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 pharmaceutical pessary.

The general principle is that the suppository is inserted as a solid, and will dissolve inside the body to deliver the medicine.

Vaginal suppositories

Vaginal suppositories are commonly used to treat gynecological 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 study in "The Lancet" [cite journal
last = Abd-El-Maeboud
first = K. H.
authorlink =
coauthors = T. El-Naggar, E. M. M. El-Hawi, S. A. R. Mahmoud and S. Abd-El-Hay
title = Rectal suppository: commonsense and mode of insertion
journal = The Lancet
volume = 338
issue = 8770
pages = 798-800
publisher = Elsevier Science
location =
date = 28 September 1991
url =
doi = 10.1016/0140-6736(91)90676-G
id =
accessdate = 20 August 2008] , 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; namely, that the shape had a strong influence on the extent to which the rectal suppository traveled internally — and, thus, upon its increased efficiency.

They (counter-intuitively) found that the ideal mode of insertion was to insert suppositories "blunt"-end first, rather than the generally used mode of inserting the "pointy"-end first. This conclusion was based on the greater distance 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.

As a consequence, and in order to guarantee the maximum optimal efficiency, they recommended that all rectal suppositories be inserted "blunt"-end first. The findings of this single study have been challenged as insufficient evidence on which to base clinical practice. [cite journal
last = Bradshaw
first = Ann
authorlink =
coauthors = Lynda Price
title = Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice
journal = Journal of Clinical Nursing
volume = 16
issue = 1
pages = 98-103
publisher = Blackwell Publishing
location =
date = 20 Dec 2006
url =
doi = 10.1111/j.1365-2702.2005.01519.x
id =
accessdate = 20 August 2008]

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. [DrugDigest: [http://www.drugdigest.org/DD/DVH/Uses/0,3915,550749|Muse,00.html Muse overview] . Retrieved July 10, 2007.] 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 patientfact|date=August 2007, as the melted grease may pass through 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.glycerogelatin is prepared by mixing glycerol n water n is solidified by 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 vomited 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

References

* 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.