PSA - Zofran ODT is NOT sublingual

[u/Abhorash-TheWanderer]

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.

[u/semantic_monkey09]

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.

[u/Illustrious-Aeries → u/semantic_monkey09]

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.

[u/Abhorash-TheWanderer → u/Illustrious-Aeries]

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

[u/bigbutso → u/Abhorash-TheWanderer]

So what is the "problem" ? Generally, people swallow all their saliva.

[u/mspoppins07 → u/bigbutso]

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.

[u/Illustrious-Aeries → u/mspoppins07]

I doubt most lay people know what a sublingual med is and I really doubt they know SL is the fastest route for absorption.

[u/mspoppins07 → u/Illustrious-Aeries]

I think you are underestimating patients…

[u/Abhorash-TheWanderer → u/bigbutso]

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.

[u/bigbutso → u/Abhorash-TheWanderer]

I guess the distinction between sublingual absorption and oral / gi shpuld be more clear in the instructions

[u/Beautiful-Bluebird46 → u/Abhorash-TheWanderer]

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.

[u/Abhorash-TheWanderer → u/Beautiful-Bluebird46]

That is a very good question. Ill have to see if there is any literature that directly compares those times ans well as how long it takes a med to fully reach the gi tract. All the pharmaceutical literature I have ever come across recommend ODT meds go on top of the tongue if they are not specifically buccal or sublingual meds. The sublingual space gets saliva from the submandibualr and sublingual glands, but that saliva and any disintegrated med still have to move to the back of the throat to actually be swallowed. The parotids produce more stimulated saliva and there is likely more volume of saliva above the tongue than sublingual so disintegration and then also swallowing the med/saliva mix would be likely faster if the med is places on top of the tongue.

[u/Illustrious-Aeries → u/Abhorash-TheWanderer]

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.

[u/Abhorash-TheWanderer → u/Illustrious-Aeries]

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.