Troches, Lollipops and Sublingual Drops: Mouth-Absorbed Medicine in Brampton

Most of us think of the mouth as the entrance to the digestive system: medicine goes in, gets swallowed, and is absorbed somewhere further down. But the mouth itself has a rich blood supply just beneath a thin lining, especially under the tongue and along the inside of the cheeks. Some medicines can be absorbed right there, without ever being swallowed.

The mouth can also be the place that needs treatment. Mouth ulcers, oral thrush, dry mouth, a sore throat or pain after dental work all benefit from medicine that stays in contact with the area for a while instead of washing straight past.

Compounding offers several forms designed to take advantage of this: troches, lozenges, medicated lollipops and sublingual drops. Pharmasave Kensington in Brampton lists these among the options on its compounded dosage forms page. This post explains what each form is, why a prescriber might choose it and how to use it properly.

How absorption through the mouth works

The tissue under the tongue (sublingual) and inside the cheek (buccal) is thin and well supplied with blood vessels. Medicines that can cross this lining enter the bloodstream directly. Swallowed medicines, by contrast, pass through the stomach and intestines and then the liver before reaching general circulation, and some of the dose can be broken down along the way.

For certain medicines, absorption through the mouth can mean a different onset or a different proportion of the dose reaching the bloodstream. Not all medicines are suited to this route. Factors like how well the drug dissolves, its taste and whether it irritates the lining all matter. That’s why the choice of form comes from the prescriber, guided by the pharmacist.

It also means that switching between a swallowed form and a mouth-absorbed form of the same medicine isn’t always a one-to-one swap. The dose may need to be different, and the timing of the effect may change. If you’ve moved from one to the other, ask what difference you might notice.

Troches: slow-dissolving and flexible

A troche (pronounced “tro-key”) is a small, usually soft or chewy lozenge designed to dissolve slowly in the mouth. Depending on the medicine and the directions, it may be placed between the cheek and gum to dissolve over a period of time, or allowed to dissolve on the tongue for a local effect in the mouth or throat.

The store’s dosage forms page notes that troches may be used for hormone replacement therapy, nausea, vitamin B12 deficiency, sexual dysfunction or antifungal treatment, among other purposes. Their slow dissolution can hold medicine in contact with the mouth’s lining or with a problem area for longer than a swallowed tablet.

Troches can be scored or cut to adjust doses when a prescriber directs, which is one reason they’re sometimes used when fine dose adjustments are expected.

Tablet triturates and sublingual drops

Tablet triturates are small, quick-dissolving tablets intended to dissolve under the tongue. Sublingual drops deliver a measured liquid dose under the tongue. Both are designed for absorption through the sublingual lining.

Drops can be helpful for people who need very small or carefully adjusted doses, and for those who can’t manage a solid form. They require careful measuring with the dropper or syringe provided, and the dose should be held under the tongue for the time specified rather than swallowed immediately.

Medicated lollipops

A medicated lollipop sounds like something designed for children, and it can be, but compounded lollipops are used for adults too. Pharmasave Kensington describes lollipops that may offer local effects, such as anaesthetic, antifungal, antiviral or anti-inflammatory action in the mouth and throat, as well as systemic effects with certain medicines. Examples listed include anti-anxiety, pain relief, smoking deterrent, cough suppressant and antihistamine uses.

The advantage of a lollipop is control. Because it’s on a stick, the patient or caregiver can remove it when enough has been taken, or when the patient becomes drowsy. That can be useful in some palliative and pediatric situations. Pediatric compounding, as described on the store’s compounded prescriptions page, includes flavoured lollipops among the options for children.

Mouthwashes and rinses

Some compounded preparations aren’t meant to be absorbed at all, but to coat and treat the mouth. Compounded mouthwashes and rinses can be prepared for problems in the mouth or throat when directed by a prescriber, for example for mouth sores during cancer treatment. Directions may specify whether to swish and spit or swish and swallow, and for how long. These details matter, so read the label carefully.

Using mouth-absorbed medicines correctly

Technique makes a significant difference with these forms. General guidance, which your pharmacist will tailor to your product, includes:

1. Place it where directed. Under the tongue, between cheek and gum, or on the tongue are different instructions with different purposes.
2. Let it dissolve fully. Avoid chewing or swallowing a troche or tablet triturate unless the directions say to.
3. Avoid eating, drinking or smoking while it dissolves and for the time specified afterward, often around 15 to 30 minutes. The store’s rapid dissolve tablets page notes a similar 30-minute guideline for sublingual testosterone tablets.
4. Alternate sides of the mouth if you’re using buccal troches regularly, to reduce irritation.
5. Report mouth irritation, sores or changes in taste to the pharmacist.

If you have a dry mouth, a troche or sublingual tablet may dissolve slowly. Ask whether you can moisten your mouth with a small sip of water beforehand.

Who might benefit from these forms

Mouth-absorbed forms are sometimes discussed for:

• People who can’t swallow tablets or capsules.
• People experiencing nausea or vomiting who have trouble keeping swallowed medicine down.
• Patients with mouth or throat conditions that benefit from direct contact.
• Children who resist liquids or tablets but accept a lollipop.
• People needing doses that are adjusted in small increments.
• Some patients in comfort-focused care where swallowing is difficult.

Whether any of these apply to you depends on the specific medicine and your prescriber’s judgement.

These forms also come with trade-offs that are worth weighing honestly. Holding a troche in the cheek for many minutes requires patience, and it can be awkward during a busy workday or a long commute where you may need to talk. Some people find the texture or taste unpleasant, even with flavouring. A sublingual dose means pausing food and drink for a set time, which can be hard to fit around meals in a household where breakfast and dinner are shared family events. Someone with frequent mouth ulcers or a sensitive mouth lining may find these forms irritating.

None of these is a reason to rule a form out, but they are good reasons to talk through your daily routine with the pharmacist. For example, a dose at bedtime may be easier to manage than one in the middle of the day, if the medicine allows it. Telling your prescriber how a form is working in practice, including what’s inconvenient, helps them decide whether to continue, adjust the timing or consider another approach. A form that you can use consistently is generally more helpful than a theoretically ideal one that you skip.

Safety: they can look like sweets

Lollipops, flavoured troches and lozenges can resemble candy, which creates a real risk in homes with children. Store them in their labelled containers, out of reach and preferably locked away. Never describe them to children as candy. Lollipops in particular should be stored where a child couldn’t find one and assume it’s a treat.

If a child or another person takes a dose not meant for them, contact the Ontario Poison Centre or seek medical help, and keep the label available.

Dental health and sugar

Some troches and lollipops are sweetened to improve taste, and holding a sweetened product in the mouth for a long time may raise questions about dental health, especially with frequent use. Ask the pharmacist what sweetener is used. Sugar-free vehicles are available for some preparations; Pharmasave Kensington’s compounding bases page lists a sugar-free syrup vehicle among its oral bases. Keep up with regular brushing and dental visits, and tell your dentist about any medicated product you hold in your mouth regularly.

Questions to ask your pharmacist

• Where exactly in the mouth should this go, and for how long?
• Can I eat or drink right after, or should I wait?
• What should I do if I accidentally swallow it or chew it?
• How should I store it, and when does it expire?
• Is it sweetened, and does that matter for my teeth or blood sugar?
• What side effects should I watch for in my mouth?

Learn more from Pharmasave Kensington

If swallowed medicines have been difficult, or your prescriber has mentioned a troche, lollipop or sublingual form, the team can show you how to use it and answer questions about storage and safety.

Pharmasave Kensington is located at 106-18 Kensington Road, Brampton, ON L6T 4S5. Give us a call at (905) 792-3100, look up store details on the contact page, or request a consultation through the booking page.

General information only. Use mouth-absorbed medicines exactly as directed by your prescriber and pharmacist.