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The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
Adverse events include nausea, vomiting, heartburn, gastrointestinal bleeding, and impairment of platelet function (prolonged bleeding time). Indomethacin should not be administered in patients with peptic ulcer, kidney, or liver disease. The drug crosses the placenta readily, and the most common side effects include stenosis of the fetal ductus arteriosus and oligohydramnios (328,332). There is also a concern about impairment of platelet function in the neonates (333). However, a meta-analysis of 28 studies showed no significant differences in the rates of intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, and neonatal mortality between the two groups (334). The standard recommendation is not to use the agent after 32 weeks of gestation or longer than 50mg (4). Indomethacin is used as an acute tocolytic. The oral dose of indomethacin is a 50 mg loading dose, followed by 25 to 50mg every 6 hours for 48 hours (total duration of treatment). The drug can also be administered rectally as a suppository.
Palliative care
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Diminishing levels of consciousness will require a switch from oral medication. It is rarely necessary to give drugs intravenously or intramuscularly and the subcutaneous route should be chosen. If the patient is expected to succumb within a day or so, intermittent injections can be acceptable, but it is often easier and less traumatic to set up a continuous infusion pump. Diamorphine or morphine can be given by this route (remember to reduce the oral dose by 50%) and, if anti-emetics are required, haloperidol or metoclopramide can be added to the infusion. Alternatively, these can be given in suppository form.
When I Control the Pain, I Control My Life: Opioids and Opioid-Containing Analgesic Medication in the Management of Chronic Intractable Pain
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
When using rectal morphine suppositories (RMS), take note of the following. There are two bases that can be used as a foundation for the manufacturing of RMS. One melts at a lower body temperature. Most of the more severely painful chronic intractable pain patients run basal temperatures around 98 degrees Fahrenheit. Therefore, the product made by Upsher-Smith is the correct RMS to be used for these patients, because it melts at lower body temperatures. If other brands are used, pain relief will be short (10–20 minutes), and the suppository will come out only partially dissolved.
The preclinical discovery and development of rectal artesunate for the treatment of malaria in young children: a review of the evidence
Published in Expert Opinion on Drug Discovery, 2021
Laís Pessanha de Carvalho, Andrea Kreidenweiss, Jana Held
Another study investigated which level of coverage of RAS is achievable in practice, in remote rural villages in Tanzania, Ghana, Guinea-Bissau, and Uganda with trained mothers and community health workers [64]. A suppository should be administered to the children when they judged it to be necessary, and directly bring the child to the next health-care facility so that the patients receive the referral treatment. Results showed that 32% of the febrile episodes were eligible for pre-referral treatment; but only 14% of the children were treated. An additional finding was that the probability of a child to be treated by a trained mother was higher (1.67 times) than by a community-based health worker [66]. Results of these studies emphasize that informing the population about the correct use of RAS as pre-referral treatment is crucial for the success of this treatment in reducing mortality. Special training of dedicated persons such as community health workers on the application of RAS could greatly influence the success of this drug. This need has been identified and training manuals for community health workers have been developed [67]. Now the roll out and implementation of these trainings must be ensured and the incorporation into the local health care systems enforced.
A technology evaluation of Annovera: a segesterone acetate and ethinyl estradiol vaginal ring used to prevent pregnancy for up to one year
Published in Expert Opinion on Drug Delivery, 2020
Elizabeth A. Micks, Jeffrey T. Jensen
The effect of co-administration of the SA/EE CVR and medications used to treat VVC was evaluated in an open-label randomized 3-month crossover study [46]. Forty-five women were randomized to three different miconazole nitrate formulations: a 1200 mg single-dose suppository, a 200 mg/day suppository for 3 days, or a 200 mg/day cream for 3 days. The single dose suppository was administered on day 8 after CVR insertion, and the 3-day suppository and cream were administered on days 8–10. Outcomes included systemic exposure to SA and EE, as well as safety and tolerability. The single-dose and multi-dose miconazole suppositories significantly increased the systemic levels of both EE and SA, whereas the cream had no effect on levels of either hormone. Women who use the SA/EE CVR are advised to use only antifungal vaginal creams or oral medications rather than vaginal suppositories for treatment of VVC.
Tolmetin sodium-loaded thermosensitive mucoadhesive liquid suppositories for rectal delivery; strategy to overcome oral delivery drawbacks
Published in Drug Development and Industrial Pharmacy, 2019
Mohamed A. Akl, Hatem R. Ismael, Fathy I. Abd Allah, Alla A. Kassem, Ahmed M. Samy
Rectal route, as an alternative to oral administration, has been effectively exploited to treat local diseases of the anorectal area as well as to deliver drugs systemically, especially for the pediatric population because these dosage forms are neither to be swallowed nor need to be taste-masked [6]. Rectal forms can also be administered in an emergency to unconscious or vomiting children [7]. Rectal suppository is also commonly used for treatment of rheumatoid arthritis and ankylozing spondylitis. A conventional suppository is a semisolid dosage form that melts or softens slowly in the rectum at body temperature. In general, a conventional suppository gives a feeling of alien, discomfort, and even leads to patient refusal, possibly lowering patient compliance. Furthermore, if the solid suppositories reach the end of the rectum, the drugs might undergo the first-pass effect [8]. Hence, the ideal suppository should be easy to administer without any pain during insertion and remain at the administration site to avoid the first-pass effect in the liver and the gastrointestinal tract [9,10].