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How to administer sublingual medication

How to administer sublingual medication

Have you been prescribed a sublingual tablet but you’re not quite sure how to use it? Read on to find out what a sublingual tablet is, why you might need it and how you can take the tablet sublingually.

What is a sublingual tablet?

A sublingual tablet looks just like any other tablet in the medicine cabinet, but the difference lies in how you use it. Rather than swallowing the tablet, you put it underneath your tongue to dissolve there, where it can be absorbed straight into your bloodstream.

As it is used in a different way to ordinary oral tablets, a sublingual tablet is made in a different way to match its purpose. The most obvious difference is the how easily the tablet dissolves.

A sublingual tablet dissolves more quickly than usual so that the drug can be readily absorbed into your bloodstream. Because of this, it can also disintegrate more easily than other tablets, so you should be more careful in the way that you store a sublingual tablet (more on this below).

Why can’t you swallow it?

Most tablets that you take need to be swallowed – why can’t you just do the same with a sublingual tablet?

After you swallow an oral tablet, there are three main steps before the can move around your body to where it is needed. It needs to:

  1. Dissolve in the acid in your stomach
  2. Be absorbed into your bloodstream
  3. Pass through the liver, where it may be metabolized (chemically altered)

Each drug is dissolved in the stomach, absorbed into the bloodstream and metabolized in the liver to a different extent. Some drugs do this very well so that almost all of it has an action on the body, known as good bioavailability. Other drugs are not dissolved or absorbed very well, or completely metabolized in the liver, so that the drug has a poor bioavailability.

For drugs with a poor bioavailability, taking the medication by swallowing the medication is not very effective. We need to find another way to deliver the drug into the bloodstream.

A sublingual tablet is a good option for this. It is simpler and safer than other options, such as an injection, and can get the drug into your bloodstream without needing to be absorbed from the stomach or passing through the liver.

4 Simple Steps to Taking a Sublingual Tablet

Taking a tablet sublingually is quite easy once you know how to do it. This quick guide should give you enough information to get started.

  1. Make sure you are sitting upright to help prevent accidental swallowing of the tablet.
  2. Place the sublingual tablet under your tongue, on either side of the frenulum.
  3. How the tablet underneath your tongue for the prescribed duration of time, keeping your mouth closed.
  4. Wait for several minutes before eating or drinking, as this may affect the absorption of the drug.

What else should you know?

If you have been prescribed a sublingual tablet to take, here are a few extra notes that you might find useful in how to use them correctly.

  • Avoid eating or drinking while waiting for the tablet to dissolve, as this may cause you to swallow some of the active ingredient.
  • Avoid smoking for at least one hour taking a sublingual tablet, as this can tighten the tiny blood vessels in your mouth, making it more difficult for them to absorb the drug underneath your tongue.
  • Sublingual tablets are not usually prescribed for long-term, continuous use, as they can cause irritation in the mouth and ulcers.

E.g. Nitroglycerin Sublingual Tablet

The most common drug taken sublingually is nitroglycerin, which is used to relieve the symptoms of angina. This is because nitroglycerin has a poor bioavailability if you swallow it as an oral medication and because it works very quickly for symptom relief when taken sublingually.

Angina is a condition that involves severe pain in the chest due to inadequate blood flow to the heart. Nitroglycerin works by providing a source of nitric oxide to the body, which has a relaxing effect on the muscles surrounding the blood vessels, allowing the vessels to expand and blood to pass through more easily.

Sublingual nitroglycerin is used for quick symptoms relief. The effects start showing within 5 minutes and can last for up to 20 minutes.

It is not always necessary to wait for the tablet to dissolve completely under the tongue if the symptoms of chest pain are already starting to improve. The tablet can be removed or swallowed when a sufficient dose has already been taken, as the swallowed tablet will not have an effect.

Do you have other questions?

If you have any other questions about sublingual tablets and how to use them, just let me know and I will try to help. You can leave a comment below or contact me via email from the contact tab at the top of this page.

How to administer sublingual medication

In this pharmacology fundamentals discussion, we’ll talk about the different routes of administration, mainly the oral and sublingual routes. We’ll get into the what each route is, how it is given, and the nursing considerations. We’ll also include the five administration abbreviations that are usually written on charts and forms by physicians.

The Oral Route

The first and most popular drug route is orally or per orem (PO). The different types of oral medications are:

  • Tablets
  • Capsules
  • Liquids

How Oral Drugs are Given

As mentioned, oral drugs are administered through the mouth. There are important rules that you have to keep in mind and follow when asking your client to ingest an oral medication, which are:

  1. Sit your client up in a Fowler’s or high Fowler’s position. A Fowler’s position is sitting upright at around 45 degrees while a high Fowler’s at a 90-degree angle.
  2. Never give oral medications when clients are lying down to avoid choking and assist in swallowing.
  3. Oral medications are usually given an hour before meals or two hours after meals, depending on the type of drug and doctor’s orders. This is primarily because there are drugs that cause an upset

Nursing Considerations for Oral Medications

What are the things that you need to avoid doing when dealing with clients who are given oral drugs?

  1. Avoid giving oral medications with certain foods or drinks.

High cholesterol clients who are taking Lipitor aren’t allowed to drink any grapefruit juice because it can counteract with the effect of the pill. Another example is the antacid, Tums that is usually taken for heartburn. This drug must not be taken with iron.

  1. Take note on the contraindications.
  • Don’t give when the client is on a supine or lying down position.
  • Don’t give when the client’s gag’s reflex is absent.
  • Don’t give when the client has trouble swallowing.
  • Don’t give when the client has a decreased level of consciousness.

Being aware of the above-mentioned contraindications will help prevent the risk of choking or having hospital-acquired pneumonia.

  1. Time-release medications have to be swallowed.

Time-release medications are those double-coated drugs that require swallowing; they are not to be crushed or sliced. Time release medications are effective because their coating protects its contents from being absorbed in the stomach, rendering it useless. These types of medications must be absorbed in the duodenum or the first part of the small intestine to maximize its effects, making it last longer inside the body.

Morphine is one of the most popular time-release medications that is usually given to clients with chronic pain.

Other terms of time-release medications are:

  • Sustained release (SR)
  • Extended-release (XR)

Sublingual Route: The Oral Piggyback

Underneath the tongue is a very vascular bed that contains numerous blood vessels. This site is quite potent in absorbing medications that drugs placed are easily utilized in a matter of seconds. This is called the sublingual route.

How Sublingual Drugs are Given

Sublingual medications are administered by placing the drug under the tongue, leaving it there until the drug’s fully absorbed.

Examples of Sublingual Drugs

Nitroglycerin, the drug for angina and myocardial infarction clients, is given sublingually. Once absorbed, Nitroglycerin is absorbed by the body in as fast as 30 seconds or less. Since the effect is immediate, the drug helps save the client’s life in emergency situations because it instantly vasodilates the blood vessels. Vitamin B12 is also given sublingually.

Nursing Considerations for Sublingual Medications

So, there are two essential things that you have to remember when given sublingual drugs, mainly:

  1. Never chew.
  2. Don’t give with water.

If the tablet goes inside the stomach and into the gastrointestinal tract, it will go through the first pass phenomenon, and the liver is going to extract and metabolize it. The goal is for the drug to be properly absorbed by the vessels underneath the tongue so it can directly proceed to the bloodstream and into the heart.

As a nurse caring for clients taking sublingual medications, you have to teach your clients that if they don’t follow the above-mentioned considerations, the drug will become ineffective.

Dosage Administration Abbreviations

There are important dosage administration abbreviations that you have to remember when dealing with pharmacology and as you go into your clinical exposures. What are these abbreviations?

PRN: As Necessary

PRN medications are only given if the client needs it. One perfect example is pain medication. When a client complains of pain, you are allowed to give the drug. However, do not overdose your clients because there are those who abuse pain medications.

Q: Every

Whenever you see a “Q” written on a client’s medication reconciliation (MR) chart, it just means “every.” This implies that drugs have to be given either every day or every hour.

AC/PC: Before Meals or After Meals

AC means before meals while PC implies after meals. Therefore, if you see in the notes that a drug has to be given PC, it only means that you have to give it once the client has eaten.

Daily: Every Day (BiD, TiD, QiD)

Medications that are given on a daily basis usually have an accompanying order either BiD, TiD, or QiD. What do they mean?

  • BiD – twice a day
  • TiD – thrice a day
  • QiD – four times a day

Stat: Give Immediately or At Once

Stat is something that you’ll hear or read often in an emergency setting. This is usually ordered when the client’s status is worsening like the heart stops beating, and a drug has to be given right away.

These are the top five medication dosage orders that you will encounter in every hospital setting, on medication reconciliation forms, and doctor’s notes. It is imperative that you remember these abbreviations before you go into your clinical exposure and be encounter all drug orders.

As a quick recap, we’ve discussed the two types of medication routes – oral and sublingual. While oral passes through the gastrointestinal tract, sublingual medications go underneath the tongue.

In our next lecture, we’ll be tackling the other routes of administration. For more nursing-related reviews, head on out to our Simple Nursing website and YouTube channel.

Sublingual Tablet

How to administer sublingual medication

Drug delivery via the oral mucous membrane is considered to be a promising alternative to the oral route.

Sublingual route is a useful when rapid onset of action is desired with better patient compliance than orally ingested tablets. In terms of permeability, the sublingual area of the oral cavity (i.e. the floor of the mouth) is more permeable than the buccal (cheek) area, which in turn is more permeable than the palatal (roof of the mouth) area.

  • Use
  • Mechanics of sublingual absorption
  • Advantages

The portion of drug absorbed through the sublingual blood vessels by passes the hepatic first pass metabolic processes giving acceptable bioavailability. Various techniques can be used to formulate sublingual tablets. New sublingual technologies address many pharmaceutical and patient needs, ranging from enhanced lifecycle management to convenient dosing for pediatric, geriatric, and psychiatric patients with dysphagia. This article is to highlights the different sublingual dosage forms, factors affecting the sublingual absorption, advantages, various in vitro and in vivo evaluation parameters and commercially available sublingual dosage forms.

The absorption potential of oral mucosa is influenced by the lipid solubility and therefore the permeability of the solution (osmosis); the ionization (pH); and the molecular weight of the substances. For example, absorption of some drugs via oral mucosa is shown to increase when carrier pH is lowering (more acidic) and decrease with a lowering of pH (more alkaline). The cells of the oral epithelium and epidermis are also capable of absorbing by endocytosis (the uptake of particles by a cell as if by hollowly wrapping itself around it. These engulfed particles are usually too large to diffuse through its wall). It is unlikely that this mechanism is used across the entire stratified epithelium.

The sublingual artery stems from the lingual artery – the body’s main blood supply to the tongue and the floor of the mouth – which arises from the external carotid artery. The proximity with the internal carotid artery allows fast access to its route supplying the greater part of the cerebral hemisphere. Osmosis In order for a drug to be effectively absorbed sublingually, it needs to be able to travel across the buccal mucous membranes; by a process of diffusion known as osmosis which applies to all forms of absorption by the body; governing both intestinal and sublingual absorption. The distribution of water across cell walls depends on the osmotic difference in the blood between the intracellular and extracellular fluid. Small particles that readily dissolve in water, rarely present a problem in permeation and diffusion, and so are able to move freely between the tissues of the body. Active transportation into cells leads to rapid metabolisation of the substances.

Molecules such as glucose (fructose) and amino acids are essential for cell metabolism and special mechanisms have evolved to facilitate their rapid diffusion and permeation across cell membranes.

It stunned me that there weren’t tons, let alone any, threads asking this question (please let me know if there is, but I looked for 20 mins). I just got some of Ceretropic’s sublingual solutions and put them under my tongue. they don’t exactly dissolve or anything so how can you tell once the chemical has been absorbed? If you just swallow it, do you also get effects, just much less pronounced? Does it vary by substance how long each must stay under the tongue?

Don’t just put it under your tongue, your gums/inner cheek can absorb things fairly well too. I usually put in under the tongue for 2 min, swish it around a bit, wait

3 min, then swallow.

I swallow and clear my mouth of excess fluid before placing anything under my tongue, then try and limit my tongues movement for five minutes. It’s definitely more successful if you can’t taste it for five minutes, then I swish.

This sounds way better/more realistic than holding it for 15 minutes under my tongue

<5minutes. anyone who says more is just being paranoid. Under your tongue or not, doesnt make a difference. As long as its their in your mouth; Ion transfer would occur between the mucus membranes either way. Go see how the stomach absorbs nutrients through its walls, it doesnt require to be devoid of liquid.. The stomach is essentially an extention of the mouth.

THe thing with ‘wait till the taste diminish’ You are being desensitized/tolerance to the taste since it started at a higher concentration (in terms of amount of saliva in your mouth) and gradually as saliva built up and dilution factor increased, hence perception. doesnt have any direct relationship to the amount absorbed.

Until you can’t taste them any more, or 15ish minutes should do.

How are you not drooling over everything after 15 minutes?!

I’m sorry but there’s absolutely no way I’m going to hold liquid under my tongue for 15 minutes. I’d rather just be tired.

This. When the taste diminishes.

Frankly, I’m a bit annoyed by trying to use solutions sublingually. The flavoring and moisture encourage too much salivation. I much prefer powders.

Perhaps they could come out with a flavored powder version of some of these. I’m only half joking about that.

Depends on the substance.

Generally speaking, sublingual will lead to faster onset for most drugs, compared to oral. I know there are some this is not true for. (I think I read some benzos don’t absorb much faster this way?)

The bioavailability (the % of a dose which is actually absorbed) between oral and sublingual can vary considerably with some drugs.

The popular addiction / maintenance drug, buprenorphine (suboxone) for example. has a sublingual bioavailability of something like 70-80%. I forget the exact number, but it’s somewhere around there. However, taken orally, you would absorb only about 10%! Swallowing the drug is almost a complete waste!

So some drugs will just absorb more slowly if you swallow them. Many others may actually be less effective, on a mg-for-mg basis. Or almost completely inactive, as the case may be.

Moreover, what are the advantages of oral route of administration?

The oral administration route is preferred over the various other administration routes of drug delivery due to the many advantages it exhibits. These advantages include safety, good patient compliance, ease of ingestion, pain avoidance, and versatility to accommodate various types of drugs (Sastry et al., 2000).

Likewise, what is the major advantage of intravenous drug administration? The administration of IV medication offers advantages over other routes of administration. Some of the main advantages include: direct access to the circulatory system, a route for administration of drugs and fluids for patients unable to tolerate oral medications and instant drug action and termination.

Secondly, what is the advantage of sublingual medication?

Advantages. Sublingual or buccal forms of drugs have their advantages. Because the medication absorbs quickly, these types of administration can be important during emergencies when you need the drug to work right away, such as during a heart attack.

Why is sublingual more effective?

Compared to commonly used tablets, capsules and other oral dosage forms, sublingual absorption is generally much faster and more efficient. Sublingual absorption is efficient. The percent of each dose absorbed is generally higher than that achieved by means of oral ingestion.

James Lacy, MLS, is a fact checker and researcher. James received a Master of Library Science degree from Dominican University.

Jenny Sweigard, MD, is a board-certified physician involved in patient care, including general medicine and critical care medicine.

The most common way people take medications is orally (by mouth). Depending on what your healthcare provider prescribed, your oral medication can be swallowed, chewed, or placed under your tongue to dissolve.

Medications that you swallow travel from your stomach or intestine into your bloodstream and then are carried to all parts of your body. This process is known as absorption. The speed with which absorption occurs depends on several factors:

  • The type of medication you are taking (e.g., liquid or tablet)
  • Whether you take your medication with food, after food or on an empty stomach
  • The ability of your medication to pass into your bloodstream (Some medications have a special coating and dissolve slowly in your stomach.)
  • How your medication reacts with the acid conditions in your stomach
  • Whether your medication interacts with other medications you are taking at the same time

If a quick effect is desired, your healthcare provider may prescribe a medication that will dissolve in your mouth and rapidly enter your bloodstream.

How to administer sublingual medication

Tablets and Capsules

In general, you should take tablets and capsules with water. Taking certain pills, such as Lipitor (atorvastatin) and Viagra (sildenafil), with grapefruit juice can cause potentially dangerous side effects. Milk can block the absorption of many antibiotics, such as Cipro (ciprofloxacin).

Your healthcare provider or pharmacist will tell you whether to take your medication on an empty stomach or before or after eating. This information is very important because digesting food can interfere with your medication dissolving and passing into your bloodstream. Always follow the directions on your prescription.

Never break, crush, or chew any capsule or tablet unless directed to by your healthcare provider or pharmacist. Many medications are long-acting or have a special coating and must be swallowed whole. If you have any questions about this, ask your pharmacist.

If you have trouble swallowing your medication, tell your healthcare provider and pharmacist. They may be able to provide you with a liquid form of the medication or a pill that is smaller and easier to swallow.

Liquid Medications

Liquid medications are good for children and adults (especially older adults) who are not able to swallow tablets or capsules.

Many liquid medications, including both prescription drugs and over-the-counter drugs, are made for children and are flavored to mask the taste of the medication. Additionally, many pharmacies can add different flavoring to liquid medications without an additional prescription by the healthcare provider.

Before measuring the proper dose of liquid medication, make sure to shake the bottle as some of the medication may have “settled” at the bottom.

Most often, you’ll be given medication measurements in teaspoons (remember that teaspoons are smaller than tablespoons). In medicine, a teaspoon means exactly 5 milliliters (ml).

Your household teaspoons may hold more or less than 5 ml. Ask your pharmacist for a spoon, medicine cup, medicine dropper, or a syringe without a needle meant specifically for measuring medications. They can show you how to properly use these.

Many over-the-counter liquid medications come with a small medicine cup attached to the top of the bottle.

If the medication has been prescribed for an infant or young child, make sure to speak with your pediatrician about the proper dosage, or amount, of liquid medication for your child.

Sublingual and Buccal Medications

Certain medications are placed under the tongue (sublingual) or between the teeth and the cheek (buccal). These medications are absorbed quickly into the bloodstream through the lining of the mouth and are used to relieve symptoms almost immediately.

Some examples of sublingual medications are Nitrostat and other nitroglycerin preparations used to treat angina (chest pain) and Suboxone (buprenorphine with naloxone), which is used to treat dependence on heroin and/or narcotic painkillers.

Other Forms of Oral Medications

Although most oral medications are swallowed, some are released in the mouth by chewing, dissolving slowly or melting on the tongue. Many of these medications are sold over-the-counter.

Chewable Tablets

Chewable tablets should be chewed until they have completely dissolved. They’re not meant to be swallowed whole.

Examples of chewable tablets include Tylenol Chewable and many brands of children’s vitamins.

Chewing Gum Medications

Chewing gum medications have a minimum time that they must be chewed to ensure that the entire amount of drug has been released, often up to 30 minutes.

Examples of medicated chewing gums include Nicorette Gum (nicotine) and Aspergum (aspirin).

Lozenges

Lozenges are meant to be “sucked” on like hard candy and allowed to dissolve slowly in your mouth. They should not be swallowed.

Examples of medicated lozenges include Commit (nicotine) and Cepacol (benzocaine).

Softchew Medications

Softchew medications are meant to melt in your mouth or to be chewed.

An example of a Softchew medication is Rolaids Soft Chew (calcium carbonate).

Tip for Swallowing Pills

Swallowing pills can be an unpleasant and uncomfortable experience for some. If you have difficulty swallowing pills, there are things that you can do to facilitate this process.

For example, German researchers found success with the following technique called the “pop bottle method.” This technique was tested with tablets.

  1. Open a bottle of water or soda bottle filled with water.
  2. Place the tablet on your tongue and close your mouth around the opening of the bottle.
  3. Tilt your head back and keep your mouth sealed around the water bottle. Don’t let any air into your mouth. Suck the water into your mouth and swallow the tablet and water.

Please note that this intervention has not been tested extensively, and, if interested, you should discuss this technique with your healthcare provider before you try it. Furthermore, if you have difficulty swallowing in general, you should probably be evaluated for dysphagia.

On a final note, always read the instructions carefully and take your medications as recommended. If you have any doubts or concerns, contact your healthcare provider or pharmacist.

Apomorphine sublingual is used to treat ”off” episodes (times of difficulty moving, walking, and speaking that may happen as medication wears off or at random) in people with advanced Parkinson’s disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance). Apomorphine is in a class of medications called dopamine agonists. It works by acting in place of dopamine, a natural substance produced in the brain that is needed to control movement.

How should this medicine be used?

Apomorphine comes as a sublingual film to take under the tongue. Apomorphine sublingual is usually used when needed, according to your doctor’s directions. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use apomorphine sublingual exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Do not use a second dose of apomorphine sublingual for treatment of the same “off” episode. Wait at least 2 hours between doses and do not use more than 5 doses a day.

Your doctor will give you another medication called trimethobenzamide (Tigan) to take when you begin to use apomorphine sublingual. This medication will help decrease your chance of developing nausea and vomiting while you are using apomorphine, especially during the beginning of treatment. Your doctor will probably tell you to begin taking trimethobenzamide 3 days before you begin to use apomorphine, and to continue taking it for up to 2 months. You should know that taking trimethobenzamide along with apomorphine may increase your risk of drowsiness, dizziness, and falls. However, do not stop taking trimethobenzamide without first talking to your doctor.

You will receive your first dose of apomorphine in a medical office where your doctor can closely monitor your condition to determine your dose. After that, your doctor will tell you to use apomorphine sublingual at home and to monitor for adverse effects.

To use apomorphine sublingual film, follow these steps:

  1. Drink water to moisten your mouth.
  2. Open the pouch using the wing tabs. Make sure to place your fingers directly on the raised dots on each wing tab. Gently pull the wing tabs apart to open the pouch. Do not open the foil package until you are ready to use the medication. Do not cut or tear the film.
  3. Hold apomorphine sublingual film between your fingers by the outside edges and remove the entire film from the pouch. Use apomorphine sublingual film whole. If it is broken, discard it and use a new dose.
  4. Place entire sublingual film under your tongue as far back under your tongue as you can. Close your mouth.
  5. Leave the film in place until it dissolves completely. It may take 3 minutes for the film to dissolve. Do not chew or swallow the film. Do not swallow your saliva or talk as the film dissolves.
  6. Open your mouth to see if the film has completely dissolved.
  7. After the sublingual film has completely dissolved, you may swallow again.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Background The preferred route of administration of analgesics for most patients in pain is oral (PO) considering the longer duration of action and convenience of use in non-hospital settings compared with subcutaneous and intravenous formulations. Soluble tablets of morphine were once commonly used for off-label sublingual (SL) administration in patients who were unable to swallow pills or large quantities of solutions. Although some hospice pharmacies still may be able to compound soluble morphine for sublingual use, the manufacture of soluble tablets of morphine has not been available in the United States since 2007. Instead, most pharmacist experts recommend the use of concentrated oral solution (20 mg/mL) of morphine or oxycodone for this clinical application.

Pharmacology of SL Morphine SL administration of morphine via soluble tablets was used to treat breakthrough pain to hasten analgesic onset and peak; however, available data do not support more rapid absorption of soluble morphine tablets when compared with more traditional oral formulations of morphine (1-3). Indeed, several clinical studies found no substantial advantage to the use of soluble morphine tablets over oral morphine (4-6).

  • Mean time to maximum concentration has been shown to be shorter for PO morphine (0.8 + 0.35hr) compared with soluble morphine tablets (1.75 + 1.30 hr), indicating that soluble morphine tablets are likely swallowed and absorbed gastrointestinally rather than through the oral mucosa (3).
  • The bioavailability (amount of drug eventually made available to the systemic circulation) of soluble morphine tablets are relatively low: only 9%
  • Agents are most readily absorbed through the oral mucosa when they are potent, non-ionized at physiological pH, and lipid soluble (see Fast Fact #103). Morphine has a relatively low potency for an opioid, is 90% ionized at the pH of the mouth, and is one of the least lipid soluble opioids. These factors likely explain its poor performance as a SL or buccal medication.

Pharmacology of Concentrated Oral Solutions of Morphine and Oxycodone In lieu of the poor evidence supporting the efficacy of soluble morphine tablets, they are not manufactured in the United States anymore. Instead, the use of concentrated (20 mg/mL) of oral morphine solution has been more commonly utilized for imminently dying patients who are unable to tolerate pills or significant volumes of an opioid solution.

  • The bioavailability of the oral solution is 23.8%.
  • Concentrated oral morphine solution is considered to be equianalgesic with soluble morphine tablets.
  • The amount of SL absorption of the 20 mg/mL concentrated oral morphine solution is estimated to be only 18-20%. Its clinical effect is more likely due to the dose being swallowed with saliva and absorbed gastrointestinally.
  • Oxycodone also comes available as a 20 mg/mL solution. The most concentrated oral solution available for methadone is a 10 mg/mL solution. Hydromorphone is not available in a concentrated oral solution.

Formulation and Dosing

  • There are several forms of short acting PO morphine available, however, only the soluble tablets or the concentrated oral solution are suitable for SL use. Nonsoluble morphine sulfate immediate release (MSIR) tablets will not be absorbed sublingually, even when crushed, because they will not liquefy under the tongue.
  • A usual starting dose for an opioid naïve patient is 5-15 mg PO or every 3 hours. The equianalgesic ratio of IV to PO morphine is 1:3 (10mg of IV morphine is approximately equianalgesic to 30 mg PO/SL morphine).

This Fast Fact was adapted with permission from the University of Wisconsin Hospital & Clinics, Madison, WI Pain Patient Care Team ‘Pain Management Fast Facts – 5 Minute Inservice’ series.

References:

  1. Osborne R, Joel S, Trew D, Slevin M. Morphine and metabolite behavior after different routes of morphine administration: demonstration of the importance of the active metabolite morphine-6-glucourinide. Clinical Pharmacology Therapy. 1990; 47:12-19.
  2. David T, Miser AW, Loprinzi CL, Kaur JS, Burnham NL, Dose AM, Ames MM. Comparative morphine pharmacokinetics following sublingual, intramuscular, and oral administration in patients with cancer. The Hospice Journal. 1993; 9(1):85-90.
  3. Colluzzi PH. Sublingual morphine: efficacy reviewed. J Pain Sympt Manage. 1998; 16(3):184-192.
  4. Pannuti F, Rossi AP, Lafelice G, et al. Control of chronic pain in very advanced cancer patients with morphine hydrochloride administered by oral, rectal, and sublingual routes: clinical report and preliminary results on morphine pharmacokinetics. Pharmacological Research Communications. 1982; 14(4):369-380.
  5. McQuay HJ, Moore RA, Bullingham RE. Sublinqual morphine, heroin, methadone, and buprenorphine: kinetics and effects. In: Foley KM & Inturrisi CE, eds. Advances in Pain Research and Therapy, Vol 8. New York, NY: Raven; 1986: pp 407-412.
  6. Robinson JM, Wilkie DJ, et al. Sublingual and oral morphine administration. Review and new findings. Nursing Clin N America. 1995; 30(4):725-743.

Version History: This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published July 2006; 3rd Edition May 2015. Further copy-editing changes occurred March 2017.

Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.

Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This information is not medical advice. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

How to administer sublingual medication

Sublingual administration occurs when the drug is placed under the tongue where it dissolves and is absorbed into the blood through the tissues.

Buccal administration involves placing a drug between the gums and the cheek. Just as with sublingual administration, the drug dissolves and is absorbed into the blood through the tissues.

There are specific reasons for using sublingual or buccal administration of a drug or supplement including:

  • It is important that the drug gets into the system quickly;
  • The patient has difficulty swallowing pills;
  • The medication is one which is not absorbed well in the stomach, or
  • Digestion would decrease the effects of the drug.

Benefits of Buccal & Sublingual Absorption

The primary benefit of buccal & sublingual absorption is avoiding digestion in the stomach or processing by the liver. Rather, the medication or supplements are absorbed directly into your bloodstream.

There are many tiny blood vessels in the cheek area, allowing the drugs to be absorbed directly into the bloodstream, bypassing the digestive system. The buccal cavity itself is lined with a mucous membrane; drugs penetrate the mucous membrane by diffusion, being carried into the blood which supplies the salivary glands and their ducts via the jugular vein.

Buccal absorption bypasses the liver which can, in some instances, allow the patient to take a lower dose of the drug with the same results. It is important to note, however, that eating, drinking or smoking can all affect how a drug is absorbed when used buccally or sublingually.

Myetin® Taken Orally

We specifically designed Myetin® as an orally dissolvable tablet because we believe the active ingredients of biotin & NAD+ are more effective with buccal & sublingual absorption.

Plus, many people with some form of inflammation or degenerative condition tell us they struggle to swallow big, bulky pills.

Initial studies show biotin benefits myelin, providing energy for neurons. While biotin is available over the counter, the dose you receive is significantly less than what you receive when taking Myetin® which delivers a full 300 mg. of biotin plus 50 mg. of NAD+ when taken twice daily.

Compare that to the micrograms listed on most “over the counter” versions of biotin and you’ll see the difference in potency!

Biotin is helpful for the individual at risk of free radical damage, inflammation and reduction in fatty acid production. High-dose biotin has also been shown to improve glucose levels and reduce pain from diabetic nerve damage as well as improving nail firmness and thickness.

Higher biotin levels generally increase the enzyme activity which is ultimately converted into energy when sufficient NAD+ is available.

Doctors believe that NAD+ and biotin work synergistically and when paired and the positive results of both increase exponentially as evidence in a recent pilot study of Myetin.