Ever wonder why your medication might be prescribed topically instead of orally? When it comes to medication delivery, route matters—each medication is trialed and tested and then made for the effectiveness of specific delivery routes. To ensure your prescribed medication is doing what it’s supposed to, you must take it appropriately in the prescribed route. Let’s talk about the most common routes of medication administration and why we’d use them.
Oral
There are 3 common ways of getting medication orally, and the most often prescribed route is orally or by mouth (PO). Taking medications orally is often convenient and easy to do. By mouth seems simple, but this is putting a tablet or capsule in your mouth and swallowing it. Some oral medications are better absorbed on an empty stomach or with food at night or in the morning. Oral medications are in a capsule or tablet, immediate or delayed release. Because of different absorption mechanisms, if you are unable to swallow your medication whole, always ask your provider or pharmacist if it can be cut, opened, or crushed and if you should take it with food or at a specific time of day.
Pros:
Convenience: Easy to administer and widely used.
Variety of formulations: Available in tablets, capsules, liquids, etc.
Cost-effective: Often less expensive than other routes.
Cons:
Slower onset: Absorption through the gastrointestinal tract takes time, usually 30 minutes to a few hours.
First-pass metabolism: The drug is metabolized by the liver before entering the bloodstream, which can reduce its effectiveness.
GI irritation: Some medications can irritate the stomach lining.
Food interactions: Some medications require fasting or specific timing around meals.
Another oral route is sublingual (SL). Sublingual means putting a medication under the tongue and letting it dissolve for more rapid absorption through the mucous membranes. If you are taking a medication that is prescribed to be taken sublingually, ensure you allow the medication to fully dissolve under the tongue before eating or drinking.
Pros:
Rapid onset: Medications are absorbed directly into the bloodstream through the mucous membrane, providing faster effects (within minutes).
Bypasses first-pass metabolism: Avoids the liver, so the drug’s effectiveness is maximized.
Cons:
Limited drug types: Not all medications can be administered sublingually.
Unpleasant taste: Some medications have a bitter or unpleasant taste that can be bothersome.
Small dosage only: Usually limited to small amounts of medication.
The last oral route is buccally absorbed medications. Buccally absorbed medications are dissolved between the cheek and gum. This route of administration the medication is absorbed via the buccal mucosa, a slower absorption than sublingual. This can be a good way to take medications if swallowing tablets or capsules is difficult for you. If taking medication buccally, let the medication fully dissolve between the cheek and gum before eating or drinking.
Pros:
Direct absorption: Like sublingual administration, buccal medication bypasses the liver and enters the bloodstream directly for better absorption.
Longer duration of effect: Drugs are released more slowly than SL but faster than PO, providing sustained release.
Cons:
Uncomfortable: Some may find holding medication in the cheek uncomfortable or inconvenient.
Limited formulations: Not all medications are suitable for buccal administration.
Taste: Similar to SL, some drugs may have an unpleasant taste.
Intramuscular (IM)
Intramuscular medications are administered with an injection into the muscle. IM injections are administered with a needle typically 1-1 ½ inches long, depending on the muscle size and the amount of subcutaneous fat present. If a medication is prescribed to be administered into a muscle, the best places for administration are into the deltoid muscle (outside of the upper arm just below the shoulder) or the quadriceps muscles (top or side of the thigh). When administering an IM injection, do not pinch or fold the skin, as this makes the fat layer on top of the muscle thicker to get through. If you are unsure if you’re administering your IM injections correctly, never hesitate to ask your provider or pharmacist.
Pros:
Rapid absorption: Medications are absorbed faster than subcutaneous or oral routes because of the rich blood supply in muscles.
Longer duration: Some medications are formulated for slow release, providing sustained effects over time.
Can deliver larger volumes: IM allows for the administration of larger doses compared to subcutaneous injections.
Patient Adherence: The longer duration of the medication can lead to higher patient adherence due to lower dose frequency.
Cons:
Invasive: Involves needle insertion, which can cause pain, anxiety, and discomfort.
Risk of complications: Improper technique can cause bleeding, infection, or nerve damage.
Absorption variability: The rate of absorption can vary based on muscle mass, circulation, and activity level.
Subcutaneous (SQ, SC)
Subcutaneous tissue is the fat layer found just underneath the skin. Subcutaneous medications are injected into the fat layer using a short, small needle, usually ½ - ⅝ inches long. The best places to inject a subcutaneous injection are typically the abdomen (avoid 2” around the umbilicus), back of the upper arm, thigh, or buttock. Pinch the skin and ensure you can pinch at least a 2” fold, and inject the medication while keeping the tissue pinched. Doing this allows for a thicker subcutaneous layer to absorb the medication. For routine subcutaneous injections, rotate injection locations for better absorption. If you are unsure if you’re administering your subcutaneous injection correctly, ask your provider or pharmacist for help.
Pros:
Slow, sustained absorption: Medications are absorbed more slowly compared to IM or IV routes, which is useful for drugs that require a gradual release.
Less painful: Compared to IM injections, SQ is generally less painful due to the location and the smaller needle used.
Stable blood levels: Offers more consistent drug levels over time.
Cons:
Limited volume: Only small volumes (typically less than 1-2 mL) can be administered, limiting the amount of drug that can be given.
Slow onset: Takes longer to reach the bloodstream compared to IM or IV routes, which may delay the therapeutic effect.
Irritation: Some medications may cause local irritation, bruising, or soreness at the injection site.
Variability in absorption: Depending on fat distribution, temperature, and site selection, absorption rates can vary.
Vaginal Route (PV)
Medications delivered into the vagina are more quickly absorbed than orally and are a great way to get medications straight to the vaginal tissue. When inserting medications into the vagina, creams, tablets or troches, be sure to wash your hands prior. To relax the muscles and comfortably insert the medication into the vaginal cavity, sit on the toilet with legs spread apart, stand with one leg up on the toilet or stool, or lay on your back with your knees bent. Insert the medication at least ½-1 inch, or as far as you comfortably can. Absorption should occur approximately 10-15 minutes after administration, but some leaking from the vagina may occur depending on the type of medication used.
Pros:
Localized treatment: Ideal treating symptoms affecting the vaginal area (e.g., infections, vaginal atrophy) without systemic side effects.
Bypasses first-pass metabolism: Drugs administered vaginally avoid liver metabolism, preserving drug potency.
Cons:
Messy application: PV medications (creams, gels, suppositories) can be messy or uncomfortable for some individuals.
Irritation: Some formulations can cause irritation or allergic reactions in the vaginal tissue.
Compliance: Some patients may feel uncomfortable or embarrassed using PV medications, leading to non-compliance.
How We Decide Between Routes
At Optimal Hormone Health, we recommend medication administration based on your personal needs. When we have the option (not all medications can be administered in all routes), we factor in different variables such as absorption, cost, your adherence, past medical history, and more. There is no one-size-fits-all approach to hormones, so you can rest assured our recommendations are made just for you.
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