Polite Dissent

One of the most important aspects of medicines and one that is frequently shown incorrectly in comics, TV shows and movies is how the medication is given to the patient. The most common ways of administering medication are orally (by the mouth), intramuscularly (injected into muscles), or intravenously (injected into veins).

Medicine taken by mouth takes about 30 minutes to work. It has to be digested in the stomach or small intestine, enter the bloodstream, and then reach its target organ.

Intramuscular (IM) injections place the medications into muscles (similar to a vaccination) where they are absorbed into the bloodstream. These medications generally work faster than oral medications, but slower than intravenous drugs. On average, an IM injection takes about fifteen minutes to work.

Intravenous (IV) medications are injected directly into the bloodstream. They work quickly with effects in 5-10 minutes. Usually, these medications are injected through IV lines already in place, though skilled individuals can inject medications directly into the veins.

Not every medication can be given every way. Some medications can only be given one way, though most have several different means of administration. Additionally, oral doses usually need to be much higher than IV or IM doses due to digestive and metabolic effects.

In addition to the common methods of administering medicine, there are other less common ones including inhalation and trans-dermal.

Some medications can be inhaled. Inhalation is quick, with the medicine traveling from the lungs to the bloodstream in a matter of minutes. Very few medications can be used this way, and it’s hard to get a consistent dose with inhaled medications.

Some medications can be given transdermally, or through the skin. This is usually done with patches, but can also be done with gels or creams. Skin absorption is a slow process, and works best for slow drugs with a steady level, like hormones or medications for chronic pain.

There are several other methods of giving medication that are only used in certain circumstances and will not be covered here (except to again point out that atropine should never never be injected directly into the heart).

Case Studies:

1. Oral: Hourman (Rex Tyler). Miraclo would not be the instantaneous drug it is supposed to be
2. Intramuscular: GOOD: In Amazing Spider-Man #508, Ezekiel injects Peter with a neuromuscular agent. It takes several minutes for it to take effect, and Peter grows weaker as it the drug takes effect. BAD: In Detective Comics #795, Batman injects the Tarantula with Cipro, a drug that should not be given intramuscularly. In JSA #17, the medications Dr. Mid-Nite injects inot Black Canary take effect immediately.
3. IV: Usually shown in hospital situations, it has been shown (among others) in recent issues of Hellblazer. No exemplary (or terrible) examples.
4. Inhalation: Batman gases a Checkmate agent in Batman: Gotham Knights #40, and in Avengers #69 the Red Skull uses a narcotic gas to knock everyone out. In real life, the Moscow police used a narcotic gas to subdue the terrorists holding theater patrons hostage about 2 years ago. The results were mixed.
5. Transdermal: Hourman II (Rick Tyler). Miraclo would work even slower as a patch than as a pill. No “hour of power” here.