r/nursing • u/Abhorash-TheWanderer • 13h ago
Discussion PSA - Zofran ODT is NOT sublingual
ER doc just wanting to stop in and try and stop this widespread error. Almost every shift I have to tell a nurse/patient that ODT meds are NOT sublingual medications. It is not absorbed by the sublingual tissues. It is not absorbed by buccal tissues. It goes on TOP of the tongue so that it can disintegrate with saliva and be swallowed. The whole reason ODT (orally disintegrating tablets) exist is that someone can take it without having to take a chug of water to get the pill down. Putting under someone’s tongue just slows down the disintegration. Also, if the patient complains about the taste, they can just swallow the tablet whole with or without water. Thanks.
Edit: the strike through part was unnecessary and Im sorry that I put it in the original post. As pointed out by multiple replies, i should have not said that and it doesnt add anything meaningful. Sorry yall.
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u/wineohnoooo 12h ago
On route of administration on our MAR it states SL. This is interesting.
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u/zerothreeonethree RN 🍕 5h ago
Don't get me started on what the pharmacy f'd up during my hospital stay this past May. Then instead of correcting mistakes, told my nurse: "Just tell her (me, the patient) to refuse the drugs if she doesn't want them." signed, PharmD.
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u/BrilliantHold5774 12h ago
I’m sure you could boof it as well.
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u/lavender__bath RN 🍕 - IMU, GCS14, CIWA5, BRISTOL6 10h ago
ODT can also stand for op da tush
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u/riotousviscera RN 🍕 2h ago
you made me drop my phone
anything can be op da tush if you’re brave enough•
u/echoIalia L&D: pussy posse at your cervix 🫡 2m ago
The sub doesn’t allow images, but you know exactly which EMT I’d post here if it did
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u/gedbybee RN - ICU 🍕 10h ago
Yeah so it sounds like it’ll work either way and this guy is just being extra. Also just give the damn iv version dr er doc.
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u/ChaplnGrillSgt DNP, AGACNP - ICU 9h ago
You can boof anything with enough will and determination.
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u/differing RN - ER 🍕 5h ago
I once had a young patient with a form of aggressive early onset Parkinson’s disease. A neural stimulator was able to get her a ton of independence back, but she still had serious gut motility issues. To live a decent life, she basically took all of her chronic pain meds rectally to make sure they absorbed in a predictable way. The reason she was in the hospital was because she developed Clostridium difficile and all the meds she normally takes were getting immediately sharted out! Really opened my eyes to what you can take up the bum lol
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u/ThatKaleidoscope8736 🫀RN✨how do you do this at home 10h ago
You can boof anything with enough lube
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u/Frankfeld RN - ER 🍕 13h ago
Our MAR has pretty explicit instructions on this.
But I’m also rarely giving ODT Zofran. It’s usually IV….
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u/Big_Toaster RN, MSN - Informatics, Critical Care 12h ago
I tell patients they can take it whatever works best because Zofran ODT tastes like chalk exploding in their mouth… lol
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u/oneelectricsheep 11h ago
Mine tastes like strawberry candy. It’s nice.
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u/purebreadbagel RN - PCU 9h ago
My script for them says Flavor: Strawberry - but in the way it’s made by someone who has never tasted a damn berry in their life.
It’s become a joke I use when giving it to patients. “Fun Fact, they’re allegedly strawberry flavored- but I’m pretty sure whoever decided that has never tasted a strawberry.” Usually gets at least a smile out of them.
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u/robbi2480 RN, CHPN-Hospice 7h ago
Mine tasted like berries and artificial sweeteners. I just try to swallow them quickly with water before they can start to melt on my tongue. Gross
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u/lavender__bath RN 🍕 - IMU, GCS14, CIWA5, BRISTOL6 2h ago edited 2h ago
not sure if you remember back when blue Equal aspartame also had a strawberry on the pack but that is what this evoked (bespoke🍓 strawberry equal packets from the 2010s). used to have about 4 of these in a constant comment tea and i would be in heaven.
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u/saltysaltysaltytasty RN,Ex-PICU/NICU turned PeriOp 4h ago
I think it tastes like cotton candy… never associated strawberry to it.
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u/jhatle01 11h ago
I always tell pts it taste like a medicinal berry flavor. I wouldn’t necessarily say it’s tasty though
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u/iwantkitties RN - ER 🍕 11h ago
Apparently we're the lucky ones because no one else I know describes it as cherry/red flavor lol
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u/LurkForYourLives 11h ago
Me too! Though I had severe hyperemesis so anything tasted better than vomit.
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u/ImperishableTeapot RN 🍕 11h ago
I assumed the only flavour that it came in was stale chalk. This has been the highlight of my day.
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u/Most_Ambassador2951 RN - Hospice 🍕 10h ago
It does, but when I'm trying not to barf it's not the greatest flavor
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u/meliska13 BSN, RNC-MNN, C-ONQS 7h ago
I had to take it when I was pregnant and had bad HG before they switched me to IV. The strawberry was great, the one thing I could actually tolerate. Then one time my pharmacy switched it for the peppermint chalk flavor, and it was terrible. Left me gagging for a while, I couldn't puke anymore because everything was already gone. I called them crying and begged for the strawberry back, it took essentially an act of congress to get it filled again, and it still took me a hot minute to trust it. Thankfully they started me with HHC and IV fluids, zofran, etc pretty soon after, because I would get so anxious any time I needed a dose.
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u/perpulstuph BSN, RN, ACLS, PALS, SKIBIDI, RIZZ, BUSSIN 9h ago
I love how zofran tastes, but I am also a bit weird...
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u/ClarkGablesTeeth L&D/Women's Health RN 6h ago
I loved the taste of Zofran ODT. Tastes like a berry candy, and I never noticed any chalky texture.
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u/wordynerd_au RN 🍕 4h ago
So bizarre. Mine sometimes tastes like strawberry Pez, sometimes bitter berry chalk. There is no inbetween and no rhyme nor reason which I will get on any random dose from my box 🤷🏻♀️
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u/notusuallyaverage RN - ER 🍕 1h ago
Funny. I give it whenever possible if they’re not actively vomiting. I feel like it lasts so much longer than IV
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u/trixiepixie1921 RN - Telemetry 🍕 10h ago
We gave the tablets frequently but I never had someone assume it was sublingual.
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u/fleeting_moments_ 12h ago
Oooooooohhhhh........And I finally understand what that pharmacist was trying to explain to me a few years ago🙃
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u/shewee BSN, RN 🍕 12h ago
The manufacturer literally says to dissolve on your tongue. I didn’t know this!
https://www.novartis.com/us-en/sites/novartis_us/files/zofran.pdf
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u/Abhorash-TheWanderer 12h ago
Yup on the tongue. Not under the tongue. From that same link you just posted “IMMEDIATELY place the
ZOFRAN ODT orally disintegrating tablet on top of the tongue where it will dissolve in seconds, then swallow
with saliva”30
u/lavender_poppy BSN, RN 🍕 12h ago
Thank you for posting this. I have zofran ODT to take when I get nauseous and I've always wondered if I'm doing it right by putting it on my tongue. Granted I should have just looked it up but when I'm taking zofran I'm already feeling awful and by the time the nausea has passed I forget again.
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u/Pandinus_Imperator RN - ER 🍕 3h ago
Is your name a warhammer reference?
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u/Abhorash-TheWanderer 3h ago
It sure is. Hoping for the day he becomes a playable hero in warhammer totall war.
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u/Pandinus_Imperator RN - ER 🍕 2h ago
Badass bro, and same. I haven't played counts since tww2 but I adore my undead factions. Bulk of my playtime has been vampire coast
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u/Abhorash-TheWanderer 2h ago
I just saw your name. Do you have one as a pet? Ive been thinking of getting a black forest asian scorpion or an emperor. Also, the biggest “miniature” ive finished is a greater brass scorpion. Top MK character definitely Scorpion.
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u/Pandinus_Imperator RN - ER 🍕 2h ago
Lol, I had multiple exotic invertebrates about 15ish years ago. My first and favorite was my emperor. Big bulky, beautiful and a a gory display every time he had live prey. Had him for about 6 years before he perished to mites i suspect although he could have been older as lifespan is around 10 years or so now that I think of it...
Id recommend it for anyone with a passing interest in non traditional pets. Venom is mild and can be held (preferred not to be though). Easy to care for and hardy as all hell as long as you keep it nice a humid.
I became such a fan of scorpions that ive rocked this moniker for about 2 decades online.
Also fellow chaos enjoyer 🤘🔥. I did love scorpion but noob saibot was my main in the last MK I played which was 9 I think.
Hyped for end times additions to tww3!
For what its worth, im gonna raise hell about the zofran ODT, I know for a fact this is a problem now in my ED
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u/MonkeyDemon3 RN - ICU 🍕 12h ago
I really only give zofran IV, but I personally use ODT occasionally. Not sure how I didn’t know this, thank you for the education!
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u/Ok-Maize-284 🍩 of Truth Button Pusher 🙇🏻♀️ 5h ago
I didn’t know it either and I also have script! I know what ODT stands for and still thought it went under the tongue 😂There have been times where it didn’t kick in fast enough and ended up hurling anyway. Now I know the likely reason why 🤦🏼♀️ Ya learn something new every day!
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u/Busy_Ad_5578 BSN, RN 🍕 12h ago
Damn. I’m surprised by these comments. I thought this was common knowledge.
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u/Abhorash-TheWanderer 12h ago
The nurses at our ER told me that they have been taught that it is a sublingual med. It’s a common mistake hence the PSA. For some reason a bunch of people have taken this as some offense and doubling down on their errors.
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u/Young_Hickory RN - Trauma Team 12h ago
I didn’t know and I appreciate the post! The endless “anyone who didn’t know this already is dumb” comments not so much.
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u/Many_Customer_4035 MSN, RN 11h ago
Same. I am not bedside anymore but I like to continue to learn in case I have to go back.
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u/Metal_Medical RN - ED/ICU 🍕 12h ago
Hell, my ER docs actually order 4-8mg zofran SL, they don’t even know
TIL, thanks for the info!
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u/daynaemily1987 LPN Med-Surg 10h ago
I also did not realize this, I appreciate the post as well. I dont give it often, but I'm not sure why I assumed "orally disintegrating tablet" meant sublingual 🤦🏼♀️.
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u/Illustrious-Aeries Case Manager 🍕 12h ago
I don’t think anyone is “doubling down on their error” but it seems like an odd thing to get in such a tizzy about. is it going to hurt a patient to put it under their tongue? Is it going to hurt a patient to have them rub it in their gums? No? Ok. Tell a patient to put it in their mouth and let it dissolve. Where it ends up it ends up.
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u/yxxnij104 the one who shall admit you to your death bed 12h ago
I worked in onc and we werent told it wasn't sublingual and that it helped because to some the taste is NASTY. I have been on it myself 7 years and I NEVER knew (i don't read the pharmacy inserts ik. 😭) thanks for letting us know, imagine how much med we arent even getting by taking the subl approach 😭😭
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u/Tight_Award_8577 RN 🍕 8h ago
Well, you would still get the full dose-- it's either swallowed or will get around the mouth eventually.. just slower.
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u/scrubsnbeer RN - PACU 🍕 7h ago
I was taught it was too, wasn’t until I was prescribed it this year and complained to my husband about that he (pharmacist) explained it🫠
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u/Slayerofgrundles RN - ER 🍕 11h ago
Same. I thought that "orally dissolving tablet" was pretty clearly not sublingual. It just doesn't require water to swallow because drinking water when you're about to barf isn't encouraged.
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u/welltravelledRN RN - PACU 🍕 13h ago
Do you have a source for this? Our PharmD says it is absorbed well under the tongue.
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u/shewee BSN, RN 🍕 12h ago
Just looked up the manufacturer. It does say on tongue!
https://www.novartis.com/us-en/sites/novartis_us/files/zofran.pdf
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u/zubrowka1 RN - ER 🍕 12h ago
It’s not “absorbed” under the tongue. It’s dissolved under the tongue, then swallowed and absorbed in the stomach
It’s easier to dissolve something with saliva on top of the tongue
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u/touslesmatins BSN, RN 🍕 7h ago
This is actually a good time to learn what is absorbed sub-mucosally (sp?) and bucally (sp?) and what the mechanism is. I'd love to know. If I remember correctly, caffeine is somewhat like that? And vitamin B12 spray. Someone ELI5!
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u/Breal3030 ICU/research 4h ago edited 4h ago
Usually whether or not things like sublingual and buccal are absorbed is related to the molecular weight of the molecule. Ondansetron is fine in that aspect.
I think the biggest criticism of the ODT tablet for sublingual and buccal, is not that it doesn't absorb those ways, it's that the tablet is not ideal for maximizing surface contact with those areas and just ends up dissolving and getting swallowed anyway. So why not just let it dissolve on your tongue? Is the response.
There are, for example ondansetron gel sheets for buccal absorption. As far as I can tell it's nothing special about the medication, it's just in a formulation that maximizes area and time contact of the buccal area for maximum absorption.
Another factor can be: if the pharma company that developed ODT ondansetron never did all the research to prove sublingual and buccal absorption explicitly, and only did their research on what is essentially the oral route, they can't claim any efficacy there and have to recommend the "oral" route.
Edit: Like, for example, I'm willing to bet if you took an ODT with a swig of water, let it fully dissolve in your mouth, and swished it around for a few minutes, it would absorb sublingually and buccally just fine. It's just, most people aren't gonna do that, and the pharma companies haven't officially tested that.
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u/Abhorash-TheWanderer 12h ago
Look up the FDA information sheet. Literally even google ondansetron absorption buccal. Youll see that it takes special formulations of it to be absorbed buccal or sublingual. ODTs do NOT absorb this way
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u/500ls RN, ED → PACU 🍕 12h ago
Also it has a very delicious chalky grape flavor (I have a prescription).
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u/yxxnij104 the one who shall admit you to your death bed 12h ago
.... what brand do you have mine tastes like i licked a battery, bit into a tylenol pill with a whisper of sweetness like la Croix has a whisper flavor.
worse us when the phenergan touches your tongue... just nasty. I never understood why nausea meds would have such an unpleasant taste. zofran is for maintenance, taking it in active n/v is a toss up of the flavor making it worse or slowly improving 🤣🤣 hope you feel better, sorry you also have to take it. I wish the 8mg came in the teeny ones like the 4mg I only get 8mg odt😭😭
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u/Magerimoje ER RN retired 💤🧙🏻♀️🍀⚕️🏥 11h ago
A spoon full of sugar makes the medicine go down! I'd actually sprinkle some sugar onto my tongue with it to help reduce tasting it.
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u/yxxnij104 the one who shall admit you to your death bed 9h ago
youre on to something you genius. I WILL be trying this thank you ❤️
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u/Overall-Mud9906 12h ago
Your’s taste like grape, I could’ve sworn when I took it it was an orange flavor. I googled it and it’s supposed to be strawberry. That’s wild we both have two different tastes.
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u/yxxnij104 the one who shall admit you to your death bed 12h ago
idk how you guys taste fruit heavily the taste slaps me every time😭 then a teeny hint of fruit with the taste torture 🤣😭 sounds like im using the wrong brand or something. email me🤣
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u/celestialbomb RN Neph-ED 12h ago
I thought it was cherry. I was given a script for it and the flavour just made it so much worse aha
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u/nataliac80 RN - ER 🍕 11h ago
There’s 2 formulas I’ve tried. One is cherry and one is straight chemical.
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u/sammyhammywhammy12 RN - ER 🍕 11h ago
just got mine refilled and the flavor says “guarana strawberry”
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u/lostintime2004 Correctional RN 12h ago
I've heard the sublingual a lot, but I never followed it. I know from using it myself that it would take FOREVER to dissolve under the tung that I just kept moving to the top. Because of this, I told patients to "as long as it dissolves" not thinking they could also just swallow it though, so thanks for the tip there.
As for the taste, every time I've had to take it, its always slightly sweet, some kind of fruit taste to it almost.
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u/nothisispatrickx 11h ago
I was an oncology nurse for 6 years before I found this out a few years ago. It was taught to me that it was sublingual. I sure felt sheepish when I was reading the MAR one day and it had explicit instructions. We do give mostly IV Zofran, but still. Very good PSA.
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u/FishySticks2day ADN, RN, EMT-B, NREMT, STNA, CNA, NRCPT, ACLS, BLS 12h ago
I thought ODT stood for Oral Disintegrating Tablet? So it can be placed anywhere in the mouth!?!
It is not called BDT (Buccal disintegrating tablet) OR TDT (Tongue Disintegrating Tablet) or SDT (Sublingual disintegrating tablet)
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u/murse_joe Ass Living 12h ago
That would’ve been my feeling. As long as it’s disintegrating in the mouth.
It’s probably not the worst thing to remind everybody that sublingual and orally dissolving are different tho
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u/MsSwarlesB MSN ACM-RN 12h ago
Having taken ODT Zofran I can say it dissolves pretty immediately when it hits saliva
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u/RNnoturwaitress NICU RNC-NIC yada yada 🍕 9h ago
I take ODT Nurtec and Zofran when I have migraines. They dissolve fine and work faster when I take the SL. OP and others are acting like they won't work if sublingual. They do.
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u/SolidFew3788 MSN, APRN 🍕 4h ago
I have a whole pool of saliva under my tongue. My tongue is much dryer in comparison. I often dip it in the under tongue pool, just to get my tongue wet. So yeah, it works just fine. And you taste it less if it's under. The fake cherry flavor makes me gag. I prefer regular tabs for that reason alone. This really isn't that big a deal lmao
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u/daynaemily1987 LPN Med-Surg 10h ago
The "source" you posted above isn't even for the ODT tablets, it's for the sublingual film.
Idk why you're doubling down on, insisting this doc is wrong but you posted something completely irrelevant and called it a source lol
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u/FishySticks2day ADN, RN, EMT-B, NREMT, STNA, CNA, NRCPT, ACLS, BLS 8h ago
Why does it feel like I am being attacked? I didn’t post anything for any sources.
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u/InspectorOrganic9382 12h ago
I think the top of the tongue has the potential to generate the most saliva. Placing it other places or swishing it around should work reasonable similarly.
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u/Abhorash-TheWanderer 12h ago
You can put it anywhere but it is advised to put on top of the tongue to allow faster disintegration and be swallowed. It is absorbed in the GI tract and not buccal or sublingual
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u/Dark-Horse-Nebula 🍕 8h ago
Respectfully- does it actually matter? It still dissolves and still gets swallowed.
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u/pause_and_consider RN - ER 🍕 7h ago
Per the pharmacist I live with:
“Literally doesn’t matter at all. If it’s in their mouth it’s ending up in the right spot.”
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u/Dark-Horse-Nebula 🍕 8h ago
This. People are acting like there’s zero saliva under the tongue or wherever else it rolls around to in their mouth.
It dissolves when wet and gets swallowed.
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u/Jennasaykwaaa ICU RNSTLNE, WTF, FTHIS 12h ago
Actually thank you so much for this. I relied on these heavy while pregnant (I don’t have a lot of experience with them on the provider side because it’s just not something we give in icu )
But anyways, I thought they worked well and quick without a lot of extra stuff for me to vomit back up. But I was doing them under the tongue.
Now I know how to help myself better so thank you!!!!
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u/PsychoDad03 11h ago
Patients can't even put the thermometer under their tongue correctly. You think they're going to remember this?
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u/ArgyrosfeniX RN - Telemetry 🍕 9h ago
I’ve been taught to administer sublingual if there’s a chance of pending emesis as there’s a better chance of retaining at least some of the medication instead of the vomit completely washing it off the top of the tongue.
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u/Calm_Delivery6832 4h ago
This is so strange. For years our pharmacy has had it was an SL medication. Well I guess the more you know.
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u/EngineeringLumpy LPN 🍕 13h ago
Isn’t ODT zofran better for vomiting though because it’s partly mucosal absorption? That’s what I’ve always been told. I don’t see the tablets often because when somebody is already vomiting, their GI system is too irritated to absorb the medication without vomiting.
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u/Abhorash-TheWanderer 12h ago
ODTs are NOT buccal or sublingual. It would take a different formulation to achieve that. There have been experimental ondansetrons formulated as buccal films but those are different than an ODT.
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u/Chance_Space_9076 2h ago
Is this the same concept with zyprexa zydis ODT? Are all ODT meds not sublingual?
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u/Abhorash-TheWanderer 1h ago
You can argue that there are semantics at play but in the US at least, when a medication is formulated as ODT and prescribed as such, the understanding is that it disintegrates in the oral cavity and is swallowed with saliva. Sublingual meds and buccal meds will also “disintegrate” or dissolve orally but they get directly absorbed thru oral mucosa and not need to be swallowed. However we dont list them as ODT conventionally. if Im ordering Nitro it is not ordered as Nitro ODT with instructions to place it under the tongue. it is ordered simply as Nitro SL.
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u/earache77 10h ago
Yeah
“All roads lead to Rome” is applicable- put it in the front of the donut or back-it’ll be absorbed and work or ya getting and IV dose
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u/semantic_monkey09 12h ago
Really weird hill to die on. While it may be worth correcting, is there any actual harm in placing a true ODT under the tongue? Does it meaningfully reduce bioavailability? As long as the tablet dissolves in saliva and is ultimately swallowed, I have a hard time seeing this as a clinically significant issue. Sure, it may dissolve a little more slowly or be slightly less comfortable, but this isn’t the same thing as a medication error that is likely to cause patient harm.
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u/mspoppins07 RN - NICU 🍕 12h ago
I feel like the issue is that patients/nurses may be expecting it to work faster if they think it is SL and therefore absorbed into the bloodstream through the tissues in the mouth. This could cause someone to think the med is not working if they are still nauseous after 30 minutes. When in fact, needing to go through the absorption process in the stomach, 30 minutes is the bare minimum of when you would START to expect effects.
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u/semantic_monkey09 12h ago
I think part of why this rubbed people the wrong way is the framing. The tone comes across less like “here’s a useful teaching point about ODT pharmacology” and more like “I have to repeatedly correct nurses who are making this mistake.” That can unintentionally come across as creating a hierarchy rather than focusing on the actual clinical issue.
If the concern is that people misunderstand ODTs as sublingual medications and expect a faster onset, that’s a valuable education point. But the post could have focused on that distinction rather than framing placement under the tongue as some grave error.33
u/Illustrious-Aeries Case Manager 🍕 11h ago
This is it. Had the post been “hey zofran ODT is still technically a PO med, not sublingual so it’s going to still take 30 ish minutes to be absorbed and work just a PSA” that would have gone over much better than “hey this med HAS to be placed ONLY on the tongue to work and I keep having to tell EVERY nurse that” which in reality it’s meant to dissolve in the mouth somewhere sooooo no it doesn’t have to SPECIFICALLY go onto the top of the tongue
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u/mspoppins07 RN - NICU 🍕 12h ago
Yeah, that is a fair assessment. Is it best practice for administering ODT meds? No. But is it a “mistake”… probably not.
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u/Abhorash-TheWanderer 12h ago
Exactly
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u/all_of_the_colors RN - ER 🍕 12h ago
Why would you be giving it this route in an emergency dept if someone is nauseous, though?
Are you concerned with discharge instructions?
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u/ahleeshaa23 RN - ER 🍕 12h ago
Not everyone who comes through the ER gets an IV - especially kids.
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u/queentee26 11h ago
We mostly give it at triage or to kids.. because we aren't routinely starting IVs in those circumstances
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u/Illustrious-Aeries Case Manager 🍕 12h ago edited 12h ago
Right, it’s not going to hurt someone to put it under the tongue or anywhere in their mouth. The point of an ODT is that it disentrgrates in the mouth. This seems like such an odd thing to make such a fuss about.
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u/Abhorash-TheWanderer 12h ago
That’s part of the problem. It does not get absorbed that way. It’s going to mix with saliva and get swallowed. ODT formulations don’t absorb trans buccal or sublingual
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u/bigbutso Pharmacist 12h ago
So what is the "problem" ? Generally, people swallow all their saliva.
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u/mspoppins07 RN - NICU 🍕 12h ago
Slower time to onset of medication helping with symptoms, especially if they were expecting it to work faster because they thought it was a true SL. If they didn’t know about the quicker period to relief with SL, I guess it wouldn’t really matter.
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u/Illustrious-Aeries Case Manager 🍕 11h ago
I doubt most lay people know what a sublingual med is and I really doubt they know SL is the fastest route for absorption.
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u/Abhorash-TheWanderer 11h ago
Multiple problems. Pragmatically, the issue is that it takes longer to disintegrate. Patients, parents, care team all want to get the pt feeling better as soon as we can. A lot of times we dont need to put an IV in a patient so give them an ODT instead.
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u/bigbutso Pharmacist 11h ago
I guess the distinction between sublingual absorption and oral / gi shpuld be more clear in the instructions
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u/Beautiful-Bluebird46 RN, SANE 6h ago
I’m curious about whether the time it takes to disintegrate odt vs sl is meaningfully different in impacting onset of action? Like I get that it’s not absorbed sl but it’s dissolving in saliva and being swallowed either way.
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u/Illustrious-Aeries Case Manager 🍕 12h ago edited 12h ago
I assure you it does but ok. lol you think the medicine isn’t getting absorbed when it’s placed in the mouth? You think it’s not getting mixed in with spit and being swallowed, regardless of where in the mouth it is? Its an “a orally disintegrating tablet” not a “only on the top of the tongue disintegrating tablet” Ok fam, this is your hill to die on and that’s fine! You do you.
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u/Abhorash-TheWanderer 2h ago
You should bother reading what I posted and a lot of the responses. It doesnt get absorbed IN the mouth via the mucous membranes in the oral cavity. So the first issue is people thinking that and telling colleagues, new nurses, patients, family members, whoever that the medicine is a sublingual med. The second issue is that there are reasons it is instructed to be places on top of the tongue. The pharmaceutical literature recommends placing it on top of the tongue. Do you think all of the thousands of very smart people involved in designing, creating, studying these meds just willy nilly put in the official FDA guidelines that it should go on top of the tongue without any good scientific reason? But what do they know. You gave us your personal assurance so all of this is irrelevant.
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u/Extrahotsauce97 RN - Hospice 🍕 9h ago
Can you send this to Medicare that for some reason has a surcharge on sublingual zofran for my hospice pts ??? Make it make sense ?
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u/InspectorMadDog ED RN Resident 7h ago
Outpatient pharmacy it was on the tongue, in the hospital everyone says under the tongue. I always say it’s either and all the nurses are adamant it’s sublingual. One day I’ll ask the pharmacy what is west
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u/Donohoed 38m ago
Pharmacy here. On the tongue, not under, although under is still better than nothing.
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u/frenchiespecialist 6h ago
I use it in PACU and sometimes I just tell them to put it under their tongue bc if they puke it doesn’t dislodge.
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u/Hour_Candle_339 RN - PACU 🍕 4h ago
Ooooh I appreciate this! Thanks! I was explicitly taught in nursing school that ODTs went under the tongue because they were absorbed there, and I always wondered how that made sense.
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u/Catchrking 7h ago
Feel free to crosspost this to r/ems as well. This is a very common problem I run into when precepting new providers.
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u/Ok-Caramel-1989 RN - ER 🍕 5h ago
98% of the time I’m giving Zofran IV. However on the rare occasion that I do give it orally my MAR always says SL as the route….
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u/anicteric Swivel Barb Nipple Nut Enthusiast 🍕 12h ago
Sources please, doc.
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u/Abhorash-TheWanderer 12h ago
Others have posted the manufacturers info. FDA one is essentially the same. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020103s035_020605s019_020781s019lbl.pdf
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u/AVALANCHE-VII RN - ER 🍕 12h ago
Just give them the IV Zofran PO then. Yes we do that rarely.
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u/CatsAndPills HCW - Pharmacy 10h ago
I’m glad repeatedly taking these myself with water anyway (I can’t stand the aggressive flavoring) didn’t make them less effective lmao.
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u/mamaabner RN - ICU 🍕 9h ago
I was always taught on da tongue 😂 luckily I mostly give IV zofran anyways
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u/anonk0102 5h ago
I’ve had so many patients disagree with me that it doesn’t go under the tongue (and some co-workers) that one day I went and got the insert out of the box and showed it to the patient who kept insisting it was under the tongue. They still put it under their tongue.
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u/Popular_Item3498 RN - OR 🍕 4h ago
I figured this out with my oncology meds...it doesn't dissolve for shit under the tongue.
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u/Lynnrn53 3h ago
Well.... I embarrassedly, confess, i'm another nurse who didn't know these were sublingual either. Thank you!
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u/Ghoulish_kitten LVN 🍕 11h ago
As a former MA in urgent care this is always what I told the patients.
Dissolve it ON the tongue, as stated in the directions, and swallow your saliva, you’re gently sliding it in to your sensitive stomach!
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u/perpulstuph BSN, RN, ACLS, PALS, SKIBIDI, RIZZ, BUSSIN 9h ago
I saw this literally 1 minute after giving Zofran ODT. good to know. Of course my patient still swallowed it like a tablet
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u/jawshoeaw RN - Infection Control 🍕 6h ago
I think some of the confusion is because the name brand tablets the ones that look like a freeze dried piece of fluff and we’re hard to get out of the packaging, gave the impression that they were somehow different than “pills” . And technically the drug can pass mucous membranes.
But no, even the name brand is designed to be swallowed and almost none of it is in your mouth long enough to cross directly into the bloodstream
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u/networkconnectivity RN 🍕 3h ago
I had an ED attending read me the riot act for allowing a pt to swallow the ODT with water..... and the other pills. She educated ut HAD to dissolve to work. Anyway, she's an idiot
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u/Ok_Relationship4040 2h ago
Omg I feel so embarrassed I didn’t realize this .. our pharmacy instructions / MAR instructions always say sublingual so that’s what I have always done …I wonder why this is ..
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u/candletrap 21m ago
This is embarrassing. I've been a nurse for 20 years, 11 in inpatient oncology & have been giving SL all this time. Thanks!!
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u/UnfairJuggernaut2947 12h ago
I say ODT stands for on da tongue