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Table 1 Advantages and limitations of benzodiazepines delivery routes in dogs

From: First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines

Administration route

Advantages

Limitations

Intravenous

Likely effective (clinical evidence)

Likely rapid onset of action (clinical evidence)

Precise control of the administered dose

Avoidance of first-pass hepatic metabolism

Subject to blood-brain barrier

Requirement for hospitalisation

Requirement for medically-trained staff

Hard to establish during seizures

Not for at-home use

Intramuscular

Likely favourable pharmacokinetics

Avoidance of first-pass hepatic metabolism

Subject to blood-brain barrier

Requirement for training or medical staff

Needle/syringe misuse by non-trained caregivers

Less suitable for at-home use

Soft tissue or nerve damage risk

Infection risk

Painful

Transdermal

Painless

Easy to use

Suitable for home

No requirement for medical training

Avoidance of first-pass hepatic metabolism

Subject to blood-brain barrier

Slow release not suitable for emergency

Buccal

Painless

Ease to administer

Suitable for home

No requirement for medical training

Avoidance of first-pass hepatic metabolism

Subject to blood-brain barrier

Potentially unfavourable pharmacokinetics

Delivery of limited drug amount

If swallowed, functions as oral

Dog’s compliance is needed

Incorrect administration during seizures

Sublingual

Similar to buccal

Similar to buccal

Oral

Painless

Easy to use

No requirement for medical training

Suitable for home

Subject to blood-brain barrier

Potentially unfavourable pharmacokinetics

Slow absorption not suitable for emergency

Potential for gastrointestinal degradation

Subject to first-pass hepatic metabolism

Dog’s compliance is needed

Rectal

Minimal pain/discomfort

Relatively easy to use

No requirement for medical training

Suitable for home

Subject to blood-brain barrier

Variability in effectiveness (clinical evidence)

Variability in pharmacokinetics

Partially subject to first-pass hepatic metabolism

Likely slow onset of action

Socially unacceptable

Intranasal

Likely effective (clinical evidence)

Likely rapid onset of action (clinical evidence)

Likely favourable pharmacokinetics

Avoidance of first-pass hepatic metabolism

Avoidance of blood-brain barrier

No requirement for medical training

Relatively easy to use

Painless

Suitable for home

Need for high concentration drug

Potentially affected by mucosal factors

Potentially affected by drug formulation

Need for a veterinary nasal device