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Medicines > routes : Inhaled or intramuscular or thigh

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classes:
[[:Category:Aminoglycosides|Aminoglycoside antibiotic]] (1) · [[:Category:Analgesics|Analgesic]] (1) · [[:Category:Antibacterials|Antibacterial]] (1) · [[:Category:Antifolates|Antifolate]] (1) · [[:Category:Antihistamines|First-generation antihistamine]] (1) · [[:Category:Antineoplastics|Antineoplastic]] (1) · [[:Category:Antipruritics|Antipruritic]] (1) · [[:Category:Anxiolytics|Anxiolytic]] (2) · [[:Category:Benzodiazepines|Benzodiazepine]] (1) · [[:Category:Corticosteroids|Corticosteroid]] (4) · [[:Category:DMARDs|DMARD]] (1) · [[:Category:Glucocorticoids|Glucocorticoid (intermediate-acting)]] (1) · [[:Category:Glucocorticoids|Glucocorticoid]] (3) · [[:Category:Hormone_replacement_therapy|Hormone replacement therapy]] (1) · [[:Category:Immunosuppressants|Immunosuppressant]] (1) · [[:Category:Inhaled_corticosteroids|Inhaled corticosteroid (ICS)]] (3) · [[:Category:Opioid analgesics|Opioid analgesic (natural phenanthrene from opium poppy)]] (1) · [[:Category:Progestogens|Progestogen]] (1) · [[:Category:Schedule II controlled substances|Schedule II controlled substance]] (1) · [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]] (1) · [[:Category:Sex_hormones|Sex hormone]] (1) · [[:Category:Skeletal muscle relaxants|Skeletal muscle relaxant (centrally-acting)]] (1) · [[:Category:Sleep aids|Sleep aid (off-label)]] (1) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · Fc-fusion biologic (1) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · First-in-class incretin mimetic (1) · [[GLP-1 receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · [[Cardiovascular risk reduction]] agent (2) · [[GLP-1 receptor agonist]] · [[GIP receptor agonist]] · [[Antidiabetic medicines|Antidiabetic]] · [[Anti-obesity medicines|Anti-obesity]] · "Twincretin" (1)
uses:
[[Type 2 diabetes mellitus]] (adjunct, second-line) (1) · [[Type 2 diabetes mellitus]] (incl. pediatric ≥10 y) · [[Obesity]] (incl. pediatric ≥12 y) · [[Cardiovascular risk reduction]] in T2DM (1) · [[Type 2 diabetes mellitus]] · [[Cardiovascular risk reduction]] in T2DM (1) · [[Type 2 diabetes mellitus]] · [[Obesity]] · [[Cardiovascular risk reduction]] in obesity without diabetes · [[MASH]] with stage 2–3 fibrosis · [[Chronic kidney disease]] in T2DM (1) · [[Type 2 diabetes mellitus]] · [[Obesity]] · [[Obstructive sleep apnea]] in obesity (1) · '"`UNIQ--vote-00000015-QINU`"', '"`UNIQ--vote-00000016-QINU`"' (1) · '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"' (1) · '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"' (1) · '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"', '"`UNIQ--vote-00000021-QINU`"', '"`UNIQ--vote-00000022-QINU`"', '"`UNIQ--vote-00000023-QINU`"', '"`UNIQ--vote-00000024-QINU`"', '"`UNIQ--vote-00000025-QINU`"' (1) · '"`UNIQ--vote-000001D9-QINU`"', '"`UNIQ--vote-000001DA-QINU`"', '"`UNIQ--vote-000001DB-QINU`"', '"`UNIQ--vote-000001DC-QINU`"' (1) · '"`UNIQ--vote-00000661-QINU`"', '"`UNIQ--vote-00000662-QINU`"', '"`UNIQ--vote-00000663-QINU`"', '"`UNIQ--vote-00000664-QINU`"', '"`UNIQ--vote-00000665-QINU`"' (1) · '"`UNIQ--vote-00000722-QINU`"', '"`UNIQ--vote-00000723-QINU`"', '"`UNIQ--vote-00000724-QINU`"', '"`UNIQ--vote-00000725-QINU`"' (1) · '"`UNIQ--vote-000007C1-QINU`"', '"`UNIQ--vote-000007C2-QINU`"', '"`UNIQ--vote-000007C3-QINU`"', '"`UNIQ--vote-000007C4-QINU`"', '"`UNIQ--vote-000007C5-QINU`"', '"`UNIQ--vote-000007C6-QINU`"', '"`UNIQ--vote-000007C7-QINU`"' (1) · '"`UNIQ--vote-0000099F-QINU`"', '"`UNIQ--vote-000009A0-QINU`"', '"`UNIQ--vote-000009A1-QINU`"', '"`UNIQ--vote-000009A2-QINU`"', '"`UNIQ--vote-000009A3-QINU`"', '"`UNIQ--vote-000009A4-QINU`"' (1) · '"`UNIQ--vote-00000F98-QINU`"', '"`UNIQ--vote-00000F99-QINU`"', '"`UNIQ--vote-00000F9A-QINU`"', '"`UNIQ--vote-00000F9B-QINU`"' (1) · '"`UNIQ--vote-000010AF-QINU`"', '"`UNIQ--vote-000010B0-QINU`"', '"`UNIQ--vote-000010B1-QINU`"', '"`UNIQ--vote-000010B2-QINU`"' (1)
starting dose:
0.75 mg SC weekly'"`UNIQ--ref-00000053-QINU`"' (1) · 2.5 mg SC weekly × 4 wk (non-therapeutic ramp)'"`UNIQ--ref-000002FB-QINU`"' (1) · Anxiety: 0.5-1 mg PO BID-TID. Insomnia: 1-2 mg PO at bedtime. Status epilepticus: 4 mg IV (adult), repeat after 5-10 minutes if needed. Acute agitation: 1-2 mg IM (1) · Anxiety: 25-50 mg PO QID. Pruritus: 25 mg PO TID-QID. Insomnia: 25-50 mg PO at bedtime. Pediatric: 50-100 mg/day divided (1) · Byetta: 5 µg SC twice daily, within 60 min before morning and evening meals'"`UNIQ--ref-000000E3-QINU`"' · Bydureon BCise: 2 mg SC once weekly'"`UNIQ--ref-000000E4-QINU`"' (1) · HRT cyclic: 200 mg PO HS days 1-12 of each month; continuous: 100 mg PO daily; ART luteal support 100 mg vaginal TID or 90 mg gel daily (1) · ICS Pulmicort Flexhaler 180-360 mcg BID; intranasal Rhinocort 64 mcg/spray, 1-2 sprays/nostril daily; Entocort EC 9 mg PO daily for active Crohn's; Symbicort 80/4.5 or 160/4.5 mcg, 2 puffs BID (1) · Inhaled (Flovent HFA) 88 mcg BID; intranasal (Flonase) 2 sprays/nostril daily; topical (Cutivate) 0.05% cream BID (1) · Intranasal Nasonex 2 sprays/nostril daily (50 mcg/spray); inhaled Asmanex 220 mcg DPI 1-2 inhalations daily/BID; topical Elocon 0.1% cream daily (1) · IR oral: 15-30 mg every 4 hours as needed. ER opioid-naive: 15-30 mg every 12 hours. IV/IM/SC: 2-10 mg every 3-4 hours. Epidural / intrathecal: see surgical or palliative-care protocols (1) · IV: traditional 1-1.7 mg/kg q8h or extended-interval 5-7 mg/kg q24h with target-trough monitoring; inhaled CF 300 mg BID × 28 days on / 28 days off; ophthalmic 1-2 drops in affected eye(s) q4h (1) · Oral: 1500 mg PO QID for 2-3 days (load), then 750-1500 mg QID maintenance. IV/IM: 1000 mg every 8 hours for acute spasm (1) · Ozempic: 0.25 mg SC weekly × 4 wk'"`UNIQ--ref-00000245-QINU`"' · Wegovy: 0.25 mg SC weekly × 4 wk'"`UNIQ--ref-00000246-QINU`"' · Rybelsus: 3 mg PO daily × 30 d'"`UNIQ--ref-00000247-QINU`"' (1) · Rheumatologic: 7.5-15 mg PO or SC '''once weekly''' (not daily — daily dosing is a recognized fatal error); folic acid 1 mg PO daily on non-MTX days; oncology dosing is far higher and indication-specific (1) · Topical 0.025-0.5% cream/ointment BID; intra-articular 5-40 mg per joint q3-6 months; intranasal Nasacort 110 mcg/spray, 2 sprays/nostril daily; oral paste 0.1% to lesion 2-3×/d (1) · Victoza: 0.6 mg SC daily × 1 wk'"`UNIQ--ref-00000181-QINU`"' · Saxenda: 0.6 mg SC daily × 1 wk'"`UNIQ--ref-00000182-QINU`"' (1)
preparations:
2.5 mg tablets; 10-50 mg/mL injection; pre-filled subcutaneous autoinjectors (Otrexup, Rasuvo); 2.5 mg/mL oral solution (Xatmep) (1) · Byetta pre-filled multi-dose pen: 5 µg / 10 µg per dose'"`UNIQ--ref-000000E5-QINU`"' · Bydureon BCise single-dose autoinjector: 2 mg extended-release microsphere suspension'"`UNIQ--ref-000000E6-QINU`"' (1) · Inhaled MDI 44/110/220 mcg per actuation; DPI (Diskus) 50/100/250 mcg; nasal spray 50 mcg/actuation; cream/ointment 0.005%, 0.05% (1) · IR tablets 15, 30 mg; oral solution 10 mg/5 mL, 20 mg/mL, 100 mg/5 mL (concentrated); suppositories; ER tablets and capsules in multiple strengths; injectable 0.5-50 mg/mL (1) · IV 10 mg/mL, 40 mg/mL; inhaled 300 mg/5 mL solution (Tobi, Bethkis); Podhaler dry powder; 0.3% ophthalmic solution and ointment (1) · Nasonex 50 mcg/actuation intranasal; Asmanex HFA MDI 100/200 mcg; Asmanex Twisthaler DPI 110/220 mcg; Elocon 0.1% cream/ointment/lotion; Sinuva sinus implant; Dulera (with formoterol) (1) · Oral 100, 200 mg capsules (peanut oil; check allergy); 100 mg vaginal insert (Endometrin); 4%, 8% vaginal gel (Crinone); IM 50 mg/mL (1) · Pre-filled multi-dose pen (0.25 / 0.5 / 1 / 2 mg, Ozempic;'"`UNIQ--ref-00000248-QINU`"' 0.25 / 0.5 / 1 / 1.7 / 2.4 mg, Wegovy'"`UNIQ--ref-00000249-QINU`"') · Oral tablet 3 / 7 / 14 mg co-formulated with SNAC absorption enhancer (Rybelsus)'"`UNIQ--ref-0000024A-QINU`"' (1) · Pre-filled multi-dose pen (3 mL): Victoza 6 mg/mL (0.6 / 1.2 / 1.8 mg per day);'"`UNIQ--ref-00000183-QINU`"' Saxenda 6 mg/mL (0.6 / 1.2 / 1.8 / 2.4 / 3.0 mg per day)'"`UNIQ--ref-00000184-QINU`"' (1) · Pre-filled single-dose pen and vial: 2.5 / 5 / 7.5 / 10 / 12.5 / 15 mg'"`UNIQ--ref-000002FC-QINU`"''"`UNIQ--ref-000002FD-QINU`"' (1) · Pre-filled single-dose pen: 0.75 / 1.5 / 3 / 4.5 mg'"`UNIQ--ref-00000054-QINU`"' (1) · Pulmicort Flexhaler DPI 90, 180 mcg/dose; Pulmicort Respules 0.25, 0.5, 1 mg/2 mL nebulized; Rhinocort intranasal 32 mcg/spray; Entocort EC 3 mg capsules; Uceris 9 mg ER tablets and rectal foam (1) · Tablets 0.5, 1, 2 mg; oral concentrate 2 mg/mL; injection 2 mg/mL and 4 mg/mL; Loreev XR capsules 1, 2, 3 mg (1) · Tablets 10, 25, 50 mg (HCl); capsules 25, 50, 100 mg (pamoate); oral suspension 25 mg/5 mL; injection 25, 50 mg/mL (IM only, never IV) (1) · Tablets 500, 750 mg; injection 100 mg/mL (1) · Topical creams, ointments, lotions, dental paste (0.025-0.5%); Kenalog 10 mg/mL, 40 mg/mL injection; Nasacort 55 mcg/spray intranasal; oral inhaler discontinued in US (1)
routes: (Click arrow to add another value)
halflife:
1-2 hours'"`UNIQ--ref-00000017-QINU`"' (1) · 12-15 hours (intermediate); '''no active metabolites''' (key clinical feature)'"`UNIQ--ref-00000023-QINU`"' (1) · 14-25 hours (longer in elderly and hepatic impairment)'"`UNIQ--ref-00000026-QINU`"' (1) · 2-3 hours (normal renal function); markedly prolonged in renal impairment'"`UNIQ--ref-000010B3-QINU`"' (1) · 3-10 hours (low dose); 8-15 hours (high dose); much longer in third-space accumulation (pleural effusion, ascites)'"`UNIQ--ref-000007C8-QINU`"' (1) · Morphine 2-4 hours; morphine-6-glucuronide active metabolite 2-4 hours (longer with renal impairment)'"`UNIQ--ref-00000020-QINU`"' (1) · Plasma ~3-5 hours; biologic effect substantially longer (~12-36 hours for intermediate-acting glucocorticoids)'"`UNIQ--ref-00000666-QINU`"' (1) · ~13 hours'"`UNIQ--ref-0000018A-QINU`"' (1) · ~165 hours (~1 week), among the longest of any GLP-1 RA'"`UNIQ--ref-00000253-QINU`"' (1) · ~2-3.6 hours (plasma)'"`UNIQ--ref-000009A5-QINU`"' (1) · ~2.4 hours (Byetta, short, hence the BID schedule)'"`UNIQ--ref-000000ED-QINU`"' · Effective release half-life ~2 weeks (Bydureon)'"`UNIQ--ref-000000EE-QINU`"' (1) · ~5 days (~120 h)'"`UNIQ--ref-00000059-QINU`"' (1) · ~5 days (~120 h)'"`UNIQ--ref-00000303-QINU`"' (1) · ~5 hours (plasma)'"`UNIQ--ref-00000F9C-QINU`"' (1) · ~5-20 hours (oral micronized; highly variable)'"`UNIQ--ref-00000726-QINU`"' (1) · ~7.8 hours (fluticasone propionate, inhaled systemic exposure)'"`UNIQ--ref-000001DD-QINU`"' (1)
bioavailability:
60-70% PO at low doses; saturable at high doses (parenteral routes preferred above 15-25 mg/week)'"`UNIQ--ref-000007C9-QINU`"' (1) · <1% oral (extensive first-pass via CYP3A4); ~30% inhaled lung deposition'"`UNIQ--ref-000001DE-QINU`"' (1) · Intranasal: <1% systemic; inhaled lung deposition with extensive first-pass clearance'"`UNIQ--ref-00000F9D-QINU`"' (1) · IV/IM ~100%; inhaled: minimal systemic; oral: negligible (not used orally for systemic infection)'"`UNIQ--ref-000010B4-QINU`"' (1) · Oral: very low (extensive first-pass); micronization improves uptake somewhat. Vaginal: high local effect with lower systemic levels (first-uterine-pass concentration)'"`UNIQ--ref-00000727-QINU`"' (1) · SC ~47%–65%'"`UNIQ--ref-0000005A-QINU`"' (1) · SC ~55%'"`UNIQ--ref-0000018B-QINU`"' (1) · SC ~65%–75%<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · SC ~80%<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · SC ~89%<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> · Oral ~0.4–1% (SNAC-enhanced)'"`UNIQ--ref-00000254-QINU`"' (1) · Topical/intranasal: high local, low systemic; intra-articular: local depot then systemic absorption'"`UNIQ--ref-00000667-QINU`"' (1) · ~100% (oral; near-complete absorption)'"`UNIQ--ref-00000018-QINU`"' (1) · ~25-40% (oral; extensive first-pass)'"`UNIQ--ref-00000021-QINU`"' (1) · ~6-13% inhaled lung deposition; ~10% oral (Entocort EC; extensive first-pass via CYP3A4 — this is the basis of the favorable hepatic-targeted local-effect profile in IBD)'"`UNIQ--ref-000009A6-QINU`"' (1) · ~80% (oral)'"`UNIQ--ref-00000027-QINU`"' (1) · ~90% (oral)'"`UNIQ--ref-00000024-QINU`"' (1)
pregnancy:
None (2) · '''Contraindicated in pregnancy''' (Category X); abortifacient and teratogenic. Discontinuation 3-6 months before conception is standard.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Aminoglycoside-class ototoxicity in fetal cochlea is documented; use only when alternatives have failed.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Avoid. Discontinue at least 1 month before planned pregnancy. Animal data show embryofetal harm.'"`UNIQ--ref-0000005B-QINU`"' (1) · Avoid. Discontinue before planned pregnancy.'"`UNIQ--ref-000000EF-QINU`"' (1) · Avoid. Discontinue before planned pregnancy.'"`UNIQ--ref-0000018C-QINU`"' (1) · Avoid. Discontinue ≥1 month pre-conception. May reduce oral contraceptive efficacy during titration.'"`UNIQ--ref-00000304-QINU`"' (1) · Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Inhaled and intranasal generally considered safe; widely used in asthma in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Intranasal long considered acceptable; widely used in obstetric rhinitis.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; older agent with substantial use experience; some signal for first-trimester exposure but not conclusive.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Long the preferred ICS in pregnancy (Pulmicort) due to the most pregnancy data among the class.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Topical/intranasal generally low-risk; intra-articular and high-dose injection: weigh risk individually.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
OTC (intranasal Flonase) and [[USLegal:Prescription only|Rx-only]] (inhaled, topical) in US (1) · OTC (intranasal Rhinocort Allergy) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · OTC (lowest-strength topicals) and [[USLegal:Prescription only|Rx-only]] (higher strengths, injectable) in US (1) · OTC (Nasonex 24HR) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · Rx-only;'"`UNIQ--ref-0000005C-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-000000F0-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-0000018D-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-00000256-QINU`"' not a controlled substance (1) · Rx-only;'"`UNIQ--ref-00000305-QINU`"' not a controlled substance (1) · [[USLegal:Prescription only|Rx-only]] in US (3) · [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, distinguishing it from carisoprodol which is Schedule IV'"`UNIQ--ref-00000019-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance, which is a meaningful clinical advantage over the benzodiazepine alternatives for short-term anxiety'"`UNIQ--ref-00000028-QINU`"' (1) · [[USLegal:Schedule II|Schedule II controlled substance]] in US; WHO essential medicine'"`UNIQ--ref-00000022-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids'"`UNIQ--ref-00000025-QINU`"' (1)

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