaries are the same as suppositories for introduction into vagina. Pessaries are of two type ... 

Apart from imidazole derivative e.g. metronidazole, tinidazole, nimorazole etc. and other agents such as hydroxy quinolines, iodine preparation (povidoneiodine) and antifungal antibiotics e.g. clotrimazole (used mainly as vaginal pessaries), there are some other compounds which are mainly used in the treatment of trypanosomiasis. They are ... 

Geirsson RT. Uterine rupture following induction of labour with prostaglandin E2 pessaries, an oxytocin infusion and epidural analgesia. J Obstet Gynecol 1981 2 76. 

Beck I, Clayton JK. Hazards of prostaglandin pessaries in postmaturity. Lancet 1982 2(8290) 161. 

A 32-year-old woman, a smoker, had an evacuation after the death of her fetus at 18 weeks. Two pessaries of gemeprost 1 mg were inserted 7.25 hours apart, and about 90 minutes later she became unconscious, apneic, and cyanotic, and had dilated pupils and no detectable blood pressure or pulse. She was given 100% oxygen, intravenous adrenaline and dobutamine, and a crystalloid infusion. Her systolic pressure rose to 100 mmHg. Coronary angiography showed left and circumflex coronary artery spasm. 

Misoprostol, an analogue of PGE1 is licensed for use in the management of gastroduodenal ulceration. It is an effective myometrial stimulant of the pregnant uterus and is used for the induction of labor and as abortifacient, both alone and in combination with other substances (for example mifepristone). It provides an effective alternative to gemeprost, the most widely used prostaglandin pessaries in combination with mifepristone. 

Ripening of the cervix was started with a pessary of gemeprost 1 mg. After 3 hours, when the cervix was 1 cm dilated, an intramuscular injection of sulprostone 500 mg was given. After 30 minutes she developed persistent abdominal pain, which became a continuous cramping and then a shooting pain a male fetus of 170 g was aborted. There was a 3 cm longitudinal cervical rupture located posteriorly that reached the posterior fornix. 

Lose G, Englev E. Oestradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. BJOG 2000 107(8) 1029-34. 

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