E-drug: Single tablet for oral, vaginal and rectal use (cont'd)
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In reply to the following sentence of Stein Lyftingsmo's message:
"Hormones, antibiotics, prostaglandine analogues and NSAIDs
might be possible".
Hormones, which are normally used either in substitution or
inhibition therapy, are in many cases proteins and therefore cannot
be given orally as they would be degraded by gastric enzymes.
They are normally given by intramuscular, intravenous or
subcutaneous injection (depending on which one is used and in
which indication). Steroid hormones can be given both orally and
parenterally. Parenteral routes include intramuscular, intravenous,
subcutaneous, transcutaneous and nasal (according to indication).
Oestrogens can be also given by the vaginal route. Of the thyroid
hormones, levothyroxine (T4)is only given orally while liothyronine
(T3) is normally given orally but is given intravenously in
hypothyroid coma.
From a clinician's point of view I can't see the need for a rectal
administration of any hormones. I don't think there have been
attempts at such preparations but I think there would be substantial
absorption problems. For instance, it has been repeatedly tried to
administer insulin, a peptide hormone, via the nasal or oral
mucosa. The absorption via this route is less than 10% of the
absorption by the subcutaneous, intravenous or intramuscular
route, therefore massive doses would be needed plus there a
number of unresolved safety issues. It would be absolutely
fantastic to have an oral or nasal preparation of insulin that could
remove the misery of diabetic patients who have to give
themselves multiple daily injections. Over the years there have
been dozens of attempts at such alternative routes but none has
been successful so far nor is there any likelihood of a breakthrough
in the near future. Unfortunately the media have irresponsibly,
repeatedly announced the imminent availability of oral or nasal
insulin, to the chagrin of diabetic patients who have come
clamouring to our doors asking for them.
NSAIDS
Diclofenac can be given orally, by intramuscular injection and
rectally, but they are three different preparations.
Valeria
Dr Valeria Frighi
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Oxford
UK
e-mail: valeria.frighi@dtu.ox.ac.uk
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