Subcutaneous administration is the insertion of medications beneath the skin either by injection or infusion. A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis. The instruments are usually a hypodermic needle and a syringe. Subcutaneous injections are highly effective in administering medications such as insulin, morphine, diacetylmorphine and goserelin. Subcutaneous administration may be abbreviated as SC, SQ, subcu, sub-Q, SubQ, SUBQ, or subcut. SUBQ is the preferred abbreviation to reduce the risk of misunderstanding and potential errors. Subcutaneous tissue has few blood vessels and so drugs injected into it are intended for slow, sustained rates of absorption, often with some amount of depot effect. Compared with other routes of administration, it is slower than intramuscular injections but still faster than intradermal injections. Subcutaneous infusion (as opposed to subcutaneous injection) is similar but involves a continuous drip from a bag and line, as opposed to injection with a syringe.
Medical uses
A subcutaneous injection is administered into the fatty tissue of the subcutaneous tissue, located below the dermis and epidermis. They are commonly used to administer medications, especially those which cannot be administered by mouth as they would not be absorbed from the gastrointestinal tract. A subcutaneous injection is absorbed slower than a substance injected intravenously or into a muscle, but faster than a medication administered by mouth.
Medications Medications commonly administered via subcutaneous injection or infusion include insulin, live vaccines, monoclonal antibodies, and heparin. These medications cannot be administered orally as the molecules are too large to be absorbed in the intestines. Subcutaneous injections can also be used when the increased bioavailability and more rapid effects over oral administration are preferred. They are also the easiest form of parenteral administration of medication to perform by lay people, and are associated with less adverse effects such as pain or infection than other forms of injection.
Insulin Perhaps the most common medication administered subcutaneously is insulin. While attempts have been made since the 1920s to administer insulin orally, the large size of the molecule has made it difficult to create a formulation with absorption and predictability that comes close to subcutaneous injections of insulin. People with type 1 diabetes almost all require insulin as part of their treatment regimens, and a smaller proportion of people with type 2 diabetes do as well — with tens of millions of prescriptions per year in the United States alone. Insulin historically was injected from a vial using a syringe and needle, but may also be administered subcutaneously using devices such as injector pens or insulin pumps. An insulin pump consists of a catheter which is inserted into the subcutaneous tissue, and then secured in place to allow insulin to be administered multiple times through the same injection site.
Antibiotics In addition to established uses such as insulin administration, the subcutaneous route has increasingly been investigated for the delivery of selected antibiotics as an alternative to intravenous therapy in specific clinical contexts. Available pharmacokinetic and clinical evidence indicates that several time-dependent agents, including β-lactams (e.g. ceftriaxone) and glycopeptides (e.g. teicoplanin), can achieve systemic exposures comparable to intravenous administration while avoiding the need for venous access. This strategy may be particularly relevant for patients with difficult venous access, within outpatient parenteral antimicrobial therapy programs, and in palliative care settings; however, its use remains largely off-label and is supported primarily by observational studies and pharmacokinetic data.
Recreational drug use Subcutaneous injection may also be used by people to (self-) administer recreational drugs. This can be referred to as skin popping. In some cases, the administration of illicit drugs in this way is associated with unsafe practices leading to infections and other adverse effects. In rare cases, this results in serious side effects such as AA amyloidosis. Recreational drugs reported to be administered subcutaneously have included cocaine, mephedrone, and amphetamine derivatives such as PMMA.
Contraindications Contraindications to subcutaneous injections primarily depend on the specific medication being administered. Doses which would require more than 2 mL to be injected at once are not administered subcutaneously. Medications which may cause necrosis or otherwise be damaging or irritating to tissues should also not be administered subcutaneously. An injection should not be given at a specific site if there is inflammation or skin damage in the area.
Risks and complications With normal doses of medicine (less than 2 mL in volume), complications or adverse effects are very rare. The most common adverse reactions after subcutaneous injections are administered are termed "injection site reactions". This term encompasses any combination of redness, swelling, itching, bruising, or other irritation that does not spread beyond the immediate vicinity of the injection. Injection site reactions may be minimized if repeated injections are necessary by moving the injection site at least one inch from previous injections, or using a different injection location altogether. There may also be specific complications associated with the specific medication being administered.
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