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 |
MelatoninΔ | 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 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.Additional data from:
Do you want to add Medilib to your home screen?