Bioavailability of drugs from suppositories in clinical practice after 1995

Abstract

A review has been supposed to be arranged on the literature published between 1996 and 2019 concerning applications of suppositories in clinical practice. The rectal route of drug administration has been in use for centuries particularly in children, elderly and comatose patients as well as in palliative care and preterm infants undergoing painful procedures. Morphine, salbutamol, methadone, lidocaine, propranolol, theophylline, and mianserin, which allow avoiding the hepatic first-pass effect, are examples of preference of rectal route over oral one. Only two main classes of antibiotics (‚-lactams and macrolides) have been studied recently after the rectal route of their administration. With the help of modern pharmaceutics and novel RDDS, higher bioavailability and controlled release of the drug have become possible. A number of antiepileptic drugs can be given rectally either for acute seizure control or in maintenance therapy. UC can be effectively treated with topical formulations and is superior to rectal corticosteroids. To suppositories most often used in Europe and the United States for their local treatments belong: bisacodyl, glycerol, mesalazine, diclofenac, glyceryl trinitrate, budesonide, prednisolone, and hydrocortisone. Suppositories applied for the treatment of systemic conditions are more numerous.