your limit has been reached. plz Donate us to allow your ip full access, Email: sshnevis@outlook.com

Medications that can be administered sublingually or buccally

NOTE: Orally disintegrating dosage forms (require swallowing) are provided in a separate table
Drug	Commercially available oral transmucosal formulations and strengths	Other formulations with oral transmucosal absorption (given off-label sublingually or buccally with documented good effect)
Alprazolam	–	Oral tablet^[1]: 0.25, 0.5, 1, 2 mg
Apomorphine	Sublingual film: 10, 15, 20, 25, 30 mg	–
Asenapine	Sublingual tablet: 2.5, 5, 10 mg	–
Atropine	–	Ophthalmic drops^[2]: 1%
Buprenorphine	Buccal film: 75, 150, 300, 450, 600, 750, 900 mcg Sublingual tablet: 2, 8 mg (0.2 and 0.4 mg SL tablets are available in some countries other than the United States)	–
Buprenorphine plus naloxone	Buccal film: 2.1-0.3, 4.2-0.7, 6.3-1 mg Sublingual film: 2-0.5, 4-1, 8-2, 12-3 mg Sublingual tablet: 0.7-0.18, 1.4-0.36, 2-0.5, 2.9-0.71, 5.7-1.4, 8-2, 8.6-2.1, 11.4-2.9 mg	–
Captopril*	–	Oral tablet^[3]: 12.5, 25, 50, 100 mg
Cholecalciferol (vitamin D3)	Sublingual liquid: 5000 units/mL (125 mcg/mL)	–
Cyanocobalamin (vitamin B12)	Sublingual liquid: 3000 mcg/mL Sublingual tablet: 2500 mcg Lozenge: 50, 100, 250, 500 mcg	–
Desmopressin (DDAVP)	Sublingual tablet: 27.7, 55.3 mcg	–
Dronabinol	–	Oral solution^[2]: 5 mg/mL
Ergotamine	Sublingual tablet: 2 mg	–
Fentanyl^¶	Buccal tablet: 100, 200, 400, 600, 800 mcg Lozenge: 200, 400, 600, 800, 1200, 1600 mcg Sublingual tablet: 100, 200, 300, 400, 600, 800 mcg Sublingual spray: 100, 200, 400, 600, 800 mcg	Intravenous solution^[4]: 50 mcg/mL
Haloperidol	–	Oral concentrate^[2]: 2 mg/mL
Hyoscyamine	Sublingual tablet: 0.125 mg	–
Isosorbide dinitrate (SL tablet not available in United States)	Sublingual tablet: 5 mg	–
Ketamine	–	Intravenous solution^[5]: 50 mg/mL, 100 mg/mL
Lorazepam (SL tablet not available in United States)	Sublingual tablet: 0.5, 1, 2 mg	Oral concentrate^[2]: 2 mg/mL Oral tablet^[6]: 0.5, 1, 2 mg
Melatonin^Δ	Sublingual liquid: 1 mg/mL, 2.5 mg/mL Sublingual tablet: 0.5, 1, 2.5, 3, 5, 10 mg	–
Methadone	–	Oral concentrate^[7]: 10 mg/mL
Midazolam	–	Intravenous solution^[8]: 5 mg/mL
Misoprostol	–	Oral tablet^[9]: 100, 200 mcg
Morphine	–	Oral solution^[2]: 20 mg/mL
Nicotine	Gum: 2, 4 mg Lozenge: 2, 4 mg	–
Nitroglycerin	Sublingual tablet: 0.3, 0.4, 0.6 mg Sublingual packet: 0.4 mg Translingual spray: 0.4 mg	–
Oxycodone	–	Oral concentrate^[2]: 20 mg/mL
Prochlorperazine (buccal tablet not available in United States)	Buccal tablet: 3 mg	–
Sufentanil^◊	Sublingual tablet: 30 mcg	Intravenous solution^[4]: 50 mcg/mL
Tacrolimus	–	Oral capsule^[10]: 0.5, 1, 5 mg Contents of capsule are administered sublingually. Dose adjustment may be needed.
Tetrahydrocannabinol and cannabidiol (not available in the United States)	Buccal spray: 27-25 mg/mL	–
Zolpidem	Sublingual tablet: 1.75, 3.5, 5, 10 mg	–

Oral transmucosal (also known as oromucosal) medication administration provides an alternative to the oral route for patients with swallowing difficulties and may offer other advantages including more rapid absorption and increased bioavailability due to bypassing of first-pass hepatic metabolism. Sublingual and buccal dosage forms are absorbed through mucosal membranes under the tongue and between the gum and cheek, respectively. Although some medications are specifically formulated for sublingual and/or buccal administration, other dosage forms (eg, certain intravenous solutions or oral tablets) may have reliable absorption via these routes.
This is not an exhaustive list of medications that can be administered sublingually or buccally. For additional information including indications, dosage, and precautions, refer to the relevant UpToDate clinical topics and the Lexicomp drug monographs included within UpToDate.

SL: sublingual.
* Sublingual administration may cause an unpredictable, potentially dangerous drop in blood pressure.
¶ Oral transmucosal fentanyl dosage forms are only for management of breakthrough pain in patients who are tolerant to and currently receiving opioid therapy for persistent cancer pain. Refer to appropriate UpToDate clinical topic before use.
Δ Melatonin is available as a dietary supplement in the United States. In several other countries, melatonin is only available by prescription.
◊ Sufentanil for acute pain management is only for use in a certified medically supervised health care setting when administered by a health care provider.

References:

Shavakhi A, Soleiman S, Gholamrezaei A, et al. Premedication with sublingual or oral alprazolam in adults undergoing diagnostic upper gastrointestinal endoscopy. Endoscopy 2014; 46:633.
Albert RH. End-of-life care: Managing common symptoms. Am Fam Physician 2017; 95:356.
Kaya A, Tatlisu MA, Kaya TK, et al. Sublingual vs. oral captopril in hypertensive crisis. J Emerg Med 2016; 50:108.
Gardner-Nix J. Oral transmucosal fentanyl and sufentanil for incident pain. J Pain Symptom Manage 2001; 22:627.
Davis MP. Recent development in therapeutics for breakthrough pain. Expert Rev Neurother 2010; 10:757.
Greenblatt DJ, Divoll M, Harmatz JS, Shader RI. Pharmacokinetic comparison of sublingual lorazepam with intravenous, intramuscular, and oral lorazepam. J Pharm Sci 1982; 71:248.
Spaner D. Effectiveness of the buccal mucosa route for methadone administration at the end of life. J Palliat Med 2014; 17:1262.
McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005; 366:205.
New FIGO Guidelines for Misoprostol Use. Available at: https://www.mhtf.org/2017/06/29/new-figo-guidelines-for-misoprostol-use/ (Accessed on June 2, 2020).
Doligalski CT, Liu EC, Sammons CM, et al. Sublingual administration of tacrolimus: current trends and available evidence. Pharmacotherapy 2014; 34:1209.

Graphic 129410 Version 5.0