A drug’s route of administration is a key consideration when providing palliative care at the end of life. Although the oral route is preferred in most settings, there are many circumstances where this is limited. Administration of medications via the rectum is an essential option that should be considered when oral intake becomes troublesome. Rectal administration of medicine has been used for centuries, dating back to the time of Hippocrates around 300 B.C.
Any oral medication can be placed into the rectum; however, there are many variables that will affect whether or not the drug is absorbed (form of drug, solubility, ionization, limited fluid in rectal cavity, need for active transport, influence of rectal microorganisms, and presence of fecal matter).
Clinical Tips for Rectal Administration:
- Ensure no fecal matter is in rectum prior to insertion of meds
- Insert drug about a fingers length (≈15 cm)
- Oral solutions may be administered via syringe to aid absorption
- 10 mL warm water may be used to facilitate dissolution of tablets
- 10-25 mL can generally be retained without difficulty
- Suppositories may be better retained if inserted base (blunt) end first
- Multiple oral tablets can be placed into a gelatin capsule for single administration