Positive Health Online | Article - Sublingual Absorption Positive Health Online listed in colon health , originally published in issue 13 - July 1996 Sublingual, meaning literally 'under the tongue' refers to a method of administering substances via the mouth in such a way that the substances are rapidly absorbed via the blood vessels under the tongue rather than via the digestive tract. The route of absorption via the highly vascularised buccal mucosa allow the substances a more direct access to the blood circulation, thus providing direct systemic administration. Medically, sublingual drug administration is applied in the field of cardiocascular drugs, steroids, some barbiturates and enzymes. It has been a developing field in the administration of many vitamins and minerals which are found to be readily and thoroughly absorbed by this method. Sublingually absorbed nutrition, which avoids exposure to the gastric system and liver, means direct nutritional benefits, particularly important for sufferers of gastro-intestinal difficulties such as ulcers, hyperactive gut, coeliac disease, those with compromised digestion, the elderly and invalids – the nutritional benefit is independent of gastro-intestinal influences.

There is considerable evidence that most sublingual substances are absorbed by simple diffusion; the sublingual area acting rather like litmus paper, readily soaking up the substances. However, not all substances are permeable and accessible to the buccal mucosa. The mucosa functions primarily as a barrier – similar to skin[1]. But while it was once believed that the barrier of human skin was 'impenetrable' it is now recognised that the dermis is a good site for the absorption of many substances (eg, vitamins E & C creams; hormones; nicotine patches) and it is a growing field of endeavour. Similarly the buccal mucosa presents an ideal site for absorption. This potential continues to be explored for the administration of many drugs – providing many useful studies and a better understanding of the modus operandi – although the benefits of the less intrusive nutrition therapies have had little opportunity as yet to be as thoroughly researched. One of the best known drugs used regularly with great success is Glyceryl Trinitrate[2] – a potent coronary vasodilator which is used for the rapid symptomatic relief of angina.

It has been found impressively effective when administered sublingually; pharmacologically active after only 1 – 2 minutes. The administration via an aerosol spray was found to provide rapid relief of symptoms, with first-class metabolism. The extent of first-class metabolism when compared to the sublingual spray decreased to 48% with sublingual tablets and 28% with the oral dose[3]. Following sublingual administration, nitrate appears in plasma . . . concentrations can be maintained for 24 hours[4]. Sublingual Verapamil[5] (a calcium channel antagonist prescribed for the management of angina, hypertension and certain supraventricular arrythmias) was effective in controlling the ventricular rate in 7 symptomatic patients and rapidly appeared in the plasma following sublingual administration. Experiments with some analgesics showed a many-times more rapid absorption from the mouth than the less lipid-soluble morphine.

Impressive absorption has been attained with sublingual administration of desoxycortisone acetate, morphine, captoprill, nifedipine and 17-B Oestradiol – interestingly, it has also been shown that the sublingual administration of 17-B Oestradiol requires only 1/4 of the oral dose. The Mechanics of Sublingual Absorption The absorption potential of the buccal mucosa is influenced by the lipid solubility and therefore the permeability of the solution (osmosis); the ionisation (pH); and the molecular weight of the substances. For example, absorption of some drugs via the buccal mucosa is shown to increase when carrier pH is lower (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 accross the entire stratified epithelium.

It is also unlikely that active transport processes operate within the oral mucosa. However, it is believed that acidic stimulation of the salivary glands, with the accompanying vasodilation, facilitates absorption and uptake into the circulatory system. The mouth is lined with a mucous membrane which is covered with squamous epithelium and contains mucous glands. The buccal mucosa are similar to the sublingual mucosal tissue. The salivary glands consist of lobules of cells which secrete saliva through the salivary ducts into the mouth. The three pairs of salivary glands are the parotid, the submandibular and the sublingual which lies on the floor of the mouth. The more acid the taste, the greater the stimulation of salivary output; serving also to avoid potential harm to acid-sensitive tooth enamel by bathing the mouth in copious neutralising fluid. With stimulation of salivary secretion oxygen is consumed and vasodilator substances are produced; and the glandular blood flow increases, due to increased glandular metabolism.

The sublingual artery travels forward to the sublingual gland, it supplies the gland and branches to the neighbouring muscles and to the mucous membranes of the mouth, tongue and gums. Two symmetrical branches travel behind the jawbone under the tongue to meet and join at its tip. Another branch meets and anastomoses with the submental branches of the facial artery. 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 nutrient to be effectively absorbed sublingually, it needs to be able to travel accross 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 accross cell walls depends on the osmotic difference in the blood between the intracellular and extracellular fluid.

The distribution of water across blood vessel walls is determined by the in-vivo osmotic pressure of plasma and the total outward hydrostatic pressure. Unlike the cell membrane, the capillary wall is freely and rapidly permeable to small molecules. The diffusion of water accross a membrane that is only permeable to water depends on the molecular weight of the particle. 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 accross cell membranes. The Water of Life Water is physiologically the most important component of the body; it is the medium in which all of the physiological activities neccessary for life take place. The properties of water greatly influence the digestion and absorption of lipids. Water molecules strongly attract each other because of the asymmetrical distribution of electrons within each molecule; the area of the oxygen atom has many electrons and hydrogen atoms have few electrons.

Water is the major component of both the the interior of the cell and the extracellular fluid that surrounds the cell. A little over half the body water is inside cells. About 15 – 20% of the extracellular water is in the plasma. The remainder is held in the extravascular, extracellular and interstitial fluid. Water is an excellent solvent. Because it is such a good solvent, it is the most abundant molecule of the body; most other molecules in the body are dissolved within the water molecules. Water is also an excellent carrier of small particles and is very readily permeable: it is absorbed passively, by osmosis. An acid is a substance that releases a hydrogen (H+ ) ion. The base is the substance that combines with it. The H+ concentration is usually shown using the pH scale; a scale of numbers which expresses the acidity/alkalinity of a solution. At pH 7 the solution is neutral – the acidity and alkalinity are balanced. The lower the pH, the more acid and the higher the percentage of H+ ions. Ascorbic Acid Ascorbic acid is the major antioxident in the aqueous phase of the body.

It is readily dissolved in water and its naturally acidic nature in aqueous solution provides a naturally low pH for rapid and efficient sublingual absorption of both itself as Vitamin C and the other solutes carried with it. Ascorbic acid readily dissolves in water. Sublingual Nutrition The advantages of sublingually administering nutrients seem to be manifold, offering improved bioavailability and more rapid metabolisation of the nutrients which are absorbed more fully. It allows individual control over the dosage for optimium benefit, within safe guidelines, and can allow absorption in a palatable and easily administered form, regardless of gastro-intestinal difficulties. It is especially useful for those who experience difficulty in swallowing tablets. Sublingual nutrients are available in readily dissolved tablets, or in fine powders, which are held under the tongue or in the mouth, until dissolved. Water soluble vitamins are passively absorbed, by osmosis, and the vitamin molecules are massed in the micelles for transport across the mucosal membranes.

References Why We Take Medicines Under Our Tongue | The Huffington Post Why We Take Medicines Under Our Tongue 02/18/2011 08:38 am ET | Updated May 25, 2011 Thomas P. Connelly, D.D.S. Practicing Dentist, New York City As a NYC Cosmetic Dentist , I get all manner of questions from patients. Most of them are garden variety tooth and mouth questions, but every now and again, I get a good one that I file away to post here. The other day, I got such a question that became the topic for this week's post: just why do we take certain medicines sublingually (under the tongue)? It made me pause for a second, because it's not something we think about all that often. But yes, we DO take certain medicines under our tongue. And I know the one obvious answer off the top of my head -- "because then the medicine gets absorbed by the body faster" -- but then that brought up more questions like "why?" (they hit the bloodstream faster?) And is the medicine then more effective? So I figured this would make an interesting topic to discuss here.

Indeed, almost everyone knows the surface answer -- "the medicine is absorbed by the body faster." But why is that? Well, I'll tell you ... essentially, when a medicine is placed under your tongue, it diffuses through the mucous membranes beneath your tongue. And because of the plethora of capillaries there, the medicine has a fairly direct route into your bloodstream. This results in the medicine working faster, and oftentimes, better (which you'll see why in a minute.) Ok, you say, but WHY does it work faster? Good question -- here's the answer: When you swallow a pill, it must go through your entire gastrointestinal tract. This means the stomach (with acid and bile), the intestines (where most absorption takes place) and then off to the liver, for some more filtering. And THEN it's delivered to where it's needed. Truthfully, it's the long way, when you think about it. Going under the tongue bypasses this entire route, and delivers the medication right to the bloodstream. No waiting, no roadblocks -- just right into the blood and off to do its job.

In addition to the speed, the medicine delivered sublingually is usually more potent, and (in general terms) needs less medication to do the job it's intended to do (you may have heard stories about people cutting pills in half, then taking them under the tongue, to produce the same effect as swallowing one pill). The reason for this increased effect is the digestive tract is incredible harsh. And it's meant to be -- it's how food is broken down, and the nutrients get stripped out, while the waste goes ... well, you know. This process, without question, will weaken most medication. So that's why some people will "cut" pills or otherwise take them under the tongue (however, I do not recommend you do this on your own without professional guidance -- in other words, ask your doctor before you start cutting your pills in half, no matter what anyone else has told you).

That said, sublingual delivery is actually preferred for certain medications (like cardiovascular drugs, steroids, etc), and recently, vitamins and minerals (in fact, I even came across some spray vitamins while reading about this topic, which I found somewhat humorous at first, but then thought "hey, why NOT?" -- I mean, some vitamins are literal horse pills in size, so I guess it just makes sense). Expanding on that last statement, there are also plenty of people who have a hard time swallowing pills (or perhaps they have a throat condition that makes swallowing anything extremely difficult). For these people, taking medication sublingually (if possible) is definitely an advantage. So far, it seems sublingual is very advantageous -- it's faster, the medicine is usually more potent, so it brings up another question: Why don't more (or all) medicines go this route? Well, the first answer is a pill is WAY easier to take then putting something under your tongue and holding it there for 10 minutes or so. But the "medical" answer is that absorption by your body is far more controlled in solid pill form.

With sublingual delivery, you may accidentally swallow some, leading to a somewhat erratic absorption rate (see merckmanuals link below), which could produce unwanted effects. In medication, "dosage" is typically very important (that goes without saying, really). And with a solid pill, there's little to no question in terms of how much is in the pill, and how much is meant to be absorbed. This is why (and it's very important that I stress this) that you ask your doctor before taking anything sublingually that wasn't "meant" to be. Your doctor may give his or her blessing and say it's fine, and they may not. And if it's not good that you cut your pills, perhaps he or she can prescribe a sublingual form, if one exists. Until next time, keep smiling!

Buprenorphine Sublingual and Buccal (opioid dependence): MedlinePlus Drug Information Buprenorphine Sublingual and Buccal (opioid dependence) URL of this page: Buprenorphine Sublingual and Buccal (opioid dependence) pronounced as (byoo pre nor' feen) [Posted 08/31/2016] AUDIENCE: Pharmacy, Internal Medicine, Psychiatry, Neurology, Family Practice ISSUE: FDA review has found that the growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths. Opioids are used to treat pain and cough; benzodiazepines are used to treat anxiety, insomnia, and seizures. In an effort to decrease the use of opioids and benzodiazepines, or opioids and other CNS depressants, together, FDA is adding Boxed Warnings, our strongest warnings, to the drug labeling of prescription opioid pain and prescription opioid cough medicines, and benzodiazepines.

See the Drug Safety Communication, available at: , for a listing of all approved prescription opioid pain and cough medicines, and benzodiazepines and other CNS depressants. FDA conducted and reviewed several studies showing that serious risks are associated with the combined use of opioids and benzodiazepines, other drugs that depress the CNS, or alcohol (see the FDA Drug Safety Communication, available at: , for a Data Summary). Based on these data, FDA is requiring several changes to reflect these risks in the opioid and benzodiazepine labeling, and new or revised patient Medication Guides. These changes include the new Boxed Warnings and revisions to the Warnings and Precautions, Drug Interactions, and Patient Counseling Information sections of the labeling. FDA is continuing to evaluate the evidence regarding combined use of benzodiazepines or other CNS depressants with medication-assisted therapy (MAT) drugs used to treat opioid addiction and dependence. FDA is also evaluating whether labeling changes are needed for other CNS depressants, and will update the public when more information is available. BACKGROUND: Opioids are powerful prescription medicines that can help manage pain when other treatments and medicines cannot be taken or are not able to provide enough pain relief.

Benzodiazepines are a class of medicines that are widely used to treat conditions including anxiety, insomnia, and seizures. RECOMMENDATION: Health care professionalsshould limit prescribing opioid pain medicines with benzodiazepines or other CNS depressants only to patients for whom alternative treatment options are inadequate. If these medicines are prescribed together, limit the dosages and duration of each drug to the minimum possible while achieving the desired clinical effect. Warn patients and caregivers about the risks of slowed or difficult breathing and/or sedation, and the associated signs and symptoms. Avoid prescribing prescription opioid cough medicines for patients taking benzodiazepines or other CNS depressants, including alcohol. Patients taking opioids with benzodiazepines, other CNS depressant medicines, or alcohol, and caregivers of these patients, should seek medical attention immediately if they or someone they are caring for experiences symptoms of unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. For more information visit the FDA website at: and . Why is this medication prescribed?

Buprenorphine and the combination of buprenorphine and naloxone are used to treat opioid dependence (addiction to opioid drugs, including heroin and narcotic painkillers). Buprenorphine is in a class of medications called opioid partial agonist-antagonists and naloxone is in a class of medications called opioid antagonists. Buprenorphine alone and the combination of buprenorphine and naloxone work to prevent withdrawal symptoms when someone stops taking opioid drugs by producing similar effects to these drugs. How should this medicine be used? Buprenorphine comes as a sublingual tablet. The combination of buprenorphine and naloxone comes as a sublingual tablet (Zubsolv) and as a sublingual film (Suboxone) to take under the tongue and as a buccal film (Bunavail) to apply between the gum and cheek. After your doctor determines an appropriate dose, these products are usually taken once a day. To help you remember to take or apply buprenorphine or buprenorphine and naloxone, take or apply it around the same time every day.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take or apply buprenorphine or buprenorphine and naloxone exactly as directed. Do not take or apply more or less of it or take or apply it more often than prescribed by your doctor. You will start your treatment with buprenorphine, which you will take in the doctor's office. Your doctor will start you on a low dose of buprenorphine and will increase your dose for 1 or 2 days before switching you to buprenorphine and naloxone. Your doctor may increase or decrease your buprenorphine and naloxone dose until the medication works properly. If you are taking the sublingual tablets, place the tablets under your tongue until they completely melt. If you are taking more than two tablets, either place them all under your tongue at the same time or place them under your tongue up to 2 at a time. Do not chew the tablets or swallow them whole. Do not eat, drink, or talk until the tablet dissolves completely.

If you are using the buccal film, use your tongue to wet the inside of your cheek or rinse your mouth with water before you apply the film. Apply the film with a dry finger against the inside of the cheek. Then remove your finger and the film will stick to the inside of your cheek. If you are to use two films, place another film on the inside of your other cheek at the same time. Do not apply films on top of each other and do not apply more than two films to the inside of the mouth at one time. Leave the film(s) in the mouth until they dissolve. Do not cut, tear, chew, swallow, touch or move the film while it dissolves. Do not eat or drink anything until the film dissolves completely. If you are using the sublingual film, rinse your mouth with water before you place the film. Place the film with a dry finger under your tongue to the right or left of the center and hold the film in place for 5 seconds. If you are using two films, place the other one on the opposite side under the tongue. Do not put the films on top of or near each other. Do not use more than 2 films at one time.

Do not cut, tear, chew, swallow, touch or move the film while it dissolves. Do not eat or drink anything until the film dissolves completely. If you need to switch from one buprenorphine or buprenorphine and naloxone product to another, your doctor may need to adjust your dose. Each time you receive your medication, check to be sure that you have received the buprenorphine product that was prescribed for you. Ask your pharmacist if you have are not sure that you received the right medication. Do not stop taking or using buprenorphine or buprenorphine and naloxone without talking to your doctor. Stopping buprenorphine or buprenorphine and naloxone too quickly can cause withdrawal symptoms. Your doctor will tell you when and how to stop taking or using buprenorphine or buprenorphine and naloxone. If you suddenly stop taking or using buprenorphine or buprenorphine and naloxone, you may experience withdrawal symptoms such as hot or cold flushes, restlessness, teary eyes, runny nose, sweating, chills, muscle pain, vomiting, or diarrhea.

Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking or using buprenorphine or buprenorphine and naloxone, tell your doctor and pharmacist if you are allergic to buprenorphine, naloxone, any other medications, or any of the other ingredients in buprenorphine or buprenorphine and naloxone sublingual tablets or film. Ask your pharmacist or check the Medication Guide for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking.

Be sure to mention any of the following: antidepressants ('mood elevators'); antifungals such as ketoconazole (Nizoral); medications for anxiety such as benzodiazepines; cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); erythromycin (E.E.S., Eryc, Erythrocin, others); HIV medications such as atazanavir (Reyataz, in Evotaz), delavirdine (Rescriptor), efavirenz (Sustiva, in Atripla), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), and ritonavir (Norvir, in Kaletra, in Technivie); lithium (Lithobid); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, in Treximet), and z

olmitriptan (Zomig); mirtazapine (Remeron); opiate (narcotic) medications for pain control; phenothiazines (medications used for mental illness or nausea); sedatives; medications for seizures such as carbamazepine (Epitol, Tegretol, Teril, others), phenobarbital, and phenytoin (Dilantin, Phenytek); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pr

istiq), milnacipran (Savella), and venlafaxine (Effexor); sleeping pills; tranquilizers; or tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil).

Also tell your doctor or pharmacist if you are taking or receiving the following monoamine oxidase (MAO) inhibitors or if you have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Many other medications may also interact with buprenorphine or buprenorphine and naloxone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan.

tell your doctor if you drink large amounts of alcohol and if you have or have ever had adrenal problems such as Addison's disease (condition in which the adrenal gland produces less hormone than normal); benign prostatic hypertrophy (BPH, enlargement of the prostate gland); difficulty urinating; a head injury; hallucinations (seeing things or hearing voices that do not exist); a curve in the spine that makes it hard to breathe; gallbladder disease; chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways); or thyroid, kidney, liver, or lung disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking or using buprenorphine or buprenorphine and naloxone, call your doctor. If you take or use buprenorphine or buprenorphine and naloxone tablets or film regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, seizures, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight.

if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking or using buprenorphine or buprenorphine and naloxone. you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using buprenorphine or buprenorphine and naloxone. you should know that buprenorphine or buprenorphine and naloxone may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. remember that alcohol can add to the breathing difficulties that can be caused by this medication. you should know that buprenorphine or buprenorphine and naloxone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking or using buprenorphine or buprenorphine and naloxone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose? Take or apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take or apply a double dose to make up for a missed one. What side effects can this medication cause? Buprenorphine or buprenorphine and naloxone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache difficulty falling asleep or staying asleep mouth numbness or redness pain in the upper right part of the stomach yellowing of the skin or eyes dark-colored urine light-colored stools Buprenorphine or buprenorphine and naloxone may cause other side effects. Call your doctor if you have any unusual problems while taking or using this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( ) or by phone (1-800-332-1088). What should I know about storage and disposal of this medication?

Keep this medication in the packaging it came in, tightly closed, and out of reach of children. Buprenorphine or buprenorphine and naloxone can be a target for people who abuse prescription medications or street drugs. Store it in a safe place so that no one else can use it accidentally or on purpose. Store buprenorphine or buprenorphine and naloxone at room temperature and away from excess heat and moisture (not in the bathroom). Do not freeze buprenorphine or buprenorphine and naloxone. You must immediately dispose of any medication that is outdated or no longer needed. Dispose of unneeded tablets or films by removing them from the packaging and flushing them down the toilet. Call your pharmacist or the manufacturer if you have questions or need help disposing of unneeded medication. In case of emergency/overdose In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: pinpoint pupils slowed breathing What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to buprenorphine and naloxone. Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are using buprenorphine or buprenorphine and naloxone. In case of an emergency, you or a family member should tell the treating doctor or emergency room staff that you are taking or using buprenorphine or buprenorphine and naloxone. Do not inject buprenorphine or buprenorphine and naloxone sublingual film or tablets. Severe reactions may happen, including withdrawal symptoms. Do not let anyone else take or use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital.

It is also important information to carry with you in case of emergencies. Brand names Nitroglycerin Sublingual: MedlinePlus Drug Information Brand names Why is this medication prescribed? Nitroglycerin sublingual tablets are used to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). It is also used just before activities that may cause episodes of angina in order to prevent the angina from occurring. Nitroglycerin is in a class of medications called vasodilators. It works by relaxing the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen. How should this medicine be used? Nitroglycerin comes as a sublingual tablet to take under the tongue. The tablets is usually taken as needed, either 5 to 10 minutes before activities that may cause attacks of angina or at the first sign of an attack. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nitroglycerin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Nitroglycerin may not work as well after you have used it for some time or if you have taken many doses. Take the fewest tablets needed to relieve the pain of your attacks. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor. Talk to your doctor about how to use nitroglycerin tablets to treat angina attacks. Your doctor will probably tell you to sit down and take one dose of nitroglycerin when an attack begins. If your symptoms do not improve very much or if they worsen after you take this dose you may be told to call for emergency medical help right away. If your symptoms do not go away completely after you take the first dose, your doctor may tell you to take a second dose after 5 minutes have passed and a third dose 5 minutes after the second dose. Call for emergency medical help right away if your chest pain has not gone away completely 5 minutes after you take the third dose. Do not chew, crush, or swallow nitroglycerin sublingual tablets. Instead, place the tablet under your tongue or between your cheek and gum and wait for it to dissolve.

You may feel burning or tingling in your mouth as the tablet dissolves. This is normal but is not a sign that the tablet is working. Do not be concerned that the tablet is not working if you do not feel the burning or tingling. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking or using nitroglycerin, tell your doctor and pharmacist if you are allergic to nitroglycerin patches, capsules, tablets, ointment, or spray; any other medications; or any of the ingredients in nitroglycerin sublingual tablets. Ask your pharmacist for a list of the ingredients. tell your doctor if you are taking riociguat (Adempas) or if you are taking or have recently taken a phosphodiesterase inhibitor (PDE-5) such as avanafil (Stendra), sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn). Your doctor may tell you not to take nitroglycerin if you are taking one of these medications.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Be sure to mention any of the following: aspirin; beta blockers such as atenolol (Tenormin), carteolol , labetalol (Trandate, in Normozide, in Trandate HCT), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Hemangeol, Inderal, Innopran), sotalol (Betapace, Sorine), and timolol; calcium channel blockers such as amlodipine, diltiazem (Cardizem, Cartia, Diltzac, others), felodipine (Plendil), isradipine (DynaCirc), nifedipine (Adalat, Afeditab CR, Procardia), and verapamil (Calan, Covera, Verelan, in Tarka); diuretics (water pills); ergot-type medications such as bromocriptine (Cycloset, Parlodel), cabergoline, dihydroergotamine (D.H.E.

45, Migranal), ergoloid mesylates (Hydergine), ergotamine (in Cafergot, in Migergot), and methylergonovine (Methergine) heparin; medications for high blood pressure, heart failure, or an irregular heartbeat. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. you should know that nitroglycerin sublingual tablets may not dissolve easily in your mouth if you are taking medications that cause dry mouth such as antihistamines; antidepressants including amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); ipratropium (Atrovent); or medications for irritable bowel disease, motion sickness, Parkinson's disease, ulcers, or urinary problems.

If this happens, use an artificial saliva product or chew gum to increase the amount of saliva in your mouth so that the tablet will dissolve. tell your doctor if you have recently had a heart attack and if you have anemia (low number of red blood cells) or any condition that causes increased pressure in your skull. Your doctor may tell you not to take nitroglycerin. tell your doctor if you think you may be dehydrated and if you have or have ever had heart failure, low blood pressure, or hypertrophic cardiomyopathy (thickening of the heart muscles). tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking nitroglycerin, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nitroglycerin. ask your doctor about the safe use of alcoholic beverages while you are taking nitroglycerin. Alcohol can make the side effects from nitroglycerin worse. you should know that nitroglycerin may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position, or at any time, especially if you have been drinking alcoholic beverages.

To avoid this problem, get up slowly, resting your feet on the floor for a few minutes before standing up. Take extra precautions to avoid falling during your treatment with nitroglycerin. you should know that you may experience headaches during your treatment with nitroglycerin. These headaches may be a sign that the medication is working as it should. Do not try to change the times that you take nitroglycerin in order to avoid headaches because then the medication may not work as well. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Nitroglycerin sublingual tablets are usually taken as needed to treat episodes of angina; do not take them on a regular basis. What side effects can this medication cause? Nitroglycerin may cause side effects. Tell your doctor if any of these symptoms or those listed in SPECIAL PRECAUTIONS section are severe or do not go away: flushing Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: blurred vision rash, blistering, or peeling of the skin hives sweating pale skin Nitroglycerin sublingual may cause other side effects.

Call your doctor if you have any unusual problems while you are taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( ) or by phone (1-800-332-1088). What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed after each use, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( ) for more information if you do not have access to a take-back program.

In case of emergency/overdose In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: headache What other information should I know? Keep all appointments with your doctor. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking nitroglycerin sublingual. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. How to Take Your Meds: Medication Administration Routes By Marian Anne Eure Updated April 20, 2016 There are many routes of medication administration (the way that a drug is placed into the body).

Based on the specific medication being used, the rate of absorption desired, and the specific site of action (where the medication needs to have an effect) your doctor or pharmacist will instruct you on the route of administration needed for you. Most drugs are manufactured for a specific route of administration and must be used as directed for safety and efficiency. Routes of Medication Administration In general, two categories of medication administration exist: parenteral and nonparenteral. These two categories also determine whether or not a drug stays in one area of the body (local effect) or absorbed by the vascular system to be distributed to body tissues (systemic effect). Parenteral This administration route involves medication that is injected in the body anywhere other than the mouth or alimentary canal (the entire passage along which food passes through the body from mouth to anus. It includes the esophagus, stomach, and intestines). Generally, parenteral is the most reliable, direct and rapidly absorbed way of administering medications. This is used when more complete and faster absorption of a drug is needed.

It describes any medication injected into the body via the following routes: Intradermal (injecting a drug into the first layers of the skin) Subcutaneous (injecting directly into the fatty tissue under the skin) Intramuscular (injecting directly into a muscle) Intrarterial (injecting a drug directly into an artery) Intracardiac (injecting directly into the heart) Intravenous (injecting directly into a vein) Intrathecal (injecting into the spinal canal) Epidural (injecting into the epidural space of the spinal cord) Intrperitoneal (injecting directly into the abdominal cavity) The speed of absorption varies with parenteral administration, but it is faster than oral administration , which is a nonparenteral route. Some of the disadvantages of using the parenteral route is that there is a slight risk of infection, tissue damage, pain and/or anxiety for some patients. ​Nonparenteral Nonparenteral is the route that oral medications (pills, capsules, syrups), topical medications (ointments, patches like nitro), and suppositories (vaginal and rectal) are administered. This route includes: Oral (medications are taken by mouth and absorbed into the system through the digestive system.

Absorption is slow. Medications that use this option cannot be used if vomiting is occurring.) Sublingual (medication is placed under the tongue for absorption by the body) Topical (applied directly to a part of the body) Transdermal (active ingredients are delivered via the skin for systemic distribution. Examples include transdermal patches) Ophthalmic (administered through the eye, usually in the form of drops) Otic (administered through the ear) Nasal (administered through the nose) Rectal (absorbed by the lower digestive tract) Vaginal (administered through the vagina) Mucosal (medications are delivered through the nose or inhaled and are absorbed through the nasal mucosa or bronchioles, respectively. Vaginal administration of a medication is also considered mucosal.) Percutaneous (medications are absorbed directly through the skin into the blood stream. Some birthcontrol pills and hormone replacements are administered by patches that are absorbed slowly and evenly through the skin, for example.) The advantages of using these nonparenteral routes is that it is easier and more convenient for most.

Unfortunately if you are nauseated, vomiting, can't swallow or have intestinal issues, taking medications via the gastrointestinal tract is not recommended. Continue Reading

Question: A sublingual medicine is applied in which part of the body?
Answer: Mouth