Prolonged rectal drug delivery

Within the last 10, years several new compounds were launched in the field of non-steroidal antiinflammatory drugs (NSAIDs) with a clear focus on cyclooxygenase type 2 selective compounds. In the field of opioids on the other hand no new drugs have passed phase III clinical trials. In this field innovation has been achieved through new pharmaceutical formulations of known drugs such as transdermal systems, e.g. buprenorphine patch, transmucosal systems, e.g. fentanyl lollipop, or rectal delivery systems containing e.g. morphine. These were developed in order to reduce opioid side effects, but also to overcome pharmacokinetical limitations, in particular to prolong compliance and duration of action. 

Research is needed to improve the delivery of drugs in children, either to enhance compliance via the route of choice or to identify alternative routes where the normal route of administration is unavailable or associated with severe side effects. The efficacy of administering ketamine and midazolam orally, rectally and intravenously to children receiving invasive procedures has been compared (Ozdemir et al., 2004). It was found that the alternatives routes were equally effective. The use of other routes may mitigate the usual prolonged sedation and psychedelic effects of intravenous administration of ketamine/midazolam in children. 

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