Approach to subcutaneous infusions in primary care: Indications, practical considerations, acceptability, and...

To provide updated and practical guidelines for the use of subcutaneous (SC) infusions, or hypodermoclysis, in primary care.

A thorough literature review of the MEDLINE database was conducted for articles published from 1945 to 2025. Most retrieved articles provided level II or III evidence; well-designed randomized controlled trials were scarce.

Compared with the intravenous (IV) route, hypodermoclysis is less invasive, better tolerated, easier to implement in outpatient settings, and associated with a lower risk of serious complications. Pharmacokinetic data indicate slightly slower absorption than IV administration, with bioavailability often exceeding 80% for hydrosoluble drugs. The main indications for hypodermoclysis include the prevention and treatment of moderate dehydration; providing palliative care (eg, analgesics, anxiolytics, antipyretics, antisecretory agents); and administration of some antibiotics (notably ceftriaxone, as well as ertapenem and teicoplanin, supported by robust evidence). In some circumstances, hypodermoclysis can also be considered for furosemide, levetiracetam, and vitamin B12 when no alternative is available. Furthermore, some vaccines may be administered subcutaneously in patients with contraindications to the intramuscular route. Local adverse events such as pain or edema are usually mild and transient; infectious complications are rare and likely less frequent than with IV therapy.

Although often used off label, hypodermoclysis is a safe and practical alternative to IV infusion, particularly suitable for older or frail patients at home or in nursing homes. It offers a timely and pragmatic solution to issues related to outpatient care and hospital overcrowding. Its wider adoption depends on improved health care professional training, standardized protocols, and stronger comparative evidence.