Pessaries
Pessaries are solid medicated dosage forms intended for insertion into
the vagina, where they melt, soften, or dissolve to release the drug
for local or systemic action. They are mainly used for treating infections,
contraception, or hormonal therapy.
Definition:
A pessary is a solid dosage form meant for vaginal
administration, containing one or more active ingredients in a suitable
base that melts or dissolves at body temperature.
Composition:
- Active ingredient: Medicinal substance for local or
systemic effect
- Base: Fatty or water-soluble
substances like cocoa butter, glycerinated gelatin, or polyethylene glycol
(PEG)
- Additives: Preservatives, stabilizers, and
lubricants to improve effectiveness and comfort
Types:
- Vaginal pessaries: Most common, used for local
effects such as antifungal or antibacterial action
- Contraceptive pessaries: Contain spermicidal agents to
prevent pregnancy
- Hormonal pessaries: Used for hormone replacement
therapy (e.g., estrogen pessaries)
Advantages:
- Provides local action at
the site of infection or irritation
- Avoids first-pass metabolism by the liver
- Useful for patients unable to
take oral medication
- Provides prolonged drug
release
- Easy to insert and convenient for
self-use
Disadvantages:
- May cause local irritation or
discomfort
- Melting or leakage may occur after insertion
- Not suitable for use during menstruation
- May require careful handling
and storage
Examples:
- Clotrimazole pessaries – used to treat vaginal fungal
infections
- Estrogen pessaries – for hormone replacement
therapy
- Nonoxynol-9 pessaries – used as contraceptives
Importance of Pessaries
- Provide
localized treatment in the vaginal, rectal, or urethral cavities:
Pessaries deliver drugs directly to the affected site, ensuring effective and focused therapy.
Example: Antifungal pessaries containing Clotrimazole are used to treat vaginal yeast infections. - Useful
for patients who cannot take oral medications:
Pessaries are suitable when patients suffer from nausea, vomiting, or difficulty swallowing.
Example: Paracetamol suppositories/pessaries can be used for fever relief in such patients. - Allow
both local and systemic drug effects:
Drugs can act locally at the site of insertion or get absorbed into the bloodstream for systemic action.
Example: Progesterone vaginal pessaries are absorbed systemically for hormonal therapy in infertility treatment. - Avoid
first-pass metabolism and digestive degradation:
Drugs administered as pessaries bypass the liver and stomach, improving their effectiveness.
Example: Estrogen pessaries avoid liver metabolism and are used for menopausal symptoms. - Provide
prolonged and sustained drug release:
Some pessaries are formulated to release the drug slowly, maintaining a steady therapeutic effect.
Example: Hormonal pessaries can provide continuous drug delivery over several hours. - Offer
comfort and ease of use for local conditions:
Pessaries are designed to melt or dissolve at body temperature, ensuring smooth application and comfort.
Example: Glycerin pessaries are used to relieve constipation by lubricating and stimulating the rectum. - Important
in gynecological and rectal therapies:
Pessaries are widely used in treating vaginal infections, hormonal disorders, and constipation.
Example: Antibacterial and antifungal vaginal pessaries play a key role in women’s reproductive health care.
