1.2. Describe the routes of administration

This guide will help you answer 1.2. Describe the routes of administration.

The term “routes of administration” refers to the ways in which medicines, fluids, or treatments are delivered into the body. Choosing the right route can impact how quickly the medicine works, how effective it is, and how it is tolerated. The decision is based on factors such as the nature of the medication, the individual’s condition, their ability to take medicines, and the desired effect.

There are several types of routes, and these can be broadly classified as enteral (involving the digestive system) and parenteral (not involving the digestive system). In this guide, we cover the main routes of administration used in health and social care settings.

Oral (By Mouth)

The oral route is the most common way medicines are given. It involves swallowing tablets, capsules, liquids, or powders.

Advantages:

• Convenient and non-invasive.
• Often the most comfortable option for individuals.
• Cheaper compared to other methods.

Disadvantages:

• Not suitable for individuals who are unconscious or have swallowing difficulties.
• Medicines absorbed via the stomach or intestines can be affected by food or digestive enzymes.
• Some drugs may irritate the stomach lining.

Examples: Painkillers like paracetamol, antibiotics like amoxicillin, and syrups for cough relief.

Sublingual (Under the Tongue)

This involves placing the medication under the tongue where it dissolves and is absorbed into the bloodstream.

Advantages:

• Quick absorption as the drug bypasses the digestive system.
• Useful for people who cannot swallow tablets.

Disadvantages:

• Limited to specific drugs that can be absorbed this way.
• Sometimes has a bad taste that individuals find unpleasant.

Examples: Nitroglycerin for angina or lorazepam for anxiety in some cases.

Buccal (Inside the Cheek)

The buccal route involves placing medication between the gum and cheek. The drug is absorbed directly through the lining of the mouth.

Advantages:

• Similar benefits to the sublingual route, offering fast absorption.
• Bypasses the digestive system and acids in the stomach.

Disadvantages:

• Only suitable for specific medications.
• Holding the medicine in the cheek can feel strange or uncomfortable.

Examples: Hormone replacement medicines such as certain types of oestrogen.

Rectal (Via the Rectum)

This involves inserting medicine or suppositories into the rectum, where it dissolves and is absorbed through the rectal wall.

Advantages:

• Useful when oral administration is not possible, such as during vomiting or if the individual is unconscious.
• Direct route to the bloodstream.

Disadvantages:

• Can feel intrusive or embarrassing for the individual.
• Not suitable for all types of medication.

Examples: Suppositories for constipation or nausea and anti-seizure medications like diazepam in emergencies.

Vaginal (Via the Vagina)

Medications are inserted into the vagina, often as creams, gels, or pessaries, where they are absorbed through the vaginal lining.

Advantages:

• Targets local infections or conditions directly in the area.
• Low risk of affecting the entire body.

Disadvantages:

• May not be culturally or personally acceptable to all individuals.
• Limited to conditions affecting the reproductive system.

Examples: Treatments for vaginal infections such as antifungals like clotrimazole.

Topical (Applied to the Skin or Mucous Membranes)

This route involves applying creams, ointments, patches, or powders to the outer surface of the body or mucous membranes such as the eyes, ears, or nose.

Advantages:

• Non-invasive and easy to apply.
• Useful for localised treatment.

Disadvantages:

• Limited absorption for systemic effects unless specially designed.
• Individuals with sensitive skin may have allergic reactions.

Examples: Steroid creams for eczema, nicotine patches for smoking cessation, or antibiotic ointments for infections.

Inhalation (Through the Mouth or Nose)

Medicines are administered as gases, aerosols, or powders and inhaled into the respiratory system. This is often done using a nebuliser, inhaler, or nasal spray.

Advantages:

• Acts quickly by targeting the airways directly.
• Lower doses needed compared to oral routes as it works locally.

Disadvantages:

• Requires technique and practice to use the equipment correctly.
• May not be effective during a severe asthma attack if the individual cannot inhale properly.

Examples: Asthma inhalers (e.g., salbutamol) or nasal sprays for allergies (e.g., beclomethasone).

Parenteral Routes

Parenteral administration bypasses the digestive system entirely. It provides quick and sometimes life-saving results. The following are the most common types of parenteral routes:

Subcutaneous (Under the Skin)

The medicine is injected into the tissue just under the skin.

Advantages:

• Provides a slow and steady release into the bloodstream.
• Can be self-administered (e.g., diabetic individuals injecting insulin).

Disadvantages:

• Small volumes of medicine can be administered this way.
• May cause discomfort or bruising at the injection site.

Examples: Insulin for diabetes, blood-thinning medications like heparin.

Intramuscular (Into the Muscle)

Here, the medicine is injected into a muscle, often in the upper arm, thigh, or buttocks.

Advantages:

• Absorbed quicker than subcutaneous injections.
• Suitable for larger volumes of medicine.

Disadvantages:

• More painful compared to subcutaneous injections.
• A professional usually needs to administer it unless trained.

Examples: Vaccines (e.g., flu vaccine) or certain types of antibiotics (e.g., penicillin).

Intravenous (Into a Vein)

Medicine is injected directly into the bloodstream via a vein. This can be either a one-time injection or a continuous infusion using a drip.

Advantages:

• Fastest route for delivering drugs systemically.
• Accurate dosing as it goes straight into the circulation.

Disadvantages:

• Requires skilled professionals to administer.
• Can be uncomfortable or cause complications like bruising or infection around the needle site.

Examples: Fluids for dehydration, pain medicines like morphine, or chemotherapy drugs.

Intradermal (Into the Skin)

This method involves injecting small amounts of medicine into the top layer of the skin.

Advantages:

• Used for specific purposes like allergy testing.
• Allows observation of localised reactions to the medication.

Disadvantages:

• Limited use and expertise required.

Examples: Tuberculosis (Mantoux) tests or allergy tests.

Other Specialist Routes

Some specialised routes are less common but equally important in certain situations:

• Ophthalmic (Eye): Drops or ointments applied directly to the eye, e.g., artificial tears or antibiotics for eye infections.
• Otic (Ear): Drops administered into the ear canal, e.g., for ear infections or wax build-up.
• Epidural (Around the Spine): Injections into the space around the spinal cord, e.g., during childbirth for pain relief.
• Intranasal (Nose): Sprays or liquids administered into the nostrils, e.g., naloxone to reverse opioid overdoses.
• Transdermal (Through the Skin): Patches placed on the skin releasing medication slowly over time, e.g., hormones or pain relievers.

Final Thoughts

Healthcare professionals determine the best route for administering medicines based on individual needs and circumstances. Some factors include:

• The speed at which the medicine needs to act.
• Any potential side effects.
• The person’s ability to tolerate the route.
• The location or target area requiring treatment.

Each route has unique advantages and limitations, meaning care workers must follow guidelines, properly store medications, and understand why a particular route is being used.

Awareness of these routes ensures medicines are delivered safely and effectively, improving outcomes for the individuals you care for.