Gynecological vaginal inflammatory diseases are common infectious diseases of female genital organs, such as bacterial vaginosis, Candida vaginitis, trichomonas vaginitis, and senile vaginitis. Currently, clinical treatment mostly uses topical topical drugs, and statistics show that both the type and number of drugs used to treat gynecologic vaginal inflammatory diseases are increasing year by year. Although topical gynecological drugs have the advantages of direct local action, less adverse reactions and easy acceptance by doctors and patients, there are many drug forms and each form has its own characteristics. Therefore, it is important to understand the characteristics of various topical drug dosage forms to promote the correct and reasonable use of topical drugs for the prevention and treatment of gynecological diseases. The following is a description of the dosage form characteristics and rational application of gynecological topical drugs.
1.Dosage form characteristics
(1) Suppositories: solid preparations made of drugs and suitable substrates with certain shapes for intracorporeal drug delivery. Suppositories commonly used in gynecology are vaginal suppositories, urethral suppositories, anal suppositories, etc., with shapes such as duckbill, torpedo, cylindrical, spherical, ovoid, etc. The characteristics are: localized medication, and the use of the drug in the human body. Its characteristics are: local medication, direct action, pain relief, itching, antibacterial and anti-inflammatory fast, not subject to the destruction of the gastrointestinal pH and enzymes and other heart]. The suppository slowly melts and releases the drug at body temperature after use.
(2) Ointment: refers to the drug and a suitable matrix evenly mixed with a certain consistency of semi-solid topical preparations. According to the different matrix, it can be divided into solution type, suspension type and cream agent. Gynecological commonly used ointment is mainly for protection, lubrication and local treatment. Its characteristics are: good spreadability, conducive to the release, penetration and absorption of drugs, can be directly coated on the affected area, the effect is direct and faster. Emulsion is a common form of ointment, which is a semi-solid topical preparation made by adding the drug into the emulsion matrix. Emulsion can promote the dissolution and dispersion of drugs, absorb skin mucous membrane secretions, and have a protective, lubricating, anti-cracking effect on the skin, mucous membranes, without affecting the normal heat dissipation of the skin. It has the characteristics of easy to apply, easy to wash off and apply directly to the affected part.
(3) effervescent agent: refers to tablets, capsules or suppositories containing effervescent disintegrants (such as sodium bicarbonate and citric acid and other substances in pairs to constitute the} kunnels). It is characterized by the fast disintegration and release of drugs under the action of effervescent agents, which can rapidly reach and evenly disperse in the lesion and avoid irritation caused by high local drug concentration.
(4) Capsules: solid preparations made by filling drugs in hollow hard capsules or sealed in flexible soft capsules, which are characterized by improved stability and bioavailability of drugs. Vaginal capsules are mostly hard capsules, which can be located in the vaginal lesion, disintegrate, dissolve and slowly release the drug to work.
(5) Irrigation agent: It is a liquid preparation for external use to clean the vagina and urethra. It is used to wash the mucous membrane or to wash away some pathological foreign bodies, etc. It is antiseptic, astringent and cleansing. Its characteristic is to play a direct and rapid role.
(6) gel: refers to the drug and suitable excipients made of uniform, mixed or emulsion-type latex thick liquid or semi-solid preparations. Gynecological local gel agent is a single dispersion system, and is divided into two types of water-based gel agent and oil-based gel agent, the clinical
More clinical applications are water-based gels. Its characteristics are: easy to spread, wash off, no greasy feeling, can absorb tissue exudate, does not hinder
Skin normal function, the consistency of small and conducive to drug release.
(7) Spray refers to the application of compressed gas as the power of the sprayer or nebulizer spray droplets of drug preparations, also known as pneumatic agents. Its characteristics are: the drug can directly reach the diseased area to play a role. Gynecological sprays can be sprayed directly on the vagina or vulva, with uniform distribution of drugs and rapid onset of action.
2.Rational application
Due to the complex composition of the excipients or substrates added during the preparation of topical drugs, in order to prevent changes in the combination of different drugs, substrates and excipients, several topical drugs should be avoided in gynecological clinics as far as possible, and it is best to use alternate application methods when combined drugs are needed. According to the clinical diagnosis of the patient and the characteristics of the drug form, the drug should be reasonably selected, and the menstrual period should be avoided when using the drug.
(1) Suppositories: Since the matrix of suppositories can be softened and melted rapidly at body temperature and release the drug, it is better to use the drug at night before going to bed and lie down after using the drug to facilitate the release of the suppositories and prevent the drug from flowing out to affect the therapeutic effect. The hot weather in summer will make the suppository soft, so it is better to put it into ice water or refrigerator for 10-20 minutes before application, and after it hardens, apply water on the tip of the suppository to make the plugging smooth. The remaining suppositories after use should be kept in
(2) anal suppository: rectal administration, mainly used for the treatment of gynecological lumbago, abdominal pain, hypospadias, pubic itching and other diseases, mainly through the rectum to absorb drugs into the blood circulation and play a therapeutic role. How to use: Clean the anus after defecation at night before going to bed, the patient takes the side lying position, the lower leg is straight, the thigh is bent forward, against the abdomen, use the finger with a finger sleeve to slowly send a pill plug (tip inward) into the anorectum. Close the legs together and keep the side lying posture for 15 minutes after administration to prevent the suppository from being pressed out, e.g.: Kang women anti-inflammatory suppository (torpedo type).
(3) Vaginal administration of ointment: wash the vulva every night before going to bed, take a lying position with knees bent, and slowly squeeze the ointment into the deep vagina with the special device for ointment. For example: Clotrimazole ointment, povidone iodine ointment, etc. Creams are mainly used in gynecology for vulvar itching and vaginal infections. Because it has a certain “reverse absorption” effect, so should pay attention to the selection of indications, avoid for erosion, ulcers, blisters and pustules, etc.. Usage: Clean the vulva, bend the knees and legs in a semi-recumbent position, apply the cream to the affected area or place the cream deep into the vagina with a special device, and follow the drug instructions or doctor’s orders for the number of times per day, dosage and duration of treatment. For example: hexestrol cream, miconazole nitrate cream, etc.
(4) Effervescent agents include vaginal effervescent tablets, effervescent capsules and effervescent suppositories: vaginal administration, mainly for vaginal infections. How to use: Wash the vulva every night before going to bed, lie down on your knees and insert the tablets deep into the vagina with your fingertips. The dosage and duration of treatment should be in accordance with the drug instructions or as prescribed by the doctor. Since vaginal effervescent agents are susceptible to moisture disintegration, patients should unseal them before use and store the remaining medication in a cool, dry place away from light, at a temperature not exceeding 20℃ to avoid affecting the use. For example: metronidazole vaginal effervescent tablets, recombinant human interferon a-2b vaginal effervescent capsules, compound hibiscus effervescent suppositories, etc.
(5) Capsules: Vaginal capsules are administered vaginally and are often used to regulate the balance of vaginal flora or inflammation. How to use: Every day after washing the vulva before going to bed, take a lying position with knees bent, and slowly put the capsule deep into the vagina with clean or finger-covered fingers. Since the capsule shell is mainly made of special gelatin, it has a disintegration and dissolution process in the vagina, so it should be kept in a lying position after use to prevent the capsule from coming out. For example, lactobacillus vaginal capsules.
(6) Irrigation agent for vaginal douching: Generally, a low concentration aqueous solution is used, which is diluted to the required concentration according to the instructions before use, and then hot to body temperature to scrub the vulva and use a special douche to send the diluted solution to the deep vaginal douching f the apocrine tract. For example: cleansing lotion, metronidazole chlorhexidine lotion, etc. However, vaginal irrigation may affect the vaginal pH value, cause pelvic inflammation, destroy the normal flora and affect the internal environment.
(7) Gel for gynecology is mainly used for gynecological inflammation: urinate before use, clean the vulva, lie down, bend both knees, insert the front end of the special gel delivery device into the deep vagina slowly, and push out the gel inside the device. The dosage, number of doses and course of treatment of the gel are according to the drug instructions. For example, Shukang Gel, Nano Silver Gynecological Inflammation No.1 Gel, etc.
(8) When spraying for vaginal inflammation, take a supine position, bend your knees and legs, insert the spray tube into the vagina and spray the medicine according to the drug instructions or the dosage prescribed by the doctor, the amount should not be too much. After spraying, lie flat for more than 10 minutes to prolong the retention time and prevent the drug from flowing out of the vagina. For vulvodynia and other skin diseases, spray directly on the affected area and keep the vulva area cool with medicine. For example, the spray can be used on the vulva.
With the development of medical science and technology, new topical drug formulations are constantly appearing and being used in clinical practice. For each new drug form, medical personnel should understand the characteristics of its form before use, in order to rational use.