Compounding Sublingual Medications

Learn the advantages of compounded sublingual medications over traditional oral medications.

Prescribing medications and filling prescriptions is common practice among physicians since a particular drug can provide therapeutic, pain-relieving, or other beneficial effects for a patient. These benefits, as well as other therapies prescribed by your doctor, can lead to a favorable treatment outcome.

You must, however, follow the instructions precisely—in the correct dosage at the proper time of day for the prescribed number of days—to get the most out of your therapy.

Patients' failure to follow their medications as directed—also known as patient compliance or adherence issues—can lead to serious, sometimes deadly repercussions. However, up to 50% of persons do not adhere to their drugs' dosage or frequency instructions. Most don't because they have a natural inclination to be non-compliant; instead, many individuals have difficulties taking pills or swallowing altogether — a condition known as dysphagia. If these problems seem similar, sublingual medicines might be a good fit for you.

What is Sublingual Drug Administration?

A sublingual medication is a type of drug that is administered by placing it under the tongue. The Latin prefix "sub," which means "below," and the root word "lingual," which refers to a language, are combined in sublingual's name. Unlike other drugs, sublingual medications are absorbed through the oral mucosa and enter the systemic circulation directly. This allows for rapid onset time, increased bioavailability, and decreased side effects.

By working with your physician, compounding pharmacies can formulate many medications in sublingual form. Typically, these medications will be delivered in a fast-dissolving tablet or sublingual strip. This allows for quick absorption and an immediate relief from symptoms such as difficulty swallowing or dry mouth.

However, not all drugs can safely be taken sublingually. For example, if the patient has oral lesions (e.g., oral thrush , ulcers), sublingual medications can cause further irritation or disease.

It is also essential to remember that the patient should only take some medication orally because of bioavailability concerns. In these cases, a compounding pharmacy could reformulate the drug into an alternative dosage form such as capsules without affecting efficacy but increasing patient comfort.

What is Sublingual Drug Administration?

The Sublingual Difference

Traditional oral medications involve swallowing a pill or tablet, are absorbed through the gastrointestinal tract, and enter the bloodstream.

This is the main difference between sublingual medications and traditional oral drugs.

Advantages of Compounding Sublingual Medications

Advantages of Compounding Sublingual Medications

Sublingual administration has many advantages over traditional formulations of the same medication. These include but are not limited to:

Quick Absorption

Sublingual formulations are absorbed by the body much quicker than traditional pills or tablets. This is because sublingual medications absorb through the mouth's tissues, leading to a much more direct path. If you have ever chewed on over-the-counter pain-relieving medication or taken one in pill form, then you know that it can take up to half an hour before they start making their effects known.

Predictable Potency

Oral medications often decrease in potency after exposure to stomach acids and liver filtration. Sublingual medications do not have this problem as they absorb through the tissues of the mouth. This ensures that sublingual medications maintain their potency from manufacture to delivery, resulting in a more predictable, controlled dosage for patients.

Avoidance of First-Pass Effect

The First-Pass Effect is the process by which the liver metabolizes medications before they can enter general circulation. When a drug is administered orally, it must pass through the stomach, small intestine, and then finally into the bloodstream after being absorbed in fat tissue of the large intestine. This entire journey can take hours for certain oral forms of medication that require significant absorption time. Sublingual tablets do not have this effect because they are, in contrast, absorbed directly into the bloodstream without experiencing First-Pass or liver metabolism. Physicians may also offer smaller dosages that are certain to reach the intended goal.

Reduces Interaction with other Medications and Foods

Because a sublingual dose of medicine is absorbed directly under the tongue, it goes around the stomach and its contents on their way to the circulation. As a result, because sublingual medicines do not react with foods or other medications before absorption, they are not affected. This is a significant advantage.

Ease of Administration

Individuals who have difficulty swallowing or have pill aversions avoid taking medicines due to the anxiety associated with oral medications. Sublingual versions of the same drugs can make taking prescription drugs considerably easier. In patients who are unconscious and unable to swallow, sublingual tablets are beneficial.

Everything You Should Know About Sublingual Drugs

Everything You Should Know About Sublingual Drugs

Sublingual medications can assist you in achieving the degree of compliance required to assure that you get all of the therapeutic, pain-relieving, and other treatment benefits from your prescription. However, for optimal therapy outcomes, you must still adhere to a few sublingual medication best practices.

Follow these simple steps for sublingual administration success:

1. Drink water before administration.

Before placing a sublingual tablet, drink plenty of water 10 to 15 minutes before administration. This step ensures that you make enough saliva to dissolve the tablet.

2. Place the tablet correctly within your mouth.

When it's time to place the tablet, look into whether the pharmacist instructed you to use sublingual or buccal (cheek) placement. Place the pill under your tongue and let it dissolve after using sublingual administration. Place the tablet between your cheek and gum for buccal administration.

3. Do not wash away the medication.

Avoid eating or drinking for at least 30 to 45 minutes after the tablet has dissolved. Food and drink can wash away a portion of your dose, causing diminished effects or the return of your symptoms.

4. Avoid interfering with the absorption.

Brushing your teeth immediately before or after taking your medication may result in the drug being less effectively absorbed by the mucous membranes in your mouth, resulting in fewer effects. Smoking or chewing tobacco for two hours before and after taking your medicine will also reduce the amount of medicine absorbed properly.

Sublingual Medications in their Various Forms
  • Tablets - quickly melt in the mouth, dissolve rapidly, and with little or no residue. This is the most common vehicle for taking medications sublingually.
  • Lozenges -  may also contain sublingual medicines in some instances. These can be flavored to the patient's taste and can easily be administered to children as well.
  • Strips - similar to tablets in that they quickly melt in the mouth and dissolve rapidly. Though rarely prescribed, strips are an effective sublingual method.
  • Drops - a concentrated solution to be dropped under the tongue. A dropper is used to administer the medication under the tongue.
  • Sprays - spray for the language; certain human and veterinary drugs are dispensed as such.
Compounding Pharmacy of Choice for Sublingual Medications

Your Compounding Pharmacy of Choice for Sublingual Medications

Compounding sublingual medications can be an excellent option for those who have difficulty swallowing pills. The benefits of this type of administration are many, and it may even help your patients stay on their medication plan more quickly because they don't need to remember as much. Bayview Pharmacy is always available to provide the best advice about which form would work best for you or your patient's needs so that we can partner with you in getting them back on track towards improved health! Have any questions? Call us at (401) 284-4505 today!

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