Guide On How To Insert Suppository

Suppositories are medications inserted into the cavity or orifice of the body. Medical doctors may prescribe one for treating a medical condition. There are different types of suppository for different conditions. They are to be administered by the patient at home. Knowing how to use it will increase effectiveness.

Insertion of suppository

To know how best to use suppository, it is important to understand how they work. Wrong use may lead to therapeutic failure. Let us take a look at the anatomy of the rectum and vaginal.

Anatomy Of Rectum And Drug Absorption

The lower and middle rectal (interior and middle hemorrhoidal) veins flow into the interior vena cava, therefore this blood goes directly to the heart and into the general circulation. In contrast, the upper rectal (superior hemorrhoidal) vein flows into the portal vein and, therefore, this blood passes through the liver before reaching the heart. This means that rectally delivered drug products can enter the general circulation either directly or by passing through the highly metabolizing liver. Drugs absorbed in the middle and lower part of the rectum will pass directly into the general circulation and avoid first-pass metabolism in the liver.

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Bioavailability from the upper part of the rectum will be low for certain drugs, as much will be metabolized by the liver during its first pass and only a proportion of the drug molecules (if they are of the high clearance type) will enter the general circulation intact.

Investigations have shown that avoiding first-pass metabolism through the liver is possible by keeping the dosage form, and thus the released drug, in the lower part of the rectum. Compared with the small intestine, this situation is very favorable as most gastrointestinal veins drain into the portal vein.

Anatomy Of Vagina And Drug Absorption

Vaginal administration is also well suited for systemic drug delivery as the vaginal tissue contains readily available blood vessels. Comprised of three layers, top epithelial layer, muscular coat and the tunica adventitia, the vaginal rugae and microridges on the epithelial surface permit the vagina to expand, increasing the surface area of the vagina and thus enhancing the drug absorption of vaginally administered products. This route of administration also offers similar advantages as rectal administration, such as avoiding first-pass metabolism, reduction in gastrointestinal and hepatic side effects and local targeting of drugs to the reproductive organs.

Comparison Between Rectal And Vagina Administration Of Drugs

Therefore, despite the unique environments present in the vagina versus the rectum, insertion of a suppository results in the same chain of events leading to the absorption of the drug

Regardless of indication, such as constipation, yeast infection, pain relief, viral prevention or antiviral treatment, drug delivery from a suppository, like all topically applied dosage forms, occurs primarily by passive diffusion for both vaginal and rectal administration. The bioavailability of drugs following rectal administration can be somewhat unpredictable compared with vaginal application, because of interindividual variations and the venous drainage of the rectum. In general, the rate and extent of drug absorption is lower than the oral route, mainly due to the smaller surface area available for absorption.

How To Use Suppository

Get the suppository plus soap and water or hand sanitizer to clean your hands. You may also need a clean, single-edge razor blade and lubricating jelly.

How To Insert Suppository Tablet

1. Gently squeeze the suppository to check if it is firm enough to insert. If it is not, let it harden by holding it under cold water while it is still in the wrapper. You can also place it in the refrigerator for a few minutes.

2. If it is rectal administration, try to pass stool to empty the colon, as suppository medication is most effective when the bowel is empty. If it is the urethra, try to empty the bladder.

3. Wash your hands with soap and running water. If not available, use an alcohol based hand sanitiser. Clean hands with a clean towel or paper towel.

4. Tear open the suppository to expose the drug. Some come with markings for tearing. If not, use a clean single edge razor blade to cut it straight.

Read Also: Types Of Suppository Bases

5. If it is the rectum, you can dip the suppository tablet into water or water based lubricating jelly like k-y jelly. This helps to lubricate it for easy insertion since the rectum does not have much moisture. For vagina insertion tablet, it may not require lubrication as it contains moisture. Take out the applicator supplied and pull out the plunger of the applicator. This opens space for the tablet. Place the tablets inside the space the applicator plunger created.

6. Time to take off underwear.

7. Position for the insertion procedure. For rectal insert, you can stand with one foot up on a chair. You can also lie down on your side with your top leg slightly bent toward your stomach and with your bottom leg straight. If you are giving the suppository to someone else, you may want to place them in this second position. For vagina insertion, either stand with the knees bent and feet apart or lie down with the knees bent toward the chest.

8. For rectal administration, relax the muscles of the buttocks and open the cheek with one hand. Insert the suppository tablet, narrow head first and gently push in with hands. For adults, push in 1 inch pass the anal sphincter. For children, half inch to 1 inch is ok. For infants, it is half an inch in.

9. For vagina insertion, push the tablet inside the vagina with the narrow head first. For a tablet with an applicator, insert the nozzle of the applicator deep inside the vagina. Push the plunger back all the way in.

How To Use Suppository Cream

1. If it is rectal administration, try to pass stool to empty the colon, as suppository medication is most effective when the bowel is empty. If it is the urethra, try to empty the bladder.

2. Wash your hands with soap and running water. If not available, use an alcohol based hand sanitiser. Clean hands with a clean towel or paper towel.

 3. Time to take off underwear.

4. Position for the insertion procedure. For rectal insert, you can stand with one foot up on a chair. You can also lie down on your side with your top leg slightly bent toward your stomach and with your bottom leg straight. If you are giving the suppository to someone else, you may want to place them in this second position. For vagina insertion, either stand with the knees bent and feet apart or lie down with the knees bent toward the chest.

5. Open the cap of the tube. Use the back of the cap and press on the aluminium foil cover on it. If the cap did not come with this functionality, get a clean pin and puncture the aluminium foil cover. Screw the nuzzle on the tube.

2. For rectum insertion, relax the muscles of the rectum and open the cheek with one hand. Insert the nuzzle deep inside the rectum and squeeze the tube from the far end. For vagina insertion, insert the nuzzle into the vagina. Squeeze gently the tube from the back until enough of the cream enters the vagina.

3. Bring out the nuzzle, unscrew the nuzzle and close back the cream

How To Use Urethral Suppository

1. Wash your hands with soap and running water. If not available, use an alcohol based hand sanitiser. Clean hands with a clean towel or paper towel.

2. Tear open the suppository to expose the drug. Some come with markings for tearing. If not, use a clean single edge razor blade to cut it straight.

3. Time to take off underwear.

4. Stretch out the penis to open the urethra.

5. Place the applicator into the hole at the tip.

6. Push the button on the applicator and hold for 5 seconds.

7. Gently move the applicator from side to side to ensure the suppository has entered the urethra.

8. Remove the applicator.

Read Also: The Different Types Of Suppository

Precautions

1. Sit or lie still for at least 10 minutes after insertion. Hold the buttocks of baby's for that time period. This allow the suppository to melt and absorb into the body

2. Except for laxatives, avoid the use of the toilet for at least 60 minutes after insertion of the suppository. This give suppository time to enter blood circulation

4. Avoid any work for at least 60 minutes. It is best doneast thing at night

3. Consider sanitary towel after the use of vagina suppository as it can leak out after application

4. Massage the stretched penis firmly for 10 to 15 seconds to allow the medicine to be absorbed.

5. Clean up the applicator, nuzzle and wash your hands