A troche is a specialized, solid medication dosage form designed to dissolve slowly within the mouth instead of being swallowed like a traditional pill. This unique delivery method allows the active ingredients to be absorbed directly through the oral tissues, offering a distinct advantage over standard oral medications. Troches often contain compounded medications, meaning a pharmacy has customized the drug, dose, and flavor to meet a patient’s specific health needs.
Defining Troche Medication
The term “troche” is derived from the Greek word trochiskos, meaning a small wheel or lozenge, describing its typical shape. A troche is a small, hard tablet or square, often made with a waxy base, that is formulated to resist immediate dissolution. It is engineered to gradually melt and release the medicinal compound over 15 to 30 minutes.
Troches differ from commercial lozenges because they contain precise, tailored doses of active therapeutic ingredients. Unlike a capsule or tablet, which is meant to be swallowed whole, a troche must remain in contact with the oral mucosa to function correctly.
How Troches Deliver Medication
The primary benefit of using a troche is its ability to bypass the body’s normal digestive process. When a troche is placed in the mouth, the medication is absorbed through the thin, highly vascular lining of the oral cavity, a process known as mucosal absorption. This delivery can occur either sublingually (under the tongue) or buccally (between the cheek and the gum).
This direct path into the bloodstream avoids the gastrointestinal tract, sidestepping what is known as first-pass metabolism. With typical pills, the drug travels to the stomach and passes through the liver, where a significant portion of the medicine can be broken down and deactivated.
Avoiding this liver breakdown allows for a higher percentage of the active drug to reach the systemic circulation, increasing its bioavailability. This makes troches a preferred method for medications that are poorly absorbed or easily degraded by stomach acids or liver enzymes, such as certain hormone replacement therapies.
Instructions for Using a Troche
Proper placement is necessary to ensure the medication is absorbed effectively. The troche should be placed either under the tongue for sublingual absorption or nestled between the upper gums and the cheek for buccal absorption, depending on the pharmacist’s instructions. It is important that the troche remains in this position for the full duration of its dissolution time.
Patients must resist the urge to chew, crush, or swallow the troche, as this sends the medication into the digestive system, defeating the purpose of the delivery method. Allow the troche to dissolve naturally and completely over the specified time, usually 15 to 30 minutes.
To promote even absorption and prevent irritation, gently move the troche to a different area of the mouth occasionally. Avoid eating or drinking anything for at least 15 to 30 minutes after the troche has fully dissolved.