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A suppository is a drug delivery system that is inserted 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. Contents 1 Rectal suppositories 1.1 Mode of insertion 1.2 Non-laxative rectal suppositories 2 Vaginal suppositories 3 Urethral suppositories 4 Constituents 5 Indications 6 Liquid suppository 7 See also 8 Notes and references Rectal suppositories Glycerin suppositories (laxative) Rectal suppositories are commonly used for: laxative purposes, with chemicals such as glycerin or bisacodyl treatment of hemorrhoids by delivering a moisturizer or vasoconstrictor delivery of many other systemically-acting medications, such as promethazine or aspirin 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,[1] 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 tapered 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.[2] Non-laxative rectal suppositories Four 500 mg acetaminophen/paracetamol 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 an examination glove or a finger cot can ease insertion by protecting the rectal wall from fingernail(s). Vaginal suppositories Vaginal suppositories are commonly used to treat gynecological ailments, including vaginal infections such as candidiasis. 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.[3] Its use has diminished since the development of oral impotence medications. 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 patient, 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. Indications Eucalyptol suppository, for the treatment of some respiratory ailments 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 suppository Liquid suppository involves injecting a liquid, typically a laxative, with a small syringe, into the rectum. See also Wikimedia Commons has media related to: Suppositories (category) Artesunate suppositories Clyster Enema Pessary Notes and references ^ Abd-El-Maeboud, K. H.; T. El-Naggar, E. M. M. El-Hawi, S. A. R. Mahmoud and S. Abd-El-Hay (28 September 1991). "Rectal suppository: commonsense and mode of insertion". The Lancet (Elsevier Science) 338 (8770): 798–800. doi:10.1016/0140-6736(91)90676-G. PMID 1681170.  ^ Bradshaw, Ann; Lynda Price (20 December 2006). "Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice". Journal of Clinical Nursing (Blackwell Publishing) 16 (1): 98–103. doi:10.1111/j.1365-2702.2005.01519.x. PMID 17181671.  ^ DrugDigest: Muse overview. Retrieved July 10, 2007. 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. v · d · eRoutes of administration / Dosage forms Oral Digestive tract (enteral) Solids Pill • Tablet • Capsule • Time release technology • Osmotic controlled release capsule (OROS)  Liquids Solution • Softgel • Suspension • Emulsion • Syrup • Elixir • Tincture • Hydrogel Buccal / Sublabial / Sublingual Solids Orally Disintegrating Tablet (ODT) • Film • Lollipop • Lozenges • Chewing gum Liquids Mouthwash • Toothpaste • Ointment • Oral spray Respiratory tract Solids Smoking device • Dry Powder Inhaler (DPI) Liquids pressurized Metered Dose Inhaler (pMDI) • Nebulizer • Vaporizer Gas Oxygen mask • Oxygen concentrator • Anaesthetic machine • Relative analgesia machine Ocular / Otologic / Nasal Nasal spray • Ear drops • Eye drops • Ointment • Hydrogel • Nanosphere suspension • Mucoadhesive microdisc (microsphere tablet) Urogenital Ointment • Pessary (vaginal suppository) • Vaginal ring • Vaginal douche • Intrauterine device (IUD) • Extra-amniotic infusion • Intravesical infusion Rectal (enteral) Ointment • Suppository • Enema (Solution • Hydrogel) • Murphy drip • Nutrient enema Dermal Ointment • Liniment • Paste • Film • Hydrogel • Liposomes • Transfersome vesicals • Cream • Lotion • Lip balm • Medicated shampoo • Dermal patch • Transdermal patch • Transdermal spray • Jet injector Injection / Infusion (into tissue/blood) Skin Intradermal • Subcutaneous • Transdermal implant Organs Intracavernous • Intravitreal • Transscleral Central nervous system Intracerebral • Intrathecal • Epidural Circulatory / Musculoskeletal Intravenous • Intracardiac • Intramuscular • Intraosseous • Intraperitoneal • Nanocell injection Additional explanation: Mucous membranes are used by the human body to absorb the dosage for all routes of administration, except for "Dermal" and "Injection/Infusion". Administration routes can also be grouped as Topical (local effect) or Systemic (defined as Enteral = Digestive tract/Rectal, or Parenteral = All other routes). v · d · eRoutes of administration by organ system Gastrointestinal Oral • Buccal • Sublabial • Sublingual • Rectal Respiratory system Pulmonary • Nasal Visual system / Auditory system Ocular (Ocular-topical / Intravitreal / Transscleral) • Otologic (Oto-topical) Reproductive system Intracavernous • Intravaginal • Intrauterine (Extra-amniotic) Urinary system Intravesical Peritoneum Intraperitoneal Central nervous system Intracerebral • Intrathecal • Epidural Circulatory system Intravenous • Intracardiac Musculoskeletal system Intramuscular • Intraosseous Skin Epicutaneous • Intradermal • Subcutaneous