When you go into your local pharmacy and look past the Rx counter you will see rows and rows of oral dosage forms (tablets and capsules), a small section of oral liquids (solutions and suspensions), and an even smaller section of topical preparations (ointments and creams), and a smattering of others (eye drops, nasal sprays, etc.). It is this way because oral dosage forms generally are easy to produce, are less costly, provide ease of use, and are more acceptable to the general public than say a rectal suppository or a sublingual (under the tongue) product which may be bitter to the taste. Pharmaceutical manufacturers know this and tend to produce and promote oral preparations over other dosage forms they don’t manufacture.
There is nothing inherently wrong with this approach except that for some medication and for some patients there may be better ways of delivering a drug. For instance: oral dosage forms go through the stomach and into the small intestine where they are absorbed into the blood stream, then go through the liver where they are partially metabolized, then into the systemic blood supply, and finally to the site of their action. Some of the problems a particular patient might encounter are: stomach upset, vomiting, diarrhea, inconsistent absorption, and liver toxicity.
Alternatives to an oral drug might be:
- sublingual drops or troches (semi-solid dissolvable disks) - medication is absorbed directly into the blood stream via the mucus membrane in the mouth. This route bypasses the stomach and the first pass through the liver. Taste can be a drawback.
- topical transdermal creams - many drugs will penetrate the skin, be absorbed into the capillary system and then into the main blood stream. This route also bypasses the stomach and the first pass through the liver. It can be used to treat pain (muscle aches, joint inflammation, back pain) right at the site of the pain. Since it is slowly absorbed into the system it has few side effects compared to oral administration.
- suppositories - the drug is absorbed through the sigmoid colon, bypassing the stomach, but still goes through the liver before it gets into the systemic circulation. Main drawback is patient acceptance.
- injections - in many ways the best route of administration from a therapeutic point of view but not practical outside the doctor’s office or hospital.
The use of alternative dosage forms is not well-known or understood by many medical providers. Compounding pharmacists are the experts. If you are having difficulty with your medication an alternative dosage form might be of value.
Contact the experts at Key Compounding Pharmacy. They can advise you and your medical provider on what possibilities exist.
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