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Dosage form

A dosage form is the physical form in which a pharmaceutical drug product is manufactured, packaged, and dispensed for administration to patients, incorporating active pharmaceutical ingredients (APIs) with excipients to ensure accurate dosing, stability, and bioavailability.^[1]^[2] Common examples include tablets, capsules, injectables, creams, and syrups, each tailored to specific routes of administration such as oral, topical, or parenteral to optimize therapeutic outcomes.^[3]^[4] Dosage forms play a critical role in pharmacotherapy by influencing drug release profiles, absorption rates, and patient adherence, ultimately impacting treatment efficacy, safety, and quality of life.^[2]^[5] They provide a structured platform for repeatable and precise dosing while protecting the API from degradation and facilitating targeted delivery to physiological sites.^[6] The selection and design of a dosage form must account for the drug's physicochemical properties, biopharmaceutical characteristics, and intended therapeutic use to minimize variability in clinical response.^[7] Pharmaceutical dosage forms are broadly classified into solid, semi-solid, liquid, and gaseous categories, with solid forms like tablets and capsules being the most prevalent due to their convenience, stability, and ease of manufacturing.^[8]^[3] Liquid forms, such as solutions and suspensions, offer advantages for pediatric or geriatric patients who may struggle with swallowing solids, while semi-solid forms like ointments and gels are suited for topical applications.^[9]^[4] Gaseous forms, including aerosols and inhalers, enable rapid pulmonary delivery for respiratory conditions.^[8] Advances in formulation technologies continue to innovate dosage forms, incorporating controlled-release mechanisms and patient-centric designs to enhance compliance and therapeutic precision.^[10]^[11]

Introduction

Definition

A dosage form is defined as the physical or chemical configuration in which an active pharmaceutical ingredient (API) is presented for administration to produce a therapeutic effect. It serves as the means by which drug molecules are delivered to sites of action within the body, incorporating the API with suitable excipients to facilitate safe and effective use. Common examples include tablets for oral ingestion, injections for parenteral delivery, and creams for topical application.^[12]^[13]^[1] Key characteristics of dosage forms include their ability to maintain the stability of the API against degradation, ensure appropriate bioavailability by controlling the rate and extent of drug release and absorption, and enhance patient compliance through user-friendly designs such as ease of swallowing or application. These attributes are critical in pharmaceutical formulation to optimize therapeutic outcomes while minimizing risks like instability or suboptimal absorption.^[14]^[15] The concept of dosage forms originated in the standardization efforts of early pharmacopeias, with the term formalized in the early 20th century through compendia like the United States Pharmacopeia (USP). The Pure Food and Drug Act of 1906 officially recognized USP standards for drug strength, quality, and purity, establishing a framework for consistent dosage form specifications.^[16]^[17]

Purpose and Benefits

Dosage forms serve as the physical embodiments of pharmaceutical products, enabling precise and reliable delivery of active pharmaceutical ingredients (APIs) to achieve therapeutic efficacy. Their primary purposes include facilitating accurate dosing to ensure patients receive the intended amount of drug, as uniform content in forms like tablets or capsules minimizes variability in administration. They also protect the API from environmental degradation, such as oxidation or hydrolysis, through protective coatings or encapsulations that maintain stability during storage and use. Additionally, dosage forms mask unpleasant tastes or odors inherent in certain APIs, improving palatability and patient acceptance, while offering ease of administration tailored to patient needs, such as swallowable solids or topical applications. Furthermore, they enable targeted release profiles, including immediate-release for rapid onset or sustained-release for prolonged effects, optimizing the drug's pharmacokinetic behavior.^[18] The benefits of diverse dosage forms extend to enhancing overall treatment outcomes by improving patient adherence through convenient and user-friendly designs, such as dissolvable films or pre-filled syringes that simplify self-administration and reduce dosing errors. Optimized routes of administration via specific forms increase bioavailability, allowing more of the API to reach systemic circulation by bypassing barriers like gastrointestinal degradation or first-pass metabolism. By localizing drug action, such as in topical or targeted oral forms, they minimize systemic exposure, thereby reducing the incidence and severity of side effects like gastrointestinal irritation or off-target toxicity. These advantages collectively contribute to better therapeutic compliance and efficacy across patient populations, including pediatrics and geriatrics.^[18]^[19]^[20] Dosage forms address key challenges in API stability, particularly for drugs sensitive to light, moisture, or pH, by incorporating opaque capsules or enteric coatings that shield the API from destructive environments until release at the target site. This protective role is crucial for maintaining potency in formulations exposed to varying storage conditions. On economic and regulatory fronts, standardization of dosage forms ensures reproducibility in manufacturing and consistent performance, as mandated by the U.S. Food and Drug Administration (FDA) guidelines stemming from the 1938 Federal Food, Drug, and Cosmetic Act, which required proof of safety and adequate labeling for proper use, thereby safeguarding public health through uniform quality control.^[18]^[21]^[22]

Classification

By Physical Form

Dosage forms are classified by physical form according to standards outlined in the United States Pharmacopeia (USP) General Chapter <1151>, which emphasizes physical characteristics such as state of matter, structure, and consistency to ensure manufacturability, stability, and suitability for patient administration. This classification provides a foundational taxonomy independent of the route of administration, focusing on how the form facilitates drug delivery, storage, and dosing while addressing potential challenges like bioavailability and patient compliance. For instance, physical forms are selected based on criteria including ease of production, content uniformity, and environmental stability, with testing protocols for disintegration, dissolution, and particle size distribution to verify performance.^[18] Solid dosage forms, such as tablets, capsules, and powders, consist of drug substances combined with excipients and processed into discrete units via compression, encapsulation, or simple mixing. Tablets are compressed solids often coated for protection or controlled release, while capsules enclose the drug in gelatin or alternative shells, and powders are finely divided particles for reconstitution or direct use. These forms offer advantages in ease of storage due to their stability against microbial contamination and chemical degradation when protected from moisture, as well as precise dosing through uniform content distribution verifiable by USP uniformity tests. However, they may pose swallowing difficulties for pediatric or geriatric patients, potentially requiring alternative presentations like chewable tablets or dispersible powders.^[18] Liquid dosage forms include solutions, suspensions, and emulsions, where the active ingredient is dissolved, dispersed, or emulsified in a vehicle to form a fluid preparation. Solutions provide clear, homogeneous delivery for rapid absorption, suspensions involve solid particles in a liquid that require shaking to prevent sedimentation, and emulsions stabilize immiscible phases for enhanced bioavailability of lipophilic drugs. These forms excel in dosing flexibility, particularly for pediatrics or patients with swallowing issues, as they can be measured volumetrically and flavored for palatability. Stability challenges, such as sedimentation in suspensions or phase separation in emulsions, necessitate preservatives and stabilizers, with storage in tight, light-resistant containers to maintain uniformity and prevent microbial growth.^[18] Semi-solid dosage forms, including ointments, creams, and gels, are viscous preparations designed for application to skin or mucous membranes, blending solid and liquid components for spreadability. Ointments use oleaginous bases for occlusion, creams are emulsions that are easily washed off, and gels form stiff networks via gelling agents like carbomers. Viscosity directly influences spreadability and contact time, enabling localized drug delivery with minimal systemic absorption, while bases like petrolatum enhance stability by protecting against evaporation. These forms are manufactured by incorporation or fusion methods to ensure homogeneity, but require careful storage below 30°C to avoid phase changes or drug migration.^[18] Gaseous dosage forms, such as aerosols and vapors, deliver drugs as fine mists, foams, or gases from pressurized containers, often using propellants for dispersion. Aerosols produce droplets or particles typically 1–5 μm for inhalation to reach the lungs or larger for topical use, while vapors involve volatile substances for respiratory administration. They provide rapid onset due to direct delivery to target sites like the lungs, bypassing first-pass metabolism. Challenges include achieving dose uniformity, as particle size and plume geometry affect deposition, requiring metered-dose valves and rigorous testing for content and delivery consistency per USP standards. Storage in cool conditions prevents propellant leakage or container rupture. Solid forms, while versatile, often overlap with oral routes for systemic delivery.^[18]

By Route of Administration

Dosage forms are classified by route of administration to ensure targeted drug delivery, optimizing therapeutic efficacy and patient safety across various physiological pathways.^[23] The primary routes include oral (enteral), which involves gastrointestinal absorption; parenteral, encompassing non-enteral injections such as intravenous, intramuscular, and subcutaneous; topical and transdermal for skin application; inhalation for pulmonary delivery; ophthalmic and otic for eye and ear administration; rectal and vaginal for local or systemic effects via mucosal membranes; and buccal or sublingual for absorption through oral mucosa.^[24] These routes determine how the drug interacts with the body, with physical forms like liquids often adapted for specific paths, such as oral solutions.^[23] The choice of route is influenced by key factors including the desired onset of action, where intravenous administration provides immediate effects for emergencies; bioavailability considerations, as non-oral routes bypass first-pass metabolism in the liver to enhance drug availability; and patient-specific conditions, such as unconsciousness requiring parenteral options for reliable delivery.^[25] Additional influences encompass drug stability, site of action, and overall convenience, ensuring the route aligns with pharmacological needs and clinical context.^[24] Standardization of routes is addressed by the ISO 11239:2023 standard, which defines structured data elements and hierarchies for pharmaceutical dose forms and routes of administration to facilitate global exchange of information and consistency in pharmacovigilance reporting.^[26] This framework supports regulatory harmonization by uniquely identifying routes, reducing errors in international drug labeling and surveillance.^[27] Historically, drug delivery relied predominantly on oral routes before the 1950s, with limited options for biologics due to gastrointestinal degradation. The discovery and introduction of insulin in 1921–1922 revolutionized this landscape by establishing parenteral injection as a vital route for proteins and peptides, expanding the repertoire of administration methods and enabling treatment of previously unmanageable conditions like diabetes.^[28] This evolution underscored the need for diverse routes to accommodate drug properties and therapeutic demands.^[24]

Oral Dosage Forms

Solid Forms

Solid oral dosage forms represent a primary category of pharmaceutical products designed for convenient oral administration, providing accurate dosing and stability for active ingredients. These forms, including tablets, capsules, powders, and granules, leverage the oral route's advantages such as patient compliance and ease of use without specialized equipment.^[29] Tablets are solid unit dosage forms produced by compressing a mixture of active pharmaceutical ingredients and excipients into various shapes, offering precise dosing and protection from environmental factors. Common types include immediate-release tablets, which disintegrate rapidly to facilitate quick drug release; enteric-coated tablets, which feature a polymer coating to protect acid-labile drugs from gastric degradation and prevent irritation to the stomach lining; and chewable tablets, intended to be masticated before swallowing to enhance palatability and absorption in patients with swallowing difficulties. Manufacturing methods for tablets typically involve wet granulation, where powders are agglomerated using a liquid binder to improve flow and compressibility, or direct compression, which blends dry powders and compresses them without granulation for simpler processing.^[9]^[30]^[31]^[32] Capsules consist of a shell enclosing the drug substance, available as hard gelatin capsules that contain dry powders, granules, or pellets, or soft gelatin capsules suitable for semisolid or liquid fills to accommodate oily or hydrophobic drugs. A key advantage of capsules is their ability to mask unpleasant tastes and odors of the active ingredient through the impermeable shell, improving patient acceptability. However, capsules can exhibit dissolution variability due to factors such as shell cross-linking or fill uniformity, potentially affecting drug release consistency.^[9]^[9]^[33] Powders and granules are finely divided solid forms that can be administered directly, mixed into foods, or reconstituted into liquids prior to use, making them particularly suitable for pediatric patients where flexibility in dosing is essential. These forms address flowability challenges through controlled particle size distribution, ensuring uniform dispensing and mixing; for instance, smaller particle sizes enhance dissolution but may require anti-caking agents to prevent aggregation.^[34]^[35] Common excipients in solid oral forms include binders such as starch, which promote adhesion during granulation and compression to form coherent units, and disintegrants like croscarmellose sodium, a superdisintegrant that swells upon contact with water to facilitate rapid breakup of the dosage form. These excipients are selected for their compatibility and functional roles in enhancing manufacturability and performance.^[36]^[6] Bioavailability of drugs from immediate-release solid forms depends on factors like disintegration and dissolution rates, with pharmacopeial standards typically requiring uncoated tablets to disintegrate within 15 minutes to ensure timely drug release in the gastrointestinal tract. This rapid disintegration, often extending to 15-30 minutes in practice for various formulations, supports effective absorption while minimizing variability.^[37]^[38]

Liquid Forms

Liquid oral dosage forms are pharmaceutical preparations in which the active ingredients are dissolved, dispersed, or emulsified in a liquid vehicle, facilitating easier swallowing and absorption compared to solid forms, particularly for pediatric, geriatric, or dysphagic patients. These forms include solutions, suspensions, and emulsions, each designed to ensure uniform distribution of the drug, stability, and palatability while minimizing risks such as microbial contamination or sedimentation. Formulation considerations prioritize bioavailability, with vehicles often incorporating sweeteners, flavors, or alcohol to enhance taste, though these can influence solubility and shelf life. According to the United States Pharmacopeia (USP), liquid oral forms must meet standards for clarity, viscosity, and content uniformity to guarantee therapeutic efficacy. Solutions represent the simplest liquid oral dosage forms, consisting of clear liquids where the active drug is fully dissolved in an aqueous or non-aqueous solvent, resulting in a homogeneous mixture that requires no shaking before administration. Common examples include syrups, elixirs, and tinctures; syrups use sugar solutions for viscosity and palatability, while elixirs often contain alcohol to solubilize poorly water-soluble drugs and act as a preservative. However, the aqueous nature of solutions predisposes them to microbial growth, necessitating the inclusion of preservatives such as parabens or benzoates at concentrations typically below 0.1-0.2% to inhibit bacteria and fungi without compromising safety. The World Health Organization (WHO) guidelines emphasize that alcohol content in elixirs should be minimized, especially for pediatric use, to avoid toxicity risks. Suspensions are heterogeneous liquid oral dosage forms in which insoluble solid particles of the active drug are uniformly dispersed in a liquid medium, requiring agitation to resuspend the particles before dosing to ensure accurate delivery. These are preferred for drugs with low solubility, such as certain antibiotics or antacids, where particle size control (often 1-50 micrometers) is critical to prevent rapid settling and maintain bioavailability. Flocculating agents, like poloxamers or bentonite, are incorporated to promote loose aggregation of particles, forming a floc that resuspends easily and avoids hard caking at the container bottom. The USP specifies that suspensions must demonstrate acceptable redispersibility, with sedimentation volume ratios approaching 1.0 for optimal performance. Emulsions are biphasic liquid oral dosage forms designed for hydrophobic drugs, typically formulated as oil-in-water systems where oil droplets (containing the drug) are dispersed in an aqueous phase, stabilized to prevent phase separation. This structure enhances the solubility and absorption of lipophilic compounds, such as vitamins A and D, by mimicking natural lipid digestion processes. Stabilizers like lecithin or polysorbates are essential, forming a protective interfacial film around droplets (usually 0.1-100 micrometers in diameter) to inhibit coalescence; without them, creaming or cracking can occur, reducing efficacy. Research in the Journal of Pharmaceutical Sciences highlights that emulsion stability is influenced by the HLB (hydrophilic-lipophilic balance) value of emulsifiers, ideally 8-18 for oil-in-water types.00002-0/fulltext) Accurate dosing of liquid oral forms is typically achieved using calibrated spoons, cups, or droppers, with volumes measured in milliliters for precision; however, challenges arise in pediatric administration. For example, acetaminophen oral suspensions for children are standardized at 160 mg per 5 mL (32 mg/mL), which, when used with provided dosing devices, helps reduce error risks in young children.^[39] The FDA recommends child-resistant packaging with clear measurement devices to mitigate over- or under-dosing, which can lead to therapeutic failures or toxicities. Variability in household spoons underscores the need for provided dosing tools, as studies show up to 20% dosing errors with improvised measures. Shelf-life stability of liquid oral dosage forms is governed by factors such as pH adjustment to 4-7, which optimizes drug solubility and minimizes hydrolysis or degradation, as outlined in pharmacopeial monographs like those from the European Pharmacopoeia. Preservatives and antioxidants further extend usability, with storage conditions (e.g., below 25°C) preventing microbial proliferation and chemical instability; for instance, buffered solutions maintain pH stability over 2-3 years under proper conditions. The International Pharmaceutical Federation (FIP) stresses that stability testing per ICH guidelines ensures these forms retain at least 90-110% of labeled potency throughout their shelf life.

Parenteral Dosage Forms

Injections

Injections represent a key category of parenteral dosage forms designed for direct delivery into the bloodstream or tissues, bypassing the gastrointestinal tract to enable rapid systemic absorption. This route is particularly valuable for achieving immediate therapeutic effects in emergencies, providing nutrition, or administering drugs that are poorly absorbed orally. Common administration methods include intravenous (IV) injections, which can be delivered as a bolus for quick action or as an infusion over time; intramuscular (IM) injections into muscle tissue; and subcutaneous (SC) injections into the fatty layer beneath the skin. Typical volumes vary by route: SC injections are limited to 0.5–2 mL to avoid discomfort and ensure absorption, IM injections range from 1–5 mL depending on muscle size, and IV injections can reach up to 100 mL for small-volume parenterals, with larger volumes possible via infusion.^[40]^[41]^[42]^[43] Injectable formulations are available as solutions, where the active ingredient is fully dissolved in a sterile vehicle for uniform dosing; suspensions, in which insoluble particles are dispersed, such as insulin suspensions for controlled release in diabetes management; and emulsions, particularly oil-in-water types used in lipid-based parenteral nutrition to supply essential fatty acids and calories. Solutions are the most straightforward and widely used, while suspensions and emulsions require careful shaking or mixing to maintain stability before administration. All injectables must adhere to stringent sterility requirements outlined in USP <797>, which governs compounding practices to prevent microbial contamination; key methods include aseptic filtration through 0.22-μm sterilizing-grade filters for heat-sensitive solutions and terminal autoclaving (steam under pressure) for heat-stable preparations to achieve a sterility assurance level of 10⁻⁶.^[24]^[44]^[45]^[46]^[47] Unintended ingredients in injectables must be tightly controlled to ensure safety; for instance, trace amounts of preservatives like benzyl alcohol (up to 1–2% w/v) are generally safe and used to prevent bacterial growth in multi-dose vials, though accumulation can pose risks in neonates. In contrast, unsafe contaminants such as bacterial endotoxins—lipopolysaccharides from Gram-negative bacteria—must be limited to below 5 EU/kg body weight per hour to avoid pyrogenic reactions like fever, chills, and hypotension, as specified in USP <85> Bacterial Endotoxins Test. The parenteral route facilitates rapid absorption, with onset times varying by method: IV administration provides immediate effects upon entry into circulation, IM injections typically begin within 15–30 minutes due to vascular muscle tissue, and SC injections follow shortly after, around 30 minutes, influenced by factors like drug solubility.^[48]^[49]^[50]^[51]^[52]^[42]

Implants and Inserts

Implants and inserts represent long-acting parenteral dosage forms designed for sustained drug release directly into systemic circulation, typically placed subcutaneously or intramuscularly to provide therapeutic levels over extended periods, from months to years. These forms are particularly useful for medications requiring consistent dosing to manage chronic conditions, minimizing fluctuations in plasma concentrations that could lead to suboptimal efficacy or side effects. Common materials include biocompatible polymers that control drug diffusion or matrix erosion to achieve predictable release profiles. Subcutaneous implants often utilize biodegradable polymers such as poly(lactic-co-glycolic acid) (PLGA), which degrade hydrolytically into non-toxic byproducts, facilitating controlled release of hormones without the need for surgical removal. For instance, Zoladex (goserelin acetate implant) employs a PLGA matrix to deliver the gonadotropin-releasing hormone agonist for treating hormone-sensitive cancers, maintaining therapeutic levels for 28 days with the 3.6 mg formulation or up to 12 weeks with the 10.8 mg version. Another historical example, Norplant, consisted of six silastic (non-biodegradable polydimethylsiloxane) capsules containing levonorgestrel, providing contraceptive protection through steady release for up to 5 years before removal. In contrast, intramuscular inserts, such as testosterone pellets (e.g., Testopel), are small cylindrical implants (75 mg each) inserted via a trocar needle into the subcutaneous tissue of the hip or buttock under local anesthesia, releasing the hormone over 3 to 6 months to treat hypogonadism; typically, 6 to 12 pellets are placed in a single procedure to achieve the desired dose of 150-450 mg.^[53] Drug release from these implants primarily occurs through diffusion, where the active pharmaceutical ingredient migrates across a polymer membrane or matrix driven by concentration gradients, or through erosion, involving gradual polymer degradation that exposes embedded drug. Many designs aim for zero-order kinetics to ensure a constant release rate, independent of remaining drug concentration, described by the equation:

\frac{dM}{dt} = k \cdot A \cdot C_s

where \frac{dM}{dt} is the release rate, k is the diffusion coefficient, A is the surface area, and C_s is the drug solubility at the implant surface under sink conditions. This profile is advantageous for maintaining steady-state plasma levels, as seen in PLGA-based systems where initial diffusion is followed by erosion-dominated release.^[54]^[55] The primary advantages of implants and inserts include enhanced patient compliance for chronic therapies, as they eliminate daily dosing and reduce the burden on patients with conditions like opioid dependence or hormone deficiencies; for example, a single insertion can provide months of treatment, improving adherence rates compared to oral or injectable alternatives. However, challenges include potential infection risks at the insertion site due to the invasive procedure, which can lead to localized inflammation or abscess formation if not performed aseptically, and difficulties in removal for non-biodegradable systems, which may require minor surgery and carry additional procedural risks. Regulatory oversight is stringent, with the U.S. Food and Drug Administration (FDA) approving such devices only after demonstrating safety and efficacy; notable examples include Probuphine (buprenorphine implant) approved in 2016 but discontinued in 2020 for maintenance treatment of opioid use disorder, providing 6 months of subdermal release via four ethylene-vinyl acetate rods.^[56]^[57]^[58]^[59]

Topical and Transdermal Dosage Forms

Semi-Solid Forms

Semi-solid dosage forms for topical application to the skin include ointments, creams, gels, and pastes, designed to deliver active ingredients locally for conditions such as infections, inflammation, or wounds, while providing occlusion to enhance penetration and hydration.^[60] These forms are anhydrous or aqueous-based, with ointments typically using hydrophobic bases like petrolatum or lanolin for prolonged contact and emollient effects, ideal for dry or scaly skin but potentially occlusive and greasy.^[60] Creams, as oil-in-water emulsions, offer a lighter, non-greasy feel suitable for moist lesions, allowing easier spreading and cleansing, though they may require more frequent application due to lower occlusion.^[61] Gels, transparent and water-based with gelling agents like carbomer or hydroxypropyl methylcellulose, provide quick absorption and are preferred for hairy areas or when a cooling sensation is desired, such as in pruritus or acne treatments.^[60] Pastes, incorporating high concentrations of powders (e.g., zinc oxide) in a semi-solid base, form a protective barrier for highly irritated skin, reducing irritation from excipients and used in diaper rash or minor burns, but their thickness limits spreadability.^[62] Advantages of these forms include enhanced drug retention, protection from environmental factors, and improved patient adherence for chronic conditions, with contact times varying from hours (creams/gels) to days (pastes). Disadvantages encompass potential for allergic reactions to bases, messiness, and staining, necessitating selection based on skin type and lesion characteristics.^[60] Transdermal patches represent a key semi-solid or matrix-based form for systemic delivery, consisting of an adhesive layer with drug reservoir or matrix (often polymeric with enhancers like alcohols), a backing film, and release liner, applied to intact skin for controlled release over 1–7 days.^[63] Examples include nicotine patches for smoking cessation or fentanyl for pain management, offering steady plasma levels, bypassing first-pass metabolism, and improved compliance, though skin irritation or adhesion issues can occur. Formulation emphasizes uniform drug distribution, permeation enhancers, and biocompatibility to achieve therapeutic flux rates of 5–20 µg/cm²/h depending on the drug.^[63]^[64] Sterility is not typically required for intact skin applications, but preservation against microbial growth is essential, often using parabens or phenoxyethanol, with pH adjusted to 4.5–6.5 for skin compatibility. Packaging in jars, tubes, or single-use sachets (e.g., 15–30 g for creams) ensures stability and ease of use.^[60]

Liquid and Spray Forms

Liquid and spray forms represent fluid topical dosage forms designed for non-occlusive application to the skin, facilitating even distribution of active ingredients without the adherence or viscosity of semi-solid preparations. These forms are particularly suited for treating large or hairy skin areas, where they provide a cooling effect through evaporation and minimize greasiness, though they may require frequent reapplication due to potential loss from evaporation.^[61]^[65] Lotions are typically suspensions or emulsions consisting of an aqueous base with insoluble drug particles dispersed in it, requiring vigorous shaking before use to ensure uniform redispersion of the solids. They are ideal for application on hairy regions such as the scalp, where their fluid nature allows easy spreading without clogging follicles, and are commonly employed as antipruritics to relieve itching in conditions like dermatitis or insect bites, as exemplified by calamine lotion formulations. The evaporative cooling provided by lotions aids in soothing inflamed or exudative skin, though their lower occlusivity limits prolonged hydration compared to thicker vehicles.^[65]^[61]^[66] Sprays deliver medication via aerosolization, utilizing either propellant-driven systems with liquefied gases like hydrocarbons or pump mechanisms with compressed gases such as nitrogen, enabling non-contact application to broad or hard-to-reach areas. In topical use, these sprays achieve dose uniformity through metered valves that dispense 50-100 µL per actuation, producing droplets of 50-100 μm for optimal cutaneous coverage without excessive runoff. They are formulated as solutions or suspensions in volatile solvents, promoting rapid absorption and reducing the risk of contamination from manual spreading.^[67]^[61] Non-patch transdermal liquids, such as solutions or sprayable formulations, incorporate permeation enhancers and solvents to facilitate systemic drug delivery through the skin without adhesive matrices, relying on simple application and natural evaporation for adherence. These forms often include mild adhesives or film-formers in low concentrations to aid temporary fixation, but prioritize fluidity for even transdermal flux, as seen in certain hormone or analgesic solutions.^[68] Key advantages of liquid and spray forms include their ability to achieve uniform distribution over large surface areas (up to 15-20% of body surface) and reduced greasiness, enhancing patient compliance for conditions requiring non-occlusive therapy. However, disadvantages encompass potential evaporation losses that diminish drug reservoir on the skin, risk of stinging from volatile components, and flammability in propellant-based sprays. Compared to semi-solids, these forms offer less occlusion but greater ease in hairy or intertriginous areas.^[61]^[67] Formulation of these dosage forms commonly employs alcohols like ethanol or isopropanol as solvents to dissolve lipophilic actives and enhance penetration, combined with water or glycols for stability, while maintaining a pH range of 5-7 to ensure compatibility with the skin's natural acidity and minimize irritation. Propellants or pumps are selected based on the desired spray pattern, with surfactants added to suspensions like lotions for better dispersibility.^[61]^[67]^[69]

Inhalation and Nasal Dosage Forms

Aerosols and Inhalers

Aerosols and inhalers represent pressurized dosage forms designed for targeted delivery of medications to the respiratory tract, including the lungs and nasal passages, via fine mist or spray generation. These systems facilitate rapid onset of action for conditions such as asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis by enabling direct mucosal absorption. Common propellants in modern formulations include hydrofluoroalkanes (HFAs), which replaced chlorofluorocarbons (CFCs) following the 2008 U.S. Food and Drug Administration (FDA) mandate to phase out CFCs due to their ozone-depleting effects.^[70] This transition improved environmental safety while maintaining therapeutic efficacy in inhalation delivery.^[71] Metered-dose inhalers (MDIs) are portable devices that deliver a precise, metered volume of aerosolized medication upon actuation, typically using HFA propellants to suspend or dissolve the active ingredient. For bronchodilators like albuterol, each puff delivers 50-100 µg of drug, allowing for quick relief of bronchospasm with 1-2 actuations as needed.^[72] The aerosol plume from MDIs consists of droplets that evaporate rapidly into respirable particles, ideally 1-5 µm in aerodynamic diameter for optimal lung penetration. Nebulizers, in contrast, convert liquid formulations into a continuous mist without propellants, using compressed air, ultrasound, or vibrating mesh technology; they are particularly suited for hospital settings or patients unable to coordinate inhalation, with typical fill volumes of 2-10 mL for sustained delivery over 5-15 minutes.^[73] Nasal sprays, a subset of aerosol systems, target the nasal mucosa for local treatment of allergies and inflammation, exemplified by fluticasone propionate, which reduces symptoms like congestion and sneezing through corticosteroid action. Formulations often incorporate mucoadhesive polymers, such as cellulose derivatives, to enhance drug retention on the nasal epithelium by prolonging contact time and resisting mucociliary clearance.^[74] Unintended ingredients in aerosols, including excipients or manufacturing residues, must be minimized; while HFAs are generally safe and non-irritating, particulates larger than 10 µm can deposit in the oropharynx, leading to throat irritation, dryness, or coughing due to local inflammatory responses.^[75] In terms of deposition, only 10-20% of the emitted dose from MDIs reaches the lungs, with the majority (50-80%) impacting the oropharyngeal region due to inertial impaction of larger droplets; the remainder is swallowed or exhaled.^[76] This low efficiency underscores the importance of proper inhalation technique, such as using spacers to reduce oropharyngeal deposition and enhance lung delivery. For nasal aerosols, deposition is more localized to the nasal cavity, with mucoadhesive enhancements improving bioavailability by 20-50% compared to non-adhesive formulations.^[77]

Dry Powder Forms

Dry powder forms represent a class of non-pressurized inhalation dosage forms designed for targeted delivery to the pulmonary or nasal regions, relying on the patient's inspiratory airflow to disperse the powder. These forms consist of finely milled active pharmaceutical ingredients (APIs) blended with excipients to facilitate aerosolization and deposition in the respiratory tract. Unlike pressurized aerosols, which eject medication via propellants, dry powders are breath-actuated and do not require precise coordination between device activation and inhalation.^[78] Dry powder inhalers (DPIs) are the primary devices for pulmonary delivery, containing micronized API particles typically sized 1-5 µm to ensure deep lung penetration. These particles are often blended with larger carrier particles, such as lactose (around 40-100 µm), to improve powder flowability and prevent aggregation during storage and handling. Upon inhalation, the patient's breath generates shear forces and turbulence that deaggregate the powder into respirable agglomerates, with the fine particle fraction (FPF)—the proportion of particles under 5 µm—needing to exceed 20% (often achieving ~30% in modern formulations) for effective therapeutic deposition in the alveoli.^[79]^[78] Nasal dry powders extend this approach to intranasal administration, particularly for vaccines, where the formulation enhances mucosal contact for rapid absorption through the nasal epithelium. These powders, often produced via spray drying or freeze drying with mucoadhesive excipients like chitosan, increase residence time in the nasal cavity compared to liquid forms, promoting quicker uptake and immune response activation at the nose-associated lymphoid tissue. Preclinical studies have demonstrated their feasibility for antigens such as influenza and norovirus, yielding both mucosal and systemic immunity with reduced dosing needs.^[77]^[80] Key advantages of dry powder forms include high portability, as they require no propellants or refrigerants, making them stable and user-friendly for chronic conditions like asthma. However, they are sensitive to humidity, which can cause particle clumping and reduce dispersibility, and efficacy depends on the patient's ability to generate sufficient inspiratory flow (typically ≥30 L/min). A seminal example is the Turbuhaler, a multi-dose DPI introduced in 1988 for budesonide delivery in asthma treatment, which pioneered carrier-free formulations for consistent dosing.^[79]^[78]^[81]

Ophthalmic and Otic Dosage Forms

Solutions and Suspensions

Solutions and suspensions represent key sterile liquid dosage forms designed for precise administration to the ocular and otic surfaces, ensuring therapeutic efficacy while minimizing irritation to sensitive tissues. Ophthalmic solutions, commonly known as eye drops, are typically formulated as isotonic aqueous vehicles with a tonicity equivalent to 0.9% sodium chloride to prevent discomfort or corneal damage upon instillation.^[82] These solutions are buffered to a physiological pH of approximately 7.4 to maintain ocular compatibility, often using phosphate-buffered saline systems.^[83] Preservatives such as benzalkonium chloride at concentrations of 0.01% are incorporated in multi-dose containers to inhibit microbial growth, though preservative-free formulations are preferred for patients with sensitivities or prolonged use.^[84] Otic solutions, or ear drops, are similarly sterile aqueous preparations primarily indicated for treating outer and middle ear infections caused by susceptible pathogens.^[85] Common active ingredients include antibiotics like ofloxacin or ciprofloxacin combined with corticosteroids for anti-inflammatory effects. To enhance patient comfort and avoid adverse effects such as dizziness from caloric stimulation of the vestibular system, these solutions should be warmed by holding the bottle in the hand for one to two minutes prior to administration.^[86] The dropper tip is positioned carefully to direct the solution into the ear canal without contamination. In contrast to clear solutions, ophthalmic suspensions are biphasic systems used to deliver poorly water-soluble drugs, such as corticosteroids like prednisolone acetate, which provide sustained release for conditions like uveitis or post-surgical inflammation.^[87] Uniform dosing is critical in suspensions due to particle settling; therefore, the container must be vigorously shaken immediately before each use to resuspend the active particles and ensure consistent drug delivery per drop.^[88] This shaking step distinguishes suspensions from solutions and helps maintain therapeutic concentrations despite the limited retention time in the eye. The administered volume of these dosage forms is optimized for the anatomy of the eye and ear. A typical ophthalmic drop delivers 30–50 µL, but the conjunctival sac maintains a normal tear volume of approximately 7–10 µL and can accommodate up to ~30 µL; however, due to rapid drainage via nasolacrimal outflow and overflow, only ~1–5 µL is retained on the ocular surface for absorption.^[89] Bottles are often sized at 2.5–5 mL for multi-dose use, though smaller 0.5–1 mL single-dose units are available for preservative-free options to reduce contamination risk. Otic drops follow similar volume principles, with 4–10 drops (approximately 0.2–0.5 mL total) per administration depending on age and condition severity. Sterility is paramount for both ophthalmic and otic solutions and suspensions to prevent endogenous infections in these immunologically privileged sites. Compliance with United States Pharmacopeia (USP) standards, including <71> for sterility testing via membrane filtration or direct inoculation methods, ensures absence of viable microorganisms. For ophthalmic products, USP <771> outlines quality tests, including assessments for particulate matter and tonicity (typically 0.5%–5% sodium chloride equivalents); isotonicity is verified using methods such as osmometry to ensure compatibility and prevent irritation. Preservative-free formulations, while reducing toxicity, lack antimicrobial protection beyond the initial manufacturing sterility; thus, preservative-free multi-dose containers should not be used beyond 28 days post-opening or as specified by the manufacturer (e.g., per USP <797> for compounded preparations: 4 days at controlled room temperature or 10 days refrigerated) to mitigate contamination risks.^[90] In brief, while semi-solid forms may offer prolonged contact for lubrication, solutions and suspensions prioritize rapid, drop-wise delivery for acute therapeutic needs.

Semi-Solid Forms

Semi-solid dosage forms for ophthalmic and otic administration are designed to provide viscous, adherent vehicles that enhance drug retention on delicate mucous membranes, thereby promoting sustained local therapeutic effects compared to more rapidly cleared liquid forms such as solutions used for initial acute treatments.^[91]^[92] Ophthalmic ointments, typically formulated with a petrolatum base, are applied at bedtime to leverage their prolonged residence time while minimizing interference with daily activities.^[91]^[93] The high viscosity of these ointments causes temporary blurred vision due to their slow clearance by tear fluid compared to liquids, allowing contact durations of up to several hours.^[91]^[82] In contrast, ophthalmic gels often employ in situ gelling systems, such as those triggered by temperature or pH changes using polymers like poloxamer or chitosan, to form a gel upon application and achieve extended retention.^[94] For example, timolol maleate gel-forming solutions have demonstrated sustained intraocular pressure reduction over 12 weeks with once-daily dosing, attributed to improved mucoadhesion and drug release profiles.^[95]^[96] For otic applications, semi-solid forms like ointments and gels utilize waxy bases, such as those incorporating glycerin or olive oil derivatives, to soften cerumen and facilitate its removal while providing localized treatment for external ear conditions.^[97]^[98] These preparations adhere to the ear canal lining, enabling prolonged drug contact that supports efficacy in antimicrobial or anti-inflammatory therapies.^[99] Overall, semi-solid forms offer advantages including extended contact times of up to 12 hours in some ophthalmic gel systems, which enhance bioavailability and reduce dosing frequency, though they present disadvantages such as messiness during application and potential for temporary visual impairment.^[94]^[99] Formulation of these semi-solids emphasizes sterility to prevent contamination of sensitive ocular and aural tissues, often achieved through aseptic processing and sterilization of components like petrolatum bases.^[91]^[100] Preservative-free options are preferred to avoid irritation, particularly in unit-dose tubes that limit microbial ingress and ensure single-use hygiene, with typical volumes around 3.5 grams for ointments.^[91]^[100]^[101] Similar sterile, preservative-free principles apply to otic semi-solids, packaged in collapsible tubes to maintain integrity during external application.^[98]

Other Dosage Forms

Rectal and Vaginal Forms

Rectal and vaginal dosage forms are mucosal administration routes designed for both local and systemic drug delivery, offering advantages such as partial avoidance of hepatic first-pass metabolism and targeted therapy for conditions affecting the lower gastrointestinal or genitourinary tracts. These forms include solid, semi-solid, and insertable devices that dissolve, melt, or release active ingredients upon insertion, providing reliable absorption through the rich vascularization of the rectal and vaginal mucosae.^[102] Suppositories represent a primary rectal dosage form, consisting of drug substances dispersed in a base that melts or softens at body temperature to release the medication. Common bases include cocoa butter (Theobroma oil), which has a melting point near 37°C, allowing it to liquefy in the rectum for effective drug dispersion. Glycerin-based suppositories, often used as laxatives, draw water into the rectum to stimulate bowel movements without systemic absorption. For antiemetics, rectal suppositories such as promethazine or prochlorperazine provide nausea relief when oral administration is not feasible, melting to deliver the drug locally and systemically.^[103]^[104]^[105]^[106]^[107] Vaginal dosage forms, including tablets and creams, are formulated for local treatment of infections while maintaining compatibility with the vaginal environment's acidic pH of 4.0–5.5, which is preserved by lactobacilli to inhibit pathogen growth. Vaginal tablets dissolve upon insertion to release antifungals directly onto the mucosa, whereas creams, applied via applicator, provide lubrication and prolonged contact for better efficacy. For example, miconazole nitrate in 2% or 4% creams or 100–200 mg suppositories treats vulvovaginal candidiasis over 3–7 days, with formulations designed to avoid disrupting the natural pH balance.^[108]^[109]^[110] Rectal administration enhances bioavailability for certain drugs by partially bypassing the hepatic first-pass effect, with approximately 50% of absorbed drug entering systemic circulation directly via the inferior and middle rectal veins, avoiding liver metabolism. Vaginal delivery similarly supports systemic hormone therapy, as the vaginal epithelium facilitates efficient absorption of estrogens without gastrointestinal interference, leading to sustained serum levels for conditions like menopausal symptoms; combined formulations also enable absorption of progestins for contraception.^[102]^[111]^[112] Insertable devices, such as vaginal rings, offer controlled release for extended periods. The NuvaRing, a flexible ethylene vinyl acetate copolymer ring, releases etonogestrel (0.120 mg/day) and ethinyl estradiol (0.015 mg/day) over 21 days when inserted into the vagina, providing contraceptive efficacy through steady hormonal absorption while minimizing daily dosing.^[112] Patient factors significantly influence the success of rectal and vaginal administration, including proper positioning to ensure retention and minimize expulsion. For rectal suppositories, patients should lie on their left side with knees drawn up, remaining in position for 15–30 minutes post-insertion to promote melting and absorption. Vaginal forms require supine positioning during application to aid retention, particularly for creams or rings. Irritation risks, such as mucosal burning or inflammation, can arise from pH-altering excipients or allergic reactions, necessitating monitoring for symptoms like itching or discharge; glycerin or lipid bases are selected to reduce such effects.^[113]^[114]^[102]^[115]

Buccal and Sublingual Forms

Buccal and sublingual dosage forms are pharmaceutical preparations designed for administration within the oral cavity, specifically targeting the buccal mucosa (inner cheek) or sublingual mucosa (under the tongue), to facilitate rapid drug absorption directly into the systemic circulation while bypassing the gastrointestinal tract and hepatic first-pass metabolism.^[116] These forms are particularly advantageous for drugs prone to degradation or those requiring quick onset of action, leveraging the rich vascular supply of the oral mucosa for efficient delivery.^[117] Lozenges are solid, hard candy-like dosage forms composed of a sucrose or sugar alcohol base that dissolve slowly in the mouth, providing localized soothing effects or sustained release for systemic absorption.^[118] They are commonly used for antitussive or antiseptic purposes but can deliver systemic drugs like nicotine for smoking cessation.^[116] Films and strips consist of thin, dissolvable polymer matrices, often mucoadhesive, that adhere to the oral mucosa and disintegrate rapidly, typically within 5 minutes, to release the active ingredient.^[117] Examples include nicotine replacement therapy strips for smoking cessation and buprenorphine films for opioid dependence treatment, offering convenient, non-invasive administration.^[119] Sublingual tablets are compressed formulations placed under the tongue, where they disintegrate quickly to enable direct absorption through the highly permeable sublingual mucosa.^[118] A classic example is nitroglycerin tablets, used for rapid relief of angina by providing coronary vasodilation within minutes.^[116] These dosage forms offer key advantages, including improved bioavailability for many drugs due to the oral mucosa's extensive vascularity and avoidance of gastrointestinal barriers.^[117] They are ideal for patients with dysphagia, as no swallowing is required, and provide faster onset compared to other mucosal routes like rectal administration.^[119] Formulation strategies for buccal and sublingual forms emphasize taste-masking to enhance patient compliance, often using sweeteners, flavors, or complexation agents to obscure bitter tastes.^[116] Permeation enhancers, such as cyclodextrins, are incorporated to improve drug solubility and mucosal penetration, thereby optimizing absorption without causing irritation.^[118]

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Glycerin dosing, indications, interactions, adverse effects, and more
Dosage Forms & Strengths. suppositories. 1g; 1.5g; 2g; 2.1g; 2.8g. Constipation. 2-6 ... Warnings. Contraindications. GI obstruction, severe impaction. Cautions.
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Promethazine (rectal route) - Side effects & dosage - Mayo Clinic
Promethazine is used to relieve or prevent the symptoms of hay fever, allergic conjunctivitis (inflammation of the eye), and other types of allergy or allergic ...
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Prochlorperazine (rectal route) - Side effects & dosage - Mayo Clinic
Prochlorperazine suppository is used to control severe nausea and vomiting. This medicine should not be used to treat behavioral problems in older adult ...
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Vaginal Drug Delivery - an overview | ScienceDirect Topics
Lactobacilli contribute significantly to vaginal health and in maintaining the vaginal pH in the range of 4.0–5.5 (Valenta, 2005). As pathogens cannot survive ...
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Miconazole for the treatment of vulvovaginal candidiasis. In vitro, in ...
Vaginal creams, suppositories and tablets for vaginal candidiasis are used once a day for 1–7 days, preferably at bedtime, to facilitate retention. Most vaginal ...Imidazoles And Triazoles · Vaginal Application · The Antifungal Miconazole
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Miconazole vaginal - Uses, Side Effects, and More - WebMD
May 12, 2024 · How is vaginal miconazole supplied (dosage forms)? · 2% vaginal cream · 4% vaginal cream · 100 mg vaginal suppository · 200 mg vaginal suppository ...
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Systemic Effects of Vaginally Administered Estrogen Therapy
This article reviews the systemic effects of vaginally administered estrogen. Effects on serum hormone levels, vasomotor symptoms, lipid profiles and use in ...
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[PDF] Nuv aRing® (etonogestrel/ethinyl estradiol v aginal ring)
One NuvaRing is inserted in the vagina. The ring is to remain in place continuously for three weeks. It is removed for a one-week break, during which a ...
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Rectal Suppository: Positions, Tips, Side Effects - Healthline
Jun 6, 2022 · Overall, the recommended position for rectal suppository administration is on your side. This allows for easy access to the buttocks during ...
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Rectal drug administration in adults: how, when, why | Nursing Times
Feb 22, 2016 · Ask the patient to remain in the left lateral position for at least 30 minutes to aid retention. Raising the foot of the bed may also help.
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Clotrimazole vaginal - Uses, Side Effects, and More - WebMD
Nov 6, 2024 · The most common side effect of vaginal clotrimazole is mild vaginal burning, itching, or irritation. Tell your healthcare provider if you have ...
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Advances in Nanoparticulate Drug Delivery Approaches for ... - NIH
This review will focus on the physiological aspects that influence buccal and sublingual drug delivery and the advances in nanoparticulate drug delivery ...
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Bioavailability Enhancement and Formulation Technologies of Oral ...
Jan 22, 2025 · Both approaches (sweeteners and advanced technological taste masking) aim to enhance the palatability of pharmaceutical products by reducement ...Missing: capsules | Show results with:capsules
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A review on bioadhesive buccal drug delivery systems - NIH
Solid buccal adhesive dosage forms. They are dry formulations which achieve bioadhesion via dehydration of the local mucosal surface.
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Sublingual and Buccal Delivery: A Historical and Scientific Prescriptive
Aug 20, 2025 · In this review, our intention was to shed some light on the history of sublingual and buccal delivery over the past 75 years.