Sublingual and buccal tablets

GRAS listed. Accepted for use in Europe as a food additive. Included in the FDA Inactive Ingredients Guide (oral preparations and buccal or sublingual tablets). Included in the Canadian List of Acceptable Non-medicinal Ingredients. Included in nonparenteral medicines licensed in the UK. 

For local but also systemic delivery, the oromucosal route might be suitable if safety is established. Mucoadhesive preparations, especially films, semi-solids and liquids, might be of interest if they do not interfere with suction and frequent feeding. Nevertheless, one of the major issues remains the taste of the preparation and the willingness as well as the ability of the child to retain buccal or sublingual tablets in the mouth, thus ensuring that sufficient absorption takes place. 

A small sublingual nicotine tablet has been developed and is currently being marketed in many European countries, but is not yet available in the USA. The product is designed to be held under the tongue, where the nicotine is absorbed sublingually over about 30 min. The product that is currently available contains 2 mg nicotine, of which 1 mg is absorbed via the buccal mucosa. Compared to the gum and lozenge, the sublingual tablet demands even less activity from the user. The levels of nicotine obtained by use of the 2-mg tablet and 2-mg nicotine gum are similar (Molander and Lunell 2001). 

Tablets are solid dosage forms that are compressed or prepared by a sintering proeess, including sublingual, buccal, chewable, effervescent, and compressed tablets. Some of these ean be easily compoimded an example of a tablet triturate is as follows ...

Examples of marketed mucoadhesive formulations are Attach buccal tablets (triamcinolone acetonide), Susadrin sublingual tablets (nitroglycerin Forest Laboratories, NY), and Buccastem buccal tablets (prochlorperazine maleate Reckitt and Colman, England). 

Nitrates can be administered by various routes. For example, glyceryl trinitrate is used not only as traditional sublingual tablets but also in the form of modified-release tablets, buccal tablets, aerosolized oral spray, intravenous injection, and topical ointment or skin patches for percutaneous absorption (23). These different formulations have been developed largely as a means of controlling the onset and duration of action of glyceryl trinitrate, since in conventional oral form its action is limited by marked hepatic first-pass metabolism. 

These are used when it is necessary for the drug to avoid the gastro-intestinal tract and therefore avoid first pass metabolism. They should not be swallowed. Sublingual tablets are designed to dissolve under the tongue and buccal tablets are designed to dissolve in the space between the gum and the cheeks or lip. 

Prior to administering medications through a feeding tube, the feeding tube tip location should be verified (stomach or small bowel) and the most suitable dosage form selected. Medications that should not be crushed and administered through a tube include enteric-coated or sustained-release capsules or tablets and sublingual or buccal tablets. 

Glyceryl trinitrate (GTN) is extremely effective at relieving the pain of angina but it has only a short half-life. Due to extensive first pass metabolism the drug is ineffective when taken orally and is administered sublingually or buccally in either tablet or aerosol form. 

Promoting an Optimal Response to Therapy N URATES The nitrates may be administered by die sublingual (under die tongue), buccal (between the cheek and gum), oral, IV, or transdermal route Nitroglycerin may be administered by die sublingual, buccal, to peal, transdermal, oral, or IV route If die buccal form of nitroglycerin has been prescribed, die nurse instructs die patient to place die buccal tablet between die cheek and gum or between die upper lip and gum above die incisors and allow it to dissolve The nurse shows the patient how and where to place die tablet in die mouth. Absorption of sublingual and buccal forms is dependent on salivary secretion. Dry mouth decreases absorption. 

For patients who have difficulty swallowing dilti-azem, tablets can be crushed and mixed with food or liquids. However, the patient should swallow the sus-tained-released tablets whole and not chew or divide them. When nifedipine is ordered sublingually, the capsule is punctured with a sterile needle and the liquid squeezed under the tongue or in the buccal pouch. 

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