Understanding standard vs alternative drug delivery

What is considered standard drug delivery, and how does it compare with alternative drug delivery? Joe Smith, DVM, MPS, PhD, DACVIM, DACVCP, cVMA, an associate professor, large animal, at the University of Tennessee College of Veterinary Medicine in Knoxville, explains standard and alternate drug delivery in a dvm360 interview at the 2026 American College of Veterinary Internal Medicine (ACVIM) Forum in Seattle, Washington. Smith, who specializes in farm animal medicine and veterinary clinical pharmacology, also discusses the importance of oral medication adherence.

The following is a transcript of this video, a portion of the interview:

Joe Smith, DVM, MPS, PhD, DACVIM, DACVCP, cVMA: When I think of standard drug delivery, I think of the common ways that we would administer drugs to our veterinary patients, and often that's going to be an oral medication, such as a pill or tablet or suspension, or potentially an injection under the skin or in the muscles, like a subcutaneous or an intramuscular injection. And when we look at alternative drug delivery, we have a whole bunch of new and other techniques that we can use that aren't the standard injection and that aren't the standard pill or tablet to get drugs to a specific area of the patient.

[There are] some examples I can think of that are intravenous regional limb perfusion. If we want to focus on structures in the distal limb or leg, we have techniques there that we can [use to] increase concentrations. Nebulization [is used] if we want to get drugs into the lungs, specifically for some inflammatory diseases or infectious diseases. We're also seeing an explosion in veterinary medicine of transdermal formulations. These are drug formulations that can be applied to the skin, but not with the intent of acting on the skin directly. These are attempting to just use the skin as the way into the animal to treat the animal systemically.

I think the transdermal applications of veterinary medicine really fascinate me, because what's a challenge we have in vet med? It's [adherence]. If I have a client and I tell them that they need to give their dog a capsule every 8 hours, it's probably not going to work that well. We have timing, we have to sleep, we have to work, things like that. And not all dogs like to take capsules very well. I don’t have a cat, but I've been told cats are even worse [in] that respect for oral medications. So the ability to put something on the skin is going to increase [adherence], and one of the things we've noticed with some of these drugs we put on the skin is they're much more slowly absorbed, so they can essentially become long-acting to further increase [adherence], to have to do fewer applications or fewer administrations.