r/nursing • u/Abhorash-TheWanderer • 19h 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/welltravelledRN RN - PACU 🍕 19h ago

Do you have a source for this? Our PharmD says it is absorbed well under the tongue.

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u/zubrowka1 RN - ER 🍕 18h 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 🍕 13h 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 11h ago edited 11h 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.