The most common route of administration used during COVID-19


  • Mena Raid Khalil College of Pharmacy, Mustansiriyah University, Department of Pharmaceutics
  • Ghaidaa S. Hameed College of Pharmacy, Mustansiriyah University, Department of Pharmaceutics
  • Dalya Basil Hanna College of Pharmacy, Mustansiriyah University, Department of Clinical Laboratory Sciences



COVID-19, Transmission, Symptoms, Treatment, Formulations


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the virus that caused the COVID-19 pandemic. Initial symptoms include fever, cough, and dyspnea. Symptoms include nausea, vomiting, and abdominal pain, GIT involvement is also possible. The COVID-19 outbreak has increased the need for alternative medicine administration routes, particularly in public places. Buccal, sublingual, and rectal administration are all considered transmucosal methods. They are self-administration options for non-invasive systemic distribution. In addition, they are great for use in palliative and end-of-life care because of their quick onset of action and decreased first-pass metabolism. A mucosal atomization device allows for the intranasal administration of a parenteral formulation through nasal spray. Rectal mucosal absorption is comparable to that of the oral route, making the rectal route an extremely versatile and useful method of drug administration for a wide variety of medications. Covid-19 illness is treated with a variety of drugs, including anti-malaria medication (hydroxychloroquine), glucocorticoids (dexamethasone), antibiotics (azithromycin), and antiviral medications (favipiravir). This article discusses the route of drug administration for COVID-19, as well as symptoms, treatments, and the various ways it can be spread


- Ahmad S, Shoaib A, Ali MS, Alam MS, Alam N, Ali M, et al. Epidemiology, risk, myths, pharmacotherapeutic management and socio-economic burden due to novel COVID-19: A recent update. Research Journal of Pharmacy and Technology. 2020;13(9):4435-42.

- Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831-3. e3.

- Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal–oral transmission. Gastroenterology. 2020;158(6):1518-9.

- Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. New England journal of medicine. 2020.

- Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. Jama. 2020;323(18):1843-4.

- Zhang W, Du R-H, Li B, Zheng X-S, Yang X-L, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging microbes & infections. 2020;9(1):386-9.

- Xu CL, Raval M, Schnall JA, Kwong JC, Holmes NE. Duration of respiratory and gastrointestinal viral shedding in children with SARS-CoV-2: a systematic review and synthesis of data. The Pediatric infectious disease journal. 2020;39(9): e249-e56.

- Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nature medicine. 2020;26(4):502-5.

- Harmer D, Gilbert M, Borman R, Clark KL. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS letters. 2002;532(1-2):107-10.

- Yuan L, Zhi N, Yu C, Ming G, Yingle L, Kumar GN, et al. Aerodynamic characteristics and RNA concentration of SARS-CoV-2 aerosol in Wuhan hospitals during COVID-19 outbreak. BioRxiv. 2020.

- Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. New England journal of medicine. 2020;382(16):1564-7.

- McIntosh K, Hirsch M, Bloom A. Coronavirus Disease 2019 (COVID-19), UpToDate. 2020. 2020.

- Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. New England journal of medicine. 2020; 382(10):970-1.

- Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406-7.

- Saber S, Khodir AE, Maghmomeh AO, Nouh NA, El-Baz AM. COVID-19 Pandemic: current Challenges and future Perspectives. Research Journal of Pharmacy and Technology. 2022;15(1):329-37.

- Ardalan T, Ardalan P, Monajjemi M. Nano theoretical study of a C16 cluster as a novel material for vitamin C carrier. Fullerenes, Nanotubes and Carbon Nanostructures. 2014 ;22(8):687-708.

- Hafeez A, Ahmad S, Siddqui SA, Ahmad M, Mishra S. A review of COVID-19 (Coronavirus Disease-2019) diagnosis, treatments and prevention. Ejmo. 2020;4(2):116-25.

- Ozturker ZK. Conjunctivitis as sole symptom of COVID-19: A case report and review of literature. European Journal of Ophthalmology. 2021 ;31(2):NP145-NP50.

- Jin Y-H, Cai L, Cheng Z-S, Cheng H, Deng T, Fan Y-P, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Medical Research. 2020;7(1):4.

- Bonavia A, Zelus BD, Wentworth DE, Talbot PJ, Holmes KV. Identification of a receptor-binding domain of the spike glycoprotein of human coronavirus HCoV-229E. Journal of Virology. 2003;77(4):2530-8.

- Ahmed MA, Al Jalelli ZN, Alani MA, Mostafa FI, Al-Hamdani AA, Ghanim SM, et al. Two-intervention social distancing strategy to control COVID-19 in Mosul city; A Comparative study. Al Mustansiriyah Journal of Pharmaceutical Sciences. 2020; 20(3):51-7.

- Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive,cross-sectional, multicenter study. The American journal of gastroenterology. 2020;115.

- Ye Q, Wang B, Zhang T, Xu J, Shang S. The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19. American Journal of Physiology-Gastrointestinal and Liver Physiology. 2020;319(2): G245-G52.

- Perisetti A, Gajendran M, Goyal H. Putative mechanisms of diarrhea in COVID-19. Clinical Gastroenterology and Hepatology. 2020;18(13):3054-5.

- Wu Y, Ho W, Huang Y, Jin D-Y, Li S, Liu S-L, et al. SARS-CoV-2 is an appropriate name for the new coronavirus. The Lancet. 2020; 395(10228):949-50.

- Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance. 2020; 25(3):2000045.

- Saghazadeh A, Rezaei N. Towards treatment planning of COVID-19: Rationale and hypothesis for the use of multiple immunosuppressive agents:Anti-antibodies, immunoglobulins, and corticosteroids. International immunopharmacology. 2020; 84:106560.

- Morrow ES, Roseweir A, Edwards J. The role of gamma delta T lymphocytes in breast cancer: a review. Translational Research. 2019; 203:88-96.

- Raoof IB, Okhti ZA, Abdalah ME. Clinical Signs, Laboratory Diagnosis and Treatments Involved in Corona Viruses-19. Al Mustansiriyah Journal of Pharmaceutical Sciences. 2021;21(1):10-5.

- Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. New England Journal of Medicine. 2020.

- Delang L, Neyts J. Medical treatment options for COVID-19. European Heart Journal: Acute Cardiovascular Care. 2020;9(3):209-14.

- Warren TK, Wells J, Panchal RG, Stuthman KS, Garza NL, Van Tongeren SA, et al. Protection against filovirus diseases by a novel broad-spectrum nucleoside analogue BCX4430. Nature. 2014;508 (7496):402-5.

- Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. Jama. 2020;323(18):1824-36.

- Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of coronavirus (COVID-19). Statpearls [internet]. 2022.

- Patel KP, Patel PA, Vunnam RR, Hewlett AT, Jain R, Jing R, et al. Gastrointestinal, hepatobiliary, and pancreatic manifestations of COVID-19. Journal of Clinical Virology. 2020; 128:104386.

- Smith H. A Comprehensive Review of Rapid-Onset Opioids for Breakthrough Pain. CNS Drugs. 2012;26(6):509-35.

- Lam JK, Cheung CC, Chow MY, Harrop E, Lapwood S, Barclay SI, et al. Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic. Advanced Drug Delivery Reviews. 2020; 160:234-43.

- Tseng C-L, Chen K-H, Su W-Y, Lee Y-H, Wu C-C, Lin F-H. Cationic gelatin nanoparticles for drug delivery to the ocular surface: in vitro and in vivo evaluation. Journal of Nanomaterials. 2013;2013.

- Gupta H, Aqil M, Khar RK, Ali A, Bhatnagar A, Mittal G. Sparfloxacin-loaded PLGA nanoparticles for sustained ocular drug delivery. Nanomedicine: nanotechnology, biology and medicine. 2010;6(2):324-33.

- Le Bourlais C, Acar L, Zia H, Sado PA, Needham T, Leverge R. Ophthalmic drug delivery systems—recent advances. Progress in retinal and eye research. 1998;17(1):33-58.

- Abdulrazik M, Behar-Cohen F, Benita S. 24 Drug Delivery Systems for Enhanced Ocular Absorption. Enhancement in drug delivery. 2007.

- Washington N, Washington C, Wilson C. Physiological pharmaceutics: barriers to drug absorption: CRC Press; 2000.

- Amesty MA, Alio del Barrio JL, Alió JL. COVID-19 disease and ophthalmology: an update. Ophthalmology and Therapy. 2020;9(3):1-12.

- Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. British Journal of Ophthalmology. 2020;104(6):748-51.

- Saleh AA, Tektook NK, Rasheed IAAM. Interleukins levels associated with Chronic Otitis Media (CSOM). Research J Pharm and Tech. 2019;12(12):5801-4.

- Abdullah ZK. The antibacterial activity of Trigonella foenum-graceum extracts against bacteria that causes Otitis media in children. Al Mustansiriyah Journal of Pharmaceutical Sciences. 2013;13 (2):147-54.

- Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clinical microbiology reviews. 2003;16 (2):230-41.

- Mohan S, Workman A, Barshak M, Welling DB, Abdul-Aziz D. Considerations in management of acute otitis media in the COVID-19 era. Annals of Otology, Rhinology & Laryngology. 2021;130(5):520-7.

- Arisov MV, Indyuhova EN, Arisova GB. The use of multicomponent ear drops in the treatment of otitis of various etiologies in animals. Journal of advanced veterinary and animal research. 2020;7(1):115.

- Paul S, Roy T, Bose A, Chatterjee D, Chowdhury VR, Rana M, et al. Liposome mediated pulmonary drug delivery system: An updated review. Research Journal of Pharmacy and Technology. 2021;14(3):1791-6.

- Fassihi SC, Nabar NR, Fassihi R. Novel approach for low‐dose pulmonary delivery of hydroxychloroquine in COVID‐19. British journal of pharmacology. 2020;177(21):4997.

- Siegel D, Hui HC, Doerffler E, Clarke MO, Chun K, Zhang L, et al. Discovery and Synthesis of a Phosphoramidate Prodrug of a Pyrrolo [2, 1-f] [triazin-4-amino] Adenine C-Nucleoside (GS-5734) for the Treatment of Ebola and Emerging Viruses. ACS Publications; 2017.

- Lax SF, Skok K, Zechner P, Kessler HH, Kaufmann N, Koelblinger C, et al. Pulmonary arterial thrombosis in COVID-19 with fatal outcome: results from a prospective, single-center, clinicopathologic case series. Annals of internal medicine. 2020;173 (5):350-61.

- Rouhezamin MR, Haseli S. Diagnosing pulmonary thromboembolism in COVID-19: a stepwise clinical and imaging approach. Academic Radiology. 2020;27(6):896.

- Chan K, Beck C, Chauvin-Kimoff L, Gripp K, Krmpotic K, Thakore S, et al. The acute management of paediatric coronavirus disease 2019 (COVID-19). Can Pediatr Soc JAMA Pediatr[Cited: 2020 Apr 20] Avaliable from URL: https://www cps ca/en/documents/position/the-acute-ma nagement-of-paediatric-coronavirus-disease-2019covid-19. 2021.

- Flannery AH, Adkins DA, Cook AM. Unpeeling the evidence for the banana bag: evidence-based recommendations for the management of alcohol-associated vitamin and electrolyte deficiencies in the ICU. Critical Care Medicine. 2016;44(8):1545-52.

- Weber AG, Chau AS, Egeblad M, Barnes BJ, Janowitz T. Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series. Molecular Medicine. 2020;26(1):1-7.

- Gulati N, Gupta H. Parenteral drug delivery: a review. Recent patents on drug delivery & Formulation. 2011;5(2):133-45.

- Chien YW. Novel drug delivery systems. Drugs and the pharmaceutical sciences. 1992;50.

- Dornblaser EK, Way SL, Brazeau GA. Dosage Forms: Parenterals. Encyclopedia of Pharmaceutical Science and Technology, Fourth Edition: CRC Press; 2013. p. 884-97.

- Herzog C. Influence of parenteral administration routes and additional factors on vaccine safety and immunogenicity: a review of recent literature. Expert review of vaccines. 2014;13(3):399-415.

- Dakhil IA, Mohamed MBM, Abbas AK, Mansour SM. Formulation and Evaluation of Trifluoperazine HCl as rectal suppositories by using different types of surfactants in Cocoa butter. Research Journal of Pharmacy and Technology. 2019;12(10):4934-40.

- Havaldar VD, Yadav AV, Dias RJ, Mali KK, Survase AB, Ghorpade VS, et al. Screening of Suppository bases for Rectal delivery of Carbamazepine. Research Journal of Pharmacy and Technology. 2017;10(8):2697-703.

- Havaldar VD, Yadav AV, Dias RJ, Mali KK, Ghorpade VS, Salunkhe NH. Rectal suppository as an effective alternative for oral administration. Research Journal of Pharmacy and Technology. 2015;8(6):759-66.

- Havaldar VD, Yadav AV, Dias RJ, Mali KK, Kale SS, Pujari PP. Rectal Suppository of Mucoadhesive Microspheres of Alverine Citrate for İrritable Bowel Disease: In vitro Evaluation. Research Journal of Pharmacy and Technology. 2018; 11(7):3091-8.