Suppository:

A suppository is a drug delivery system that is inserted into the rectum (rectal,suppository), vagina (vaginal suppository) or urethra (urethral suppository), where it dissolves or melts.

They are used to deliver both systemically-acting and locally-acting medications.

The alternative term for delivery of medicine via such routes is pharmaceutical pessary.

The general principle is that the suppository is inserted as a solid, and will dissolve or melt inside the body to deliver the medicine pseudo received by the many blood vessels that follow the larger intestine.

Rectal suppositories:

Rectal suppositories are commonly used for:

• laxative purposes, with chemicals such as glycerin or bisacodyl

• treatment of hemorrhoids by delivering a moisturizer or vasoconstrictor

• delivery of many other systemically-acting medications, such as promethazine or aspirin

• general medical administration purposes: the substance crosses the rectal mucosa into the bloodstream; examples include paracetamol (acetaminophen), diclofenac, opiates, andeucalyptol suppositories.

Mode of insertion:

In 1991, Abd-El-Maeboud and his colleagues published a study in The Lancet,^[1] based upon their investigation into whether there was some hidden and forgotten knowledge behind the traditional shape of a rectal suppository.

Their research very clearly demonstrated that there was, indeed, a very good reason for the traditional torpedo shape; namely, that the shape had a strong influence on the extent to which the rectal suppository traveled internally — and, thus, upon its increased efficiency.

They (counter-intuitively) found that the ideal mode of insertion was to insert suppositories blunt end first, rather than the generally used mode of inserting the tapered end first. This conclusion was based on the greater distance of internal travel of the suppository once inserted, which was entirely a mechanical consequence of the natural actions of the bowel's muscular structure and the rectal configuration.

As a consequence, and in order to guarantee the maximum optimal efficiency, they recommended that all rectal suppositories be inserted blunt end first. The findings of this single study have been challenged as insufficient evidence on which to base clinical practice.^[2]

Non-laxative rectal suppositories:

Non-laxative rectal suppositories are to be used after defecation, so as not to be expelled before they are fully dissolved and the substance is absorbed. The use of an examination glove or a finger cot can ease insertion by protecting the rectal wall from fingernail(s).

Vaginal suppositories:

Vaginal suppositories are commonly used to treat gynecological ailments, including vaginal infections such as candidiasis.

Urethral suppositories:

Alprostadil pellets are urethral suppositories used for the treatment of severe erectile dysfunction. They are marketed under the name Muse in the United States.^[3] Its use has diminished since the development of oral impotence medications.