Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles have larger and more numerous blood vessels than subcutaneous tissue, leading to faster absorption than subcutaneous or intradermal injections. Medication administered via intramuscular injection is not subject to the first-pass metabolism effect which affects oral medications. Common sites for intramuscular injections include the deltoid muscle of the upper arm and the gluteal muscle of the buttock. In infants, the vastus lateralis muscle of the thigh is commonly used. The injection site must be cleaned before administering the injection, and the injection is then administered in a fast, darting motion to decrease the discomfort to the individual. The volume to be injected in the muscle is usually limited to 2–5 milliliters, depending on injection site. A site with signs of infection or muscle atrophy should not be chosen. Intramuscular injections should not be used in people with myopathies or those with trouble clotting. Intramuscular injections commonly result in pain, redness, and swelling or inflammation around the injection site. These side effects are generally mild and last no more than a few days at most. Rarely, nerves or blood vessels around the injection site can be damaged, resulting in severe pain or paralysis. If proper technique is not followed, intramuscular injections can result in localized infections such as abscesses and gangrene. While historically aspiration, or pulling back on the syringe before injection, was recommended to prevent inadvertent administration into a vein, it is no longer recommended for most injection sites by some countries. Uses Intramuscular injection is commonly used for medication administration. Medication administered in the muscle is generally quickly absorbed in the bloodstream, and avoids the first pass metabolism which occurs with oral administration. The medication may not be considered 100% bioavailable as it must still be absorbed from the muscle, which occurs over time. An intramuscular injection is less invasive than an intravenous injection and also generally takes less time, as the site of injection (a muscle versus a vein) is much larger. Medications administered in the muscle may also be administered as depot injections, which provide slow, continuous release of medicine over a longer period of time. Certain substances, including ketamine, may be injected intramuscularly for recreational purposes. Disadvantages of intramuscular administration include skill and