Sublingual administration is a method of taking medication where the drug is placed directly under the tongue. This technique allows the medicine to dissolve and be absorbed through the mucous membrane in that area. This delivery method is commonly used for certain medications when a rapid effect is desired or when the drug would otherwise be broken down too quickly in the stomach. Sublingual medication is formulated to disintegrate quickly and should never be swallowed like a traditional tablet.
Step-by-Step Guide to Sublingual Administration
Before handling the medication, wash your hands thoroughly to prevent the transfer of germs or contaminants to the tablet. Sit upright in a comfortable position, as this posture helps prevent accidental swallowing while the medication is dissolving. This position also helps ensure the tablet remains in the correct location under the tongue for maximum absorption.
Carefully place the tablet deep under the tongue, resting it directly on the floor of the mouth. Once the drug is in place, keep your mouth closed and hold your tongue still to keep the tablet from moving. The medication is designed to dissolve quickly from the small amount of saliva present, typically within one to three minutes.
Do not chew, crush, or swallow the tablet, as this directs the medication into the digestive tract and reduces its effectiveness. While the tablet is dissolving, manage your saliva by trying not to swallow it immediately, allowing the medicine to fully absorb into the sublingual tissue. Once the tablet is completely dissolved, the remaining liquid can be safely swallowed.
Why This Delivery Method Is Used
This method is chosen for certain medications because it offers a direct route into the bloodstream, bypassing the digestive system. The area beneath the tongue is highly vascular, rich with a dense network of capillaries. This thin, permeable tissue allows drug molecules to diffuse rapidly into the blood circulation.
Bypassing the digestive system prevents the drug from being exposed to stomach acids and digestive enzymes that could degrade the active ingredient. More significantly, sublingual administration avoids “first-pass metabolism.” This process occurs when an orally swallowed drug travels to the liver, where a large portion is metabolized and deactivated before reaching its target.
Avoiding metabolism in the liver leads to increased bioavailability, meaning a greater proportion of the active drug reaches the systemic circulation. This rapid uptake results in a faster onset of action, which is particularly beneficial for drugs used to treat acute conditions requiring quick relief.
Important Precautions and Contraindications
To ensure the medication works as intended, avoid eating, drinking, or smoking for at least 15 to 20 minutes immediately before and after sublingual administration. Food and beverages can wash the medication away, causing premature swallowing, and smoking constricts blood vessels, slowing the absorption rate. The tablets are highly sensitive to moisture and light, so they must be stored properly in their original container at room temperature, away from humid environments.
If you accidentally swallow the tablet before it has fully dissolved, do not take another dose immediately; instead, contact a healthcare professional or poison control center for guidance. Swallowing the medication may reduce its effectiveness, but taking an extra dose could lead to an overdose. You may experience common side effects such as a mild headache, dizziness, or a tingling sensation under the tongue.
Certain pre-existing conditions or concurrent medications can make the sublingual route unsuitable. For instance, drugs like nitroglycerin are contraindicated if you are taking phosphodiesterase type 5 (PDE-5) inhibitors, such as those used for erectile dysfunction, due to the risk of severe hypotension. Inform your doctor if you have severe anemia or any condition causing increased pressure in the skull, as these can also be contraindications for certain sublingual medications.