Active implantable drug delivery systems: engineering factors, challenges, opportunities

Implantable drug delivery systems represent a transformative approach in modern pharmacology, offering precise and controlled drug administration tailored to individual patient needs. By circumventing physiological barriers such as the gastrointestinal tract and the blood-brain barrier, these systems enhance bioavailability and therapeutic efficacy while reducing systemic side effects. Key features include sustained or on-demand drug release, remote activation, and programmable dosing, which collectively improve patient compliance and minimize the frequency of interventions. Innovations in actuation mechanisms, powering technologies, and biocompatible materials have advanced the field, enabling the development of miniaturized, energy-efficient, and scalable devices. Applications range from chronic disease management to localized therapies for neurological and cardiovascular conditions. Despite significant progress, challenges remain in integrating power systems, communication protocols, and regulatory compliance for clinical translation. This review synthesizes the current state of active implantable drug delivery systems, discussing engineering trade-offs, system requirements, and future research directions toward achieving reliable, patient-centered solutions to guide system designers toward developing reliable, scalable, and patient-centered solutions that bridge the gap between cutting-edge research and clinical application.