technique required, pain from injection, anxiety or fear (especially in children), and difficulty in self-administration which limits its use in outpatient medicine. Vaccines, especially inactivated vaccines, are commonly administered via intramuscular injection. However, it has been estimated that for every vaccine injected intramuscularly, 20 injections are given to administer drugs or other therapy. This can include medications such as antibiotics, immunoglobulin, and hormones such as testosterone and medroxyprogesterone. In a case of severe allergic reaction, or anaphylaxis, a person may use an epinephrine autoinjector to self-administer epinephrine in the muscle. Contraindications Because an intramuscular injection can be used to administer many types of medications, specific contraindications depend in large part on the medication being administered. Injections of medications are necessarily more invasive than other forms of administration such as by mouth or topical and require training to perform appropriately, without which complications can arise regardless of the medication being administered. For this reason, unless there are desired differences in rate of absorption, time to onset, or other pharmacokinetic parameters in the specific situation, a less invasive form of drug administration (usually by mouth) is preferred. Intramuscular injections are generally avoided in people with low platelet count or clotting problems, to prevent harm due to potential damage to blood vessels during the injection. They are also not recommended in people who are in hypovolemic shock, or have myopathy or muscle atrophy, as these conditions may alter the absorption of the medication. The damage to the muscle caused by an intramuscular injections may interfere with the accuracy of certain cardiac tests for people with suspected myocardial infarction and for this reason other methods of administration are preferred in such instances. In people with an active myocardial infarction, the decrease in circulation may result in slower absorption from an IM injection. Specific sites of administration may also be contraindicated if the desired injection site has an infection, swelling, or inflammation. Within a specific site of administration, the injection should not be given directly over irritation or redness, birthmarks or moles, or areas with scar tissue. Risks and complications As an injection necessitates piercing the skin, there is a risk of infection from bacteria or other organisms present in the environment or on the skin before the injection. This risk is minimized by using proper aseptic technique in preparing the injection and sanitizing the injection site before administration. Intramuscular injections may also cause an