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Nonenteral Routes of Administration for Psychiatric Medications

A Literature Review

Received July 17, 1998; accepted August 19, 1998. From the Magee Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213. Address correspondence and reprint requests to Dr. Thompson at the same address.

In the treatment of psychiatric patients with complicating medical illness, clinicians may encounter patients who cannot take oral medications. This review will acquaint the practicing clinical psychiatrist with psychotropic medications available by nonenteral routes of administration. A computerized MEDLINE search was conducted of the literature 1981 to 1997. All articles citing nonenteral routes of psychotropic medication administration were reviewed. The results are summarized according to drug class and specific routes of administration (intravenous, intramuscular, sublingual, rectal). Psychotropic medications now available by these alternative routes are also listed in table form. The majority of the information available comes from small case series or case reports. Intravenous and intramuscular routes of administration of psychotropics are the most common. In addition, certain psychotropics are available by less common routes, such as sublingual or rectal administration. Consideration of alterations in pharmacokinetics, including poorer absorption and slower metabolism, are discussed. Clinicians may need to consider these novel routes of medication administration when dealing with patients unable to take oral medications.

Key Words: Psychotropics • Pharmacokinetics

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