Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions

  title={Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions},
  author={Mellar P. Davis and Declan Walsh and Susan B Legrand and Michael Naughton},
  journal={Supportive Care in Cancer},
Abstract Rectally administered medications are essential in palliative medicine, particularly in the last days of life. They are underutilized. The pharmacology of rectally administered medications relates not only to the medication but also to the suppository base, additives, drug ionization, pKa, absorptive surface of the rectum, and rectal health. The pharmacokinetics may differ from those of orally administered medications owing to reduced hepatic first-pass clearance. In this review the… 

Rectal Bioavailability of Sertraline Tablets in a Critically Ill Patient With Bowel Compromise.

The case of a 55-year-old woman in whom sertraline tablets were administered rectally for depression and anxiety and where PK monitoring was performed is described.

Perioperative rectal administration of nonopioid analgesics.

  • C. Pasero
  • Medicine
    Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
  • 2010

Alternative routes to oral opioid administration in palliative care: a review and clinical summary.

A literature review was performed to describe the most commonly used and available routes that can substitute for oral opioid therapy and to provide a summary of factors affecting choice of opioid for use in palliative care in terms of benefits, indications, cautions, and general considerations.

A review of short bowel syndrome and palliation: a case report and medication guideline.

A case report and review should assist practitioners with the palliative management of patients with short bowel syndrome and the case presented highlights a specific difficulty encountered.

Oral transmucosal fentanyl citrate: a novel agent for breakthrough pain related to cancer

Actiq is a formulation of fentanyl citrate delivered via the transmucosal route in a sucrose base and patients using this agent are instructed to paint the unit on the buccal mucosa in order to achieve relief.

Breakthrough Pain in Cancer Patients— Pharmacologic Symptomatic Treatment

Pharmacotherapeutic approaches to managing breakthrough pain are discussed, including different routes of administration and newer opioid formulations, and the current guidelines for managing breakthroughPain are examined.

Promoting Excellence in Symptom Management Case Series

A case study on the use of a new innovation for the rectal delivery of medication to control EOL symptoms of a 62-year-old male hospice patient with end-stage metastatic prostate cancer and how this new innovation can be used to ensure rapid symptom management and decreased burden of care is demonstrated.

Long-term rectal administration of high-dose sustained-release morphine tablets

It is found that rectal administration of sustained-release morphine tablets for oral administration provide excellent analgesia although their use by this route is not approved by the United States Food and Drug Administration.

Advancements in Rectal Drug Delivery Systems: Clinical Trials, and Patents Perspective

The present review addresses the rectal physiology, rectal diseases, and pharmaceutical factors influencing rectal delivery of drugs and discusses different rectal drug delivery systems including suppositories, suspensions, microspheres, nanoparticles, liposomes, tablets, and hydrogels.

Vías alternativas a la vía oral para administración sistémica de opioides en Cuidados Paliativos. Revisión de la Literatura.

This review of the literature is aimed at describing the indications, the limits and the main aspects of the pharmacokinetics and pharmacodynamics relative to the alternative routes of administration of opioids most commonly used in clinical practice.



Practical use of rectal medications in palliative care.

  • D. E. Warren
  • Medicine, Biology
    Journal of pain and symptom management
  • 1996

Rectal Absorption of Lamotrigine Compressed Tablets

The single‐dose pharmacokinetics of la‐motrigine (LTG) compressed tablets after rectal and oral administration in healthy volunteers were compared to show whether rectal administration can be a useful alternative when the oral route of administration is not possible.

Pharmacokinetics of Rectal Drug Administration, Part II

In Part II of this article, this discussion is extended to drugs which act peripherally and to methods of enhancing rectal drug absorption.

Rectal administration of antiepileptic drugs in children.

Use of adjuvants for enhancement of rectal absorption of cefoxitin in humans

The quantity of sodium salicylate was found to have an influence on the quantity of cefoxitin absorbed, and the salicYLate was absorbed over an extended period of time from the rectum.

[Effects of domperidone suppository against adverse reactions in digestive organs induced by cancer chemotherapy].

The effects of domperidone suppository against adverse reactions in digestive organs to antitumor agents were examined and 13 patients out of 15 (86.7%) showed improvement of symptoms.

Is Rectally Administered Cisapride an Effective Prokinetic Agent?

Considering the varied patient populations and evaluation methods used in these studies, the lack of a commercially available cisapride suppository, and absence of studies involving extemporaneously prepared cisAPride suppositories, the use of suppositories should be limited to investigational trials.

Drug absorption by sublingual and rectal routes.

The disadvantages associated with administration of drugs rectally include: interruption of absorption by defaccation, which may occur particularly with irritant drugs; the surface area of the rectum is far smaller for absorption than that of the duodenum, and this may produce problems with dissolution of some drugs.

Antidepressants for the Virtually Eviscerated Patient: Options Instead of Oral Dosing

There are options for administration of antidepressant medication when oral intake is impossible and antidepressants can be administered intravenously, by rectal suppository, or topically.

Comparison of rectal midazolam and diazepam for premedication in pediatric dental patients.

  • J. RoelofseP. van der Bijl
  • Medicine
    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
  • 1993