Project PEOLC11COV

Alternative routes of administration for medication at the end of life

Systematic literature review of alternative routes of administration for medication at the end of life


The Coronavirus disease 2019 (COVID-19) pandemic has led to a surge in need for alternative routes of administration of drugs for end of life and palliative care, particularly in community settings. Transmucosal routes include intranasal, buccal, sublingual and rectal. They are non-invasive routes for systemic drug delivery with the possibility of self-administration, or administration by family caregivers. In addition, their ability to offer rapid onset of action with reduced first-pass metabolism make them suitable for use in palliative and end-of-life care to provide fast relief of symptoms.This is particularly important in COVID-19, as patients can deteriorate rapidly.

Despite the advantages, these routes of administration face challenges including a relatively small surface area for effective drug absorption, small volume of fluid for drug dissolution and the presence of a mucus barrier, thereby limiting the number of drugs that are suitable to be delivered through the transmucosal route. In this review, the merits, challenges and limitations of each of these transmucosal routes are discussed. The goals are to provide insights into using transmucosal drug delivery to bring about the best possible symptom management for patients at the end of life, and to inspire scientists to develop new delivery systems to provide effective symptom management for this group of patients.

Project aims

This project reviewed the literature concerning alternative routes of administration for medication at the end of life.

Project activity 

Literature review with extensive discussion of mechanisms and processes involved


Lam J, Cheung C, Chow M, Lapwood S, Barclay S, Wong I (Oct 2020) Transmucosal drug administration as an alternative route in palliative care during the COVID-19 pandemic Advanced Drug Delivery Reviews; 160 (2020): 234 - 243

Who was involved 

Principal Investigator: Prof I Wong, University of Hong Kong

Researchers and institutions:

  • J Lam, University of Hong Kong
  • C Cheung, University of Hong Kong
  • M Chow, University of Hong Kong
  • E Harrop, Oxford Hospitals NHS Trust
  • S Lapwood, Oxford Hospitals NHS Trust
  • S Barclay, University of Cambridge 
  • I Wong, University of Hong Kong