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New review: Benefits and risks of subcutaneous injections

19 Sep 2017

A narrative literature review by Eric Baars, newly published in European Journal of Integrative Medicine, explores the benefit/risk balance of using subcutaneous injections.

Injectables are therapeutically applied in anthroposophic medicine and homeopathy for a wide range of conditions. Anthroposophic and homeopathic practitioners often favour injectables as their first choice of medication in the treatment of acute and chronic conditions because of the anticipated quicker and better clinical effect, the possibility to control compliance (the injection is generally given by the physician/therapist or nurse), and the fact that the exact location of administration can be chosen. Other advantages of injectables are that active ingredients do not have to pass the gastrointestinal tract or skin barrier, and that the point of injection can be chosen in line with acupuncture trigger points to achieve an optimal systemic or local effect.

The pharmaceutical companies that manufacture them and the doctors who prescribe them consider injectables to have additional clinical value compared with the oral route of administration; they consider the risk of the parenteral route of administration as very low. However, overall, regulatory authorities regard the use of injectables as only justified for acute cases; they view oral products as better alternatives for both ethical and safety reasons.

The review considers the favourable and unfavourable effects, the uncertainty of the effects and the possible mode of action of the subcutaneous route of administration. An estimation of the benefit/risk balance is performed. It demonstrates a high prescriber demand, evidence on the existence of several favourable effects (higher clinical efficacy, higher bio-availability, quicker onset of action), some unfavourable low risk effects (related to exposure, substance and the needle) and overall a positive benefit/risk balance.

The review concludes that its results justify a more positive attitude from regulatory authorities towards the use of subcutaneous injections and towards ampoule prescribing doctors.

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