Editing Route of administration (section)

====Parenteral route====
[[File:Needle-insertion-angles-1.png|thumb|Needle insertion angles for 4 types of parenteral administration of medication: intramuscular, subcutaneous, intravenous, and intradermal injection.]]
The parenteral route is any route that is not [[Enteral administration|enteral]] (''[[wikt:para-#Etymology 1|par-]]'' + ''enteral'').

Parenteral administration can be performed by [[Injection (medicine)|injection]], that is, using a needle (usually a [[hypodermic needle]]) and a [[syringe]],<ref>{{cite web|url=http://dictionary.cambridge.org/dictionary/english/injection|title=injection|website=Cambridge dictionary|access-date=2017-07-30|archive-url=https://web.archive.org/web/20170730202011/http://dictionary.cambridge.org/dictionary/english/injection|archive-date=2017-07-30|url-status=live}}</ref> or by the insertion of an [[indwelling catheter]].

Locations of application of parenteral administration include:
* Central nervous system:
:* [[Epidural]] (synonym: peridural) (injection or infusion into the [[epidural space]]), e.g. epidural anesthesia.
:* Intracerebral (into the cerebrum) administration by direct injection into the brain. Used in experimental research of chemicals<ref>{{cite web |url=http://www.neurotransmitter.net/mdmametabolites.html |title=MDMA (ecstasy) metabolites and neurotoxicity: No occurrence of MDMA neurotoxicity from metabolites when injected directly into brain, study shows |publisher=Neurotransmitter.net |access-date=2010-08-19 |archive-url=https://web.archive.org/web/20100807215102/http://www.neurotransmitter.net/mdmametabolites.html |archive-date=2010-08-07 |url-status=live }}</ref> and as a treatment for malignancies of the brain.<ref>{{cite journal|title=A potential application for the intracerebral injection of drugs entrapped within liposomes in the treatment of human cerebral gliomas  |date=2010-07-06 |pmc=1028604|last2=Firth|first2=G|last3=Oliver|first3=S|last4=Uttley|first4=D|last5=O'Laoire|first5=S|volume=48|issue=12|pages=1213–1219|journal=Journal of Neurology, Neurosurgery, and Psychiatry|doi=10.1136/jnnp.48.12.1213|pmid=2418156|author=McKeran RO, Firth G, Oliver S, Uttley D, O'Laoire S}}</ref> The intracerebral route can also interrupt the blood brain barrier from holding up against subsequent routes.<ref>{{cite journal|title=Blood–brain barrier changes following intracerebral injection of human recombinant tumor necrosis factor-α in the rat |doi=10.1007/BF01057957 |volume=20 |journal=Journal of Neuro-Oncology |pages=17–25 |year=1994 |author=Wright JL, Merchant RE|issue=1 |pmid=7807180 |s2cid=12445653 }}</ref>
:* [[intracerebroventricular injection|Intracerebroventricular]] (into the cerebral ventricles) administration into the ventricular system of the brain. One use is as a last line of opioid treatment for terminal cancer patients with intractable [[cancer pain]].<ref>{{cite journal |url=http://www.anesthesia-analgesia.org/cgi/content/full/89/5/1209 |title=Acute Decreases in Cerebrospinal Fluid Glutathione Levels after Intracerebroventricular Morphine for Cancer Pain |publisher=Anesthesia-analgesia.org |date=1999-06-22 |doi=10.1213/00000539-199911000-00023 |access-date=2010-08-19 |archive-url=https://web.archive.org/web/20060106043224/http://www.anesthesia-analgesia.org/cgi/content/full/89/5/1209 |archive-date=2006-01-06 |url-status=live |last1=Goudas |first1=Leonidas C. |last2=Langlade |first2=Agnes |last3=Serrie |first3=Alain |last4=Matson |first4=Wayne |last5=Milbury |first5=Paul |last6=Thurel |first6=Claude |last7=Sandouk |first7=Pierre |last8=Carr |first8=Daniel B. |journal=Anesthesia & Analgesia |volume=89 |issue=5 |pages=1209–1215 }}</ref>

[[File:Applying transdermal patch.jpg|thumb|A transdermal patch which delivers medication is applied to the skin. The patch is labelled with the time and date of administration as well as the administrator's initials.]]
[[File:Instilling nasal medication.jpg|thumb|A medical professional applies nose drops.]]
* Epicutaneous (application onto the skin). It can be used both for local effect as in allergy testing and typical [[local anesthesia]], as well as [[:wikt:systemic|systemic]] effects when the active substance diffuses through skin in a [[transdermal]] route.
*{{Anchor|buccal}}Sublingual and buccal medication administration is a way of giving someone medicine orally (by mouth). [[Sublingual administration]] is when medication is placed under the tongue to be absorbed by the body. The word "sublingual" means "under the tongue." Buccal administration involves placement of the drug between the gums and the cheek. These medications can come in the form of tablets, films, or sprays. Many drugs are designed for sublingual administration, including cardiovascular drugs, steroids, barbiturates, opioid analgesics with poor gastrointestinal bioavailability, enzymes and, increasingly, vitamins and minerals.
* [[Extra-amniotic administration]], between the [[endometrium]] and [[fetal membranes]].
* [[Nasal administration]] (through the nose) can be used for topically acting substances, as well as for [[Insufflation (medicine)|insufflation]] of e.g. [[decongestant]] nasal sprays to be taken up along the [[respiratory tract]]. Such substances are also called ''inhalational'', e.g. [[inhalational anesthetics]].
* Intra-arterial (into an [[artery]]), e.g. [[vasodilator]] drugs in the treatment of [[vasospasm]] and [[thrombolytic drug]]s for treatment of [[embolism]].
* Intra-[[joint|articular]], into a joint space. It is generally performed by [[joint injection]]. It is mainly used for symptomatic relief in [[osteoarthritis]].
* [[Intracardiac]] (into the heart), e.g. [[adrenaline]] during [[cardiopulmonary resuscitation]] (no longer commonly performed).
* [[Intracavernous injection]], an injection into the base of the [[penis]].
* [[Intradermal]], (into the skin itself) is used for [[Skin allergy test|skin testing]] some [[allergens]], and also for [[mantoux test]] for [[tuberculosis]].
* Intralesional (into a skin lesion), is used for local skin lesions, e.g. acne medication.
* [[Intramuscular injection|Intramuscular]] (into a [[muscle]]), e.g. many [[vaccine]]s, antibiotics, and long-term psychoactive agents. Recreationally the colloquial term 'muscling' is used.<ref name="Fenway Community Health">{{cite web|url=http://www.fenwayhealth.org/site/PageServer?pagename=CM_efc_effects |website=Fenway Community Health|title = Crystal Meth: The Effects |publisher=[[Fenway Health]] |url-status = dead|archive-url = https://web.archive.org/web/20101210183228/http://www.fenwayhealth.org/site/PageServer?pagename=CM_efc_effects|archive-date = 10 December 2010}}</ref>
[[File:Instilling eye medication.jpg|thumb|Topical ocular administration]]
* Intraocular, into the eye, e.g., some medications for [[glaucoma]] or [[eye neoplasm]]s.
* [[Intraosseous infusion]] (into the [[bone]] marrow) is, in effect, an indirect intravenous access because the bone marrow drains directly into the venous system. This route is occasionally used for drugs and fluids in emergency medicine and pediatrics when intravenous access is difficult.
* [[intraperitoneal injection|Intraperitoneal]], (infusion or injection into the [[peritoneum]]) e.g. [[peritoneal dialysis]].
* [[Intrathecal]] (into the spinal canal) is most commonly used for spinal [[anesthesia]] and [[chemotherapy]].
* Intrauterine.
* [[Intravaginal administration]], in the [[vagina]].
* [[intravenous therapy|Intravenous]] (into a [[vein]]), e.g. many drugs, [[Parenteral nutrition|total parenteral nutrition]].
* [[Intravesical drug delivery|Intravesical]] infusion is into the urinary bladder.
* [[Intravitreal]], through the eye.
* Subcutaneous (under the skin).<ref>{{cite book|last=Malenka|first=Eric J. Nestler, Steven E. Hyman, Robert C.|title=Molecular Neuropharmacology: A Foundation for Clinical Neuroscience|year=2009|publisher=McGraw-Hill Medical|location=New York|isbn=978-0-07-148127-4|edition=2nd}}</ref> This generally takes the form of [[subcutaneous injection]], e.g. with [[insulin]]. [[Skin popping]] is a slang term that includes subcutaneous injection, and is usually used in association with [[recreational drugs]]. In addition to injection, it is also possible to slowly infuse fluids subcutaneously in the form of [[hypodermoclysis]].
* [[transdermal technology|Transdermal]] (diffusion through the intact skin for systemic rather than topical distribution), e.g. [[transdermal patch]]es such as [[fentanyl]] in pain therapy, [[nicotine]] patches for treatment of [[Substance use disorder|addiction]] and [[Glyceryl trinitrate (pharmacology)|nitroglycerine]] for treatment of [[angina pectoris]].
* [[Perivascular administration]] (perivascular medical devices and perivascular drug delivery systems are conceived for local application around a blood vessel during open vascular surgery).<ref>{{cite journal | author = Mylonaki I, Allémann É, Saucy F, Haefliger J-A, Delie F, Jordan O | year = 2017 | title = Perivascular medical devices and drug delivery systems: Making the right choices | url = https://archive-ouverte.unige.ch/unige:92897 | journal = Biomaterials | volume = 128 | pages = 56–68 | doi = 10.1016/j.biomaterials.2017.02.028 | pmid = 28288349 | access-date = 2020-03-23 | archive-date = 2020-04-23 | archive-url = https://web.archive.org/web/20200423234047/https://archive-ouverte.unige.ch/unige:92897 | url-status = live }}</ref>
* Transmucosal (diffusion through a mucous membrane), e.g. [[Insufflation (medicine)|insufflation]] (snorting) of [[cocaine]], [[sublingual]], i.e. under the tongue, [[Sublabial route of administration|sublabial]], i.e. between the lips and [[gingiva]], and oral spray or vaginal suppository for  [[nitroglycerine]].