Sublingual administration

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Sublingual (

Sublingual administration has certain advantages over oral administration. Being more direct, it is often faster onset of action, and it ensures that the substance will risk degradation only by salivary enzymes before entering the bloodstream, whereas orally administered drugs must survive passage through the hostile environment of the gastrointestinal tract, which risks degrading them, by either stomach acid or bile, or by enzymes such as monoamine oxidase (MAO). Furthermore, after absorption from the gastrointestinal tract, such drugs must pass to the liver, where they may be extensively altered; this is known as the first pass effect of drug metabolism. Due to the digestive activity of the stomach and intestines, the oral route is unsuitable for certain substances, such as salvinorin A.

Forms

Pharmaceutical preparations for sublingual administration are manufactured in the form of:

• Sublingual tablets—tablets which easily melt in the mouth, dissolve rapidly and with little or no residue. Nitroglycerine tablets are an example, the anti-emetic ondansetron is another.
• Sublingual strips—similar to tablets in that they easily melt in the mouth and dissolve rapidly.
  Suboxone
  is an example of medication that comes in a sublingual strip.
• Multi-purpose tablets—Soluble tablets for either oral or sublingual (or buccal) administration, often also suitable for preparation of injections, Hydrostat (hydromorphone) and a number of brands of morphine tablets and cubes.
• Sublingual drops—a concentrated solution to be dropped under the tongue, as with some nicocodeine cough preparations,
• Sublingual spray—spray for the tongue; certain human and veterinary drugs are dispensed as such.
• Lozenge—effects a metred and patient-controlled-rate combination of sublingual, buccal, and oral administration, as with the Actiq fentanyl.
• Effervescent buccal or sublingual tablets—this method drives the drug through the mucous membranes much faster (this is the case in the stomach with carbonated or effervescent liquids as well) and is used in the Fentora fentanyl buccal tablet.

Substance

Almost any form of substance may be amenable to sublingual administration if it dissolves easily in saliva. Powders and aerosols may all take advantage of this method. However, a number of factors, such as

Allergens may also be applied under the tongue as a part of allergen immunotherapy.

Therapeutic peptides and proteins

A relatively new way of administration of therapeutic

The sublingual route may also be used for vaccines against various infectious diseases. Thus, preclinical studies have found that sublingual vaccines can be highly immunogenic and may protect against influenza virus^[4][5] and Helicobacter pylori,^[6] but sublingual administration may also be used for vaccines against other infectious diseases.^{[citation needed]}

Footnotes