The same drugs are often produced in different forms and it is easy to get confused in them. We tell you what is the difference between them and why it is not always more useful to “drip” than to take medicine.
How the drugs work
The main task of pharmacology is the creation of drugs that are convenient to take with maximum efficiency and minimal side effects. The ideal option is a medicine that acts pointwise and does not affect the rest of the body. To achieve this, in different cases, different forms of drug release are needed.
To determine the correct operation of the drug in pharmacology, there are two concepts: bioavailability and half-life.
Bioavailability is the amount of a substance that has reached its intended destination. This process is hindered by the protective barriers of the body. The choice of dose for treatment and the route of administration depend on bioavailability.
The half-life is the time after which the level of the drug is halved from the original and ceases to actively affect the body. It depends on this period how many times a day you need to take the medicine.
Why are the shapes different?
Initially, there were only two ways to deliver the drug to the body: swallow or apply, other options were not available to physicians of the past.
But with the development of medicine, it became clear that these options do not always work. When swallowed, the drug has to go a long way. Before getting to the right place, the tablet passes through the aggressive environment of the stomach. And after absorption, with the blood flow, the substances enter the liver, where toxins are neutralized and the drug may become inactive before it reaches the target organ.
Also, some drugs can adversely affect the work of the gastrointestinal tract. Cause nausea, vomiting, or simply not work if the stomach or intestines are not in order and absorption is impaired.
“A classic example is when we changed a drug in a patient,” says Andrey Besedin, GMS Clinic therapist, “during exacerbations of gastric ulcer, duodenal ulcer, or after surgery on the gastrointestinal tract. In this case, it is better to choose intramuscular or intravenous administration ”
There are situations when it is necessary to administer drugs intravenously. Most often this is due to urgency, but there are drugs that are destroyed in the gastrointestinal tract. For example, some antibiotics exist only in the form of injections, in which case injections are indispensable.
“Any intramuscular, subcutaneous, intravenous injection is a small operation,” Andrey Besedin explains, “during which we violate the integrity of the body, skin, muscles, depending on what we are doing. Therefore, if possible, it is better to use tablets and capsules.
There are medicines that have a serious effect on the whole body if they are taken in the form of tablets or injections. For such cases, invented local forms. So hormones in creams and nasal spray are useful for skin manifestations and allergic rhinitis, but the same hormones in large doses can cause serious consequences when taken for a long time by pills or intravenous injections.
For children, medicines are produced in the form of chewable tablets, drops or tablets of a reduced size, so as not to turn each dose of the medicine into a battle or not to associate the treatment with pain. Unfortunately, this is not always possible, especially in children’s hospitals.
“In medicine, there are no unambiguous dogmas,” says Andrey Besedin, “in each situation, we choose the type of drug administration individually, depending on what goals we want to achieve with a particular patient.”
What determines the choice
The doctor determines the form of admission, based not only on those drugs that are available. He pays attention to the age, gender, financial capabilities of the patient, and even his mood and attitude towards treatment. Children require special attention.
“The choice of the form of the drug is partly a creative process,” says Ekaterina Bokova, a therapist at the 120 by 80 clinic, “there are no ready-made solutions here. But most often we focus on age. If it’s just a baby, then we choose liquid or rectal forms to eliminate spitting and choking. So the child with a greater guarantee will receive his dose of the active substance. Sometimes you even have to make a choice in favor of an injectable drug. In any case, the child should not be prescribed “adult” pills and divide them into parts.
The wish of the patient or relatives is also important when choosing the form of the drug. For older people, it is important that you have to take fewer pills per day, otherwise you can get confused, especially if there are a lot of drugs. In such cases, pillboxes or planners help.
“Unfortunately, older people usually insist on prescribing the most budgetary drug,” says Ekaterina Bokova, “here, if possible, we go forward.”
How to choose the right shape
Even medicines with the same form of administration can differ from each other. For example, capsules and tablets.
“Capsules are more expensive because of the difference in technology,” Andrey Besedin explains. – They hide the unpleasant smell and taste of drugs, unlike pills. Capsules enter the body: the stomach, intestines and dissolving, release the powder, which is absorbed much faster. But there is a factor that many of my patients do not like. Tablets can often be split in half or quarters, and sometimes half the dose is sufficient in an emergency. In the case of a capsule, this will not work, so the choice is made in favor of tablets.
There are patients who are sure that injections and droppers are much more useful than pills and specifically insist on this form of treatment. It is believed that in this case the medicine enters the bloodstream immediately and will definitely work. Although this method of administration is more difficult, more painful and most often there is no difference in the result if the same medicine is in the form of tablets or in ampoules.
“For example, patients are asked to inject intramuscular or intravenous painkillers for headaches,” says Andrey Besedin. – This type of administration does not have any advantages compared to oral forms: powders, capsules, tablets, if the patient can take drugs by mouth. As a rule, injections are effective if a person has a large loss of fluid or for some reason he cannot drink on his own.
Intravenous and intramuscular delivery methods are more useful in emergency cases of stomach or intestinal disease or in a situation where the drug is destroyed in the digestive tract, such as heparin or insulin.