Difference Between Suppository And Pessary

When you hear the word 'suppository and pessary' what comes to mind? There has been a little bit of confusion as to what both mean and their differences. However, this post will shed light on the area where the error is coming from.

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Medicines are drugs designed for therapeutic effect. Tailored to meet different needs, some are designed to be swallowed. Others are injected with a syringe and needle into the body while others are applied on the skin. However, these routes may still not be enough to satisfy some needs hence the use of suppository and pessary.

Suppository

Suppositories are also called pharmaceutical pessaries. They are meant to be inserted into the body such as vagina and rectum. They are made of material that dissolve at human temperature releasing the content of the drug.

To make insertion easy, they are made to have a small shape like that of a bullet. They are round and cone shaped.

Suppository and its shell

Suppositories are designed to either treat local disease of the rectum or vagina or bypass the systemic first pass effect of the stomach. In other cases, they are meant to treat a condition when the patient is not able to swallow. They can be inserted by the user.

Pessary

When we mention suppository, everybody seems to agree with the above definition. But that is not the case with pessary. Pessary got two definitions and that can be confusing. I will explain.

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According to many people, pessary is a medical device inserted into the vagina or rectum for structural purposes. They never mentioned it as a drug. It is commonly used to treat urinary incontinence to stop urinary leakage and pelvic organ prolapse to maintain the location of organs in the pelvic regions. Other uses are incarcerated uterus, prevention of preterm birth and an incompetent cervix. They can also be used to prevent pregnancy. Pessary unlike suppository can only be inserted by a health professional.

Pessary device
Source: mayoclinic

However, according to the British pharmacopoeia (BP), a pessary is a solid single dose preparation. They contain one or more active pharmaceutical ingredients (API) dispersed or dissolved in a suitable base that may be soluble or dispersible in water or may melt at body temperature. Excipients may be added if need be. Excipients are diluent, adsorbent, surfactant or surface active agents, lubricants, antimicrobial preservatives and cooling agents.

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From the above definition, one can see that a pessary is a suppository. That is why Wikipedia decided to call pessary 'pharmaceutical pessary' to differentiate it from pessary devices. But BP said a single dose. Does that mean that suppository meant for multiple applications cannot be considered a pessary anymore? Maybe. However, not all suppositories are vagina suppositories hence that name should only be restricted to a suppository intended to be inserted into the vagina.

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