A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry
Open accessAbstract
There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.
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Absorption from the injection site can be influenced by properties of the drug, including water solubility and the delivery vehicle, and patient factors such as body weight, subcutaneous fat, and vascularity of the site of injection.
“Absorption from the injection site can be influenced by properties of the drug, including water solubility and the delivery vehicle, and patient factors such as body weight, subcutaneous fat, and vascularity of the site of injection [25, 34, 35].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [34]
The Introduction links tissue vascularity to drug absorption, and 'Consequences of unsuccessful injections' says subcutaneous deposition can slow absorption. 'Subcutaneous fat, BMI, and gender' discusses weight, fat thickness, and low-solubility oil depots that release drug over time. The paper does not specifically identify water solubility as a factor. (LLM, conf=0.83)
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The Effect of Structured Education on Nurses’ Ventrogluteal Injection Knowledge and Skills
Şimşek, A. K., Okuroğlu, G. K., Çaylı, N., & Alpar, Ş. E. (2024) · Clinical and Experimental Health Sciences · doi:10.33808/clinexphealthsci.1215219 · Cited by 2 · see citing works
How to give an intramuscular injection to an adult with an intellectual disability
McAleer, P. R., & Marsh, L. (2021) · Learning Disability Practice · doi:10.7748/ldp.2021.e2153 · Cited by 2 · see citing works
Searles, V. B., Herbst, E. D., & Kalapatapu, R. K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.750686 · Cited by 2 · see citing works
“If the IM route is indicated, staff must be properly trained in injection technique to avoid unpredictable absorption patterns and inadequate response (24).”
BackgroundVarnost pri aplikaciji intramuskularne injekcije
Senekovič, A., Fekonja, Z., & Vrbnjak, D. (2020) · Slovenian Nursing Review · doi:10.14528/snr.2020.54.2.3017 · Cited by 2 · see citing works
Moura, J. W. D. S., Takashima, M., Silva, T. L., de Souza, S., Bitencourt, A. D. S., da Rosa, F. F. D. P., Hjelmgren, H., dos Santos, L. M., Ullman, A. J., & Rocha, P. K. (2025) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2025.12.013 · Cited by 1 · see citing works
Understanding pharmacokinetic variability in women across different life stages
Campesi, I., Capobianco, G., Virdis, G., & Franconi, F. (2025) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2025.2608753 · Cited by 1 · see citing works
“…absorption, as the fat layer can act as a drug depot, and may require needles of different lengths to ensure effective intramuscular delivery [64,65] as well as to reduce the high failure rates of intramuscular injections observed in women, especially postmenopausal, due to differences in…”
Oğul, T., Gözen, D., & Gür, E. (2026) · EXPLORE · doi:10.1016/j.explore.2026.103409 · Cited by 1 · see citing works
Dunbar, A., Rakhmanina, N. Y., Unternaher, J., Anderson, P. L., & Brooks, K. M. (2026) · The Journal of Clinical Pharmacology · doi:10.1002/jcph.70249 · Cited by 1 · see citing works
“35 Injection into subcutaneous fat can result in slower absorption compared to absorption from the muscle due in part to reduced vascularity.”
Altaee, M. M., & Qassim, A. H. (2022) · Al-mağallaẗ al-ʻirāqiyyaẗ li-l-ʻulūm al-bayṭariyyaẗ/Iraqi journal of veterinary sciences · doi:10.33899/ijvs.2021.131529.1961 · Cited by 1 · see citing works
“Within the category of parenteral medications are intramuscular injections, which are widely used for medication administration worldwide (1).”
BackgroundAn Optical Guidance Method for Robotic Intramuscular Injection System
Zhu, Y., Zhang, W., Yan, B., & Yang, R. (2022) · International Congress on Image and Signal Processing (CISP) · doi:10.1109/cisp-bmei56279.2022.9979870 · Cited by 1 · see citing works
“Moreover, many studies have confirmed the low success rate of IM injection in clinical use, which is only between 32 %and 52 % [1].”
BackgroundEffect of cold application on intramuscular injection pain among patients with fractures
Mahmoud, H. S., Aziz, S. H. A., & Ibrahim, M. E. (2022) · Egyptian Nursing Journal · doi:10.4103/enj.enj_51_21 · Cited by 1 · see citing works
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Elaboração e validação de vídeo educativo sobre a utilização da Técnica em Z
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Pharmacokinetics between intramuscular and subcutaneous manual epinephrine administration
Song, T. T., & Pittman, L. M. (2023) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2023.05.008 · Cited by 1 · see citing works
White, L. M., Senouci, S. I., Mohankumar, R., Naraghi, A., Salonen, D., Dickson, B. C., & Wunder, J. S. (2021) · Skeletal Radiology · doi:10.1007/s00256-021-03791-y
The skill of administering IM medications: 3 questions to consider
Kalapatapu, R. K. (2022) · Current Psychiatry · doi:10.12788/cp.0219
Bhusal, P., Kanniammal, C., & Malarvizhi, P. (2022) · International Journal of Science and Healthcare Research · doi:10.52403/ijshr.20220142
Orandi, A. H., Mansour, A., Bagheri, N., Majedi, H., Meibodi, S. A. E., Pestehei, S. K., & Saberian, P. (2024) · Rheumatology Advances in Practice · doi:10.1093/rap/rkae150
“For intramuscular injection of tetracosactide, a 3-ml syringe with a 21-gauge needle containing 1 mg of intramuscular tetracosactide was inserted in the dorsogluteal region, 5–7.5cm below the iliac crest in the upper outer quadrant of the butt at a 90-degree angle [21].”
Uniting an academic community via Bio-Design and Manufacturing
Yang, H. (2025) · Bio-Design and Manufacturing · doi:10.1631/bdm.2520000
“[6] [9] [10] [11] [12] [7] [13] [14] [15] [16] Fig.”
Vehbi, H., Alaskarov, E., Özçelіk, N., & Allahverdiyeva, A. (2026) · European journal of medical research · doi:10.1186/s40001-026-04352-6
- Authors
- Soliman, E., Ranjan, S., Xu, T., Gee, C., Harker, A., Barrera, A., & Geddes, J.
- Affiliations
- University of Oxford (GB)
- Oxford Health NHS Foundation Trust (GB)
- Warneford Hospital (GB)
- Corresponding author
- Soliman, Erfan
- Ranjan, Sarujan
- Xu, Tianyou
- Venue
- Bio-Design and Manufacturing
- Published
- 2018-07-27
- Volume
- 1
- Issue
- 3
- Pages
- 161-170
- ISSN
- 2096-5524 (ISSN-L)
- 2522-8552
- PMC
- PMC6267269
- OpenAlex
- W2883939874
- Cited by
- 61
- References
- 51
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 8 · 2023: 10 · 2022: 14 · 2021: 12 · 2020: 5
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Bio-Design and Manufacturing (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- University of Oxford
- Topics
- Health Sciences › Medicine › Emergency Medicine › Intramuscular injections and effects
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Advanced Drug Delivery Systems
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Keywords
- intramuscular injection, injection success rate, gluteal muscles, subcutaneous fat thickness, obesity, antipsychotic drugs, injection site, medical devices, drug bioavailability, psychiatric patients
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