By Dr. Shabistan Fatma Taiyabi
Masalike Advia (Routes of administration of drugs)
The choice of route of administration of drugs is an important step in Pharmacotherapy. The selection of route of administration depends on the properties of drugs, types of disease, condition of the patient, age, and convenience. It is crucial to understand the characteristics of the various routes and related techniques. To achieve the goal of pharmacotherapy administration of suitable drugs in accurate doses at the right time through the appropriate route is necessary. Each route of drug administration has its own advantage and disadvantage that must be considered during selecting an appropriate route. The choice of route of administration of drugs also depends upon the need for systemic or local effects.
The route of medication administration is broadly classified into two types, external application, and internal administration. The drugs which are applied on the skin or external organs are called topical drugs (advia Kharjiya) and those drugs which are administered into the body are called internal drugs (advia dakhliya). Oil, paste, foams, gels, jumaad, lotions, creams, and ointments are an example of topical drugs. The topical drugs are administered through two routes –
- Application on skin: These are the easiest, safest, and most convenient routes. drugs administered through this route are jumad, ghaza, ubtan, tila, quarooti, creams, ointments, lotions, etc.
- Application through the skin: These are also simple and convenient routes. The drugs administered through this route are dugs of massage on the skin, vapour bath, ghasool, aabzann, pashweha, sakoob, kaboos, etc.
Advia dakhliya is administered into the body. The route of administration of internal drugs (Advia dakhliya) is broadly classified into two types.
I. By natural passage II. By abnormal (by invasion).
- Natural passage of administration of drugs: Seven visible natural passages in the body can be used to administer the drugs into the body. These natural passages are oral, respiratory (Inhalation), anal (rectal), urethral, vaginal, ophthalmic (eye), and ear routes.
- Abnormal (Invasive) routes of drug administration: In some situations to full fill the need for treatment drugs are entered into the body by invasion. These routes are not naturally found in the body. These passages are made by instrumentation like injection or incision.
Natural passage of administration of drugs (tabyee masalik-e-advia)
- Barah-e-dehen (Oral route): This is the most common and widely accepted route of drug administration. This route is safe, convenient, and cost-effective. By the oral route, drugs can be self-administered without any technical knowledge. This route is convenient for the long-term and repeated use of drugs. Drugs administered through this route are liquid, solid, powders, and semisolids. Both the drugs for local effects in the oral cavity and drugs for systemic effects are administered through this route. Drugs, like sannon, gharghara, mazmaza, wajoor, mazoogh, masoos etc are used for their local effects in the oral cavity, while drugs like itrifilal, aqras, jawarishat, halwajaath, hareerajaath, haboob, qurs, capsule, khameerajaath, joshanda, khaisanda, sheerajaath, sharbat, sharab, sikanjabeen, gulqand, arqiyath, lavooqath, murabbajaath, lu’aabath, maa-ul-asl, maa-us-shaeer, ma’ajeen are used for systemic effects. There are a few limitations of the oral route, like it is difficult to administer drugs in patients who have altered mental status or nausea or vomiting. Drugs with unpleasant smells or tastes may cause nausea or vomiting.
- Barah-e-Majari-e-tannafus (Inhalation): drugs administered by the respiratory route are volatile liquids and gases. For effective delivery, the particle size of the inhaled medication is usually 1 to 10 µm in size. The form of drugs used through this route is bukharat (vapours), dukhani (smoky), shamoom (volatile drugs). For local effects in the nasal cavity (or intranasal route) several other forms are also used like sayyal (liquid), neem sayyal (semi-liquid), zaroor, qatoor, shiyaf and tila on the nose. Both mouth and nose are used for the respiratory route of medication. The limitation of this route is that an irritant drug to respiratory passage can cause increased respiratory secretion and bronchospasm.
- Barah-e-Mubarraz (Anal route): This route can be used for systemic effects apart from local effects. This route is used for desired effects in the lower portion of intestinal tracts, and alternative to the oral route. Irritant and unpleasant drugs that are difficult to ingest through the oral route can be administered through the anal route. In several conditions like Iltehab-e-halaq, Khannaq, tumor, cancer, coma, surgery, etc. which oral route is contraindicated, and, the anal route can be used instead of it. The anal route is also used for the effects in neighbor organs like the uterus, urethra, etc.
- Barah-e-Muhbal (Vagina route): This route is preferred for the desired effect in the female genital tract. Formulations that are given vaginally are tablets, creams, gels, ointments, and pessaries by the technique of pichkari, farzaja, humool, qutoor, tila, and marham.
- Barah-e-Ahleel (Urethral route): This route of drug administration is used in the diseases of the Kidney, urinary bladder, and tract (majariy-e-baul); like gonorrheoa (sozak), inflammation of the bladder (Iltehab-e-masana), urinary calculi (Hisat-e-masana), ulcers of the bladder (Qurooh-e-masana), etc. In the male, this route may be used in the disease of genital organs. Only liquid (sayyal & neem sayyal) form of drugs is used by this route.
- Barah-e-chashm (ophthalmic route): This route is used in the disease of eyeball, and orbit. Several formulations of safoof, surma, shiyaf, qutoor, marham, etc are administered through the eyes.
- Barah-e-gosh (auditory route): The drugs administered by the ear to act on the ear cavity and the tympanic membrane (Ghisha-e-tabli). The form of drugs used by this route is qautoor, shayaf, fateela, pichkari, sakoob, tabkheer, and tadkheen.
Invasive routes of drug administration (Ghair tabyee masalike advia): Several invasive routes are used by the Unani physicians since ancient times. These routes are not found naturally in the body. To achieve therapeutic purpose this route is made by instrumentation. The commonly used invasive route is injections but the surgical incision is also used to create the drug administration route.
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