Sublingual and buccal medications are administered by placing them in the mouth, either under the tongue (sublingual) or between the gum and the cheek (buccal). The medications dissolve rapidly and are absorbed through the mucous membranes of the mouth, where they enter into the bloodstream. The medications are compounded in the form of small, quick-dissolving tablets, sprays, lozenges, or liquid suspensions.
Purpose
Sublingual and buccal medications are given for a variety of conditions. The most common sublingual medication is the nitroglycerin tablet. Its rapid action to relax the blood vessels reduces the workload on the heart and relieves the pain of angina pectoris. Other buccal and sublingual medications, however, serve a variety of purposes—such as narcotic pain relief, migraine pain relief, blood pressure control, and mental decline due to dementia (i.e., ergoloid mesylates). This form of medication is extremely effective, because it bypasses the digestive system and is absorbed into the bloodstream in minutes. Not all medications can be prepared for sublingual or buccal administration; some of the compounding difficulties are taste, solubility, and dosage limitations of the medicine.
Precautions
Sublingual medications should not be administered if the gums or mucous membranes have open sores or areas of irritation. Rather, the physician should be notified, and medication held. The patient should be placed in a sitting position to prevent accidental aspiration of the medication. Buccal or sublingual medication should not be used when a patient is uncooperative or unconscious. The patient should not eat, drink, chew, or swallow until the medication has been absorbed; swallowing the medication must be prevented, as it will decrease the drug's effectiveness. The patient should not smoke while taking sublingual or buccal medication, because smoking causes vasoconstriction of the blood vessels. This will decrease the absorption of the medication.
Description
To administer sublingual tablets, the clinician should have the patient open his or her mouth and raise the tongue. The tablet should then be placed under the
tongue. Administration of buccal tablets is similar to that of sublingual tablets. First, the patient should open his or her mouth. The tablet should be placed between the gum and the wall of the cheek. With the mouth closed, the tablet should be held in this position for five to 10 minutes, or until it has dissolved. Lozenges are also placed in the mouth and held until they dissolve. Administration of sublingual or buccal sprays also requires having the patient open the mouth. The patient should be reminded not to breathe while the nurse is spraying the medicine. If the spray is ordered sublingual, the spray should be held about one inch (2.5 cm) away from the site, and directed toward the tongue. If the patient cannot hold up his or her tongue voluntarily, the nurse tongue should be held by the nurse with his or her non-dominant hand, using a 2x2 gauze pad to provide grip. If the spray is ordered buccal, the tongue should be held out of the way, the cheek held outward, and the spray directed into the gum area between the cheek and the teeth. Liquid suspensions may be given in a medicine cup or squirted into the patient's mouth using a medicine syringe with no needle. The patient should be directed to hold and swish the liquid in the mouth for the amount of time designated by the physician's order. Some liquid suspensions are then swallowed and some expectorated into a sink or basin. In all cases, the physician's orders should be followed.
Preparation
The clinician should wash his or her hands and put on gloves. The medication label must be checked each time medication is administered, to avoid medication errors. It must be confirmed that it is the right medicine, the right dose (strength), the right time, the right patient, and the right method. The expiration date on the label should be checked. If the medicine is outdated, it should not be used. The patient should be placed in a sitting or upright position. Oral medications need to be given before sublingual or buccal medications. The clinician should examine the mucous membranes of the patient's mouth for irritation or sores. If there are sores in the mouth, the physician should be contacted any sublingual or buccal drugs are administered. Alternating sites should be used when giving regular doses of sublingual or buccal medications. The procedure should be explained to the patient, who should also be reminded that nothing should be eaten, drank, swallowed, chewed, or smoked until the tablet has dissolved. When administering a liquid suspension, the bottle should be shaken the bottle before the appropriate dose is poured. When administering sprays, the container also needs to be shaken, and the top taken off before the medication is given.
Aftercare
The patient should be reminded not to eat, drink, swallow, chew, or smoke until the tablet has dissolved. The nurse can assist the patient by noting the time the medicine is given, as well as the time when it will be okay to drink or eat. If a liquid suspension must be spit out after a specific amount of time, the nurse must be sure that the patient knows when that is, and has a basin nearby or access to a sink. If the patient experiences a tingling or burning sensation from a sublingual tablet, he or she should be encouraged to move the tablet to another part of the mouth. Sublingual medicines deteriorate rapidly with heat or humidity. The nurse should be sure to close the cover of the tablet bottle securely. Gloves should be removed and placed, with the gauze pads, in a plastic bag that can be sealed and discarded. The clinician must wash his or her hands when the procedure is complete.
Complications
Complications of sublingual and buccal medications are rare, but could include inflammation of the mucous membranes. If symptoms such as soreness, redness, swelling, bleeding, or sores in the mouth are evident, the physician should be contacted before the medication is adminstered. If the patient demonstrates any symptoms of an allergic reaction (i.e., itching, hives, or swelling of the lips or tongue), the remaining tablet should be removed. The patient should rinse his or her mouth, and the clinician should contact the physician immediately.
Results
Sublingual and buccal medications are fast acting and when given correctly act within one to five minutes of administration. The length of time to reach the desired therapeutic response, however, depends upon the dose and type of medication administered. For example it may take three doses of sublingual nitroglycerin given five minutes apart to relieve the pain of angina.
Health care team roles
Sublingual and buccal medications are administered by a registered nurse (R.N.) or a license practical nurse (L.P.N). in the health care setting. Sublingual or buccal medicine may be administered in some settings by unlicensed staff, but only under the direction of a registered nurse. A licensed nurse, however, must evaluate the mucous membranes of the mouth regularly and assess the outcome of medication administration. The patient, or members of the patient's family, can be taught to administer sublingual or buccal medications in the home setting.
KEY TERMS
Angina pectoris—Severe pain in the chest caused by vasoconstriction of the blood vessels and a decreased level of oxygen to the cardiac muscle.
Aspiration—The accidental sucking of fluid or solids along with air into the bronchial tubes or lungs.
Buccal—The inner aspect of the cheek or mouth cavity.
Sublingual—The area in the mouth under the tongue.
Vasoconstriction—The narrowing or constriction of blood vessels.
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