Quote from garyd11
Thanks for your reply.
Is there a difference in absorption between taking it sublinguallyor by mouth, irrespective of food?
You ended your answer with "kwim?" What does that mean?
My experience is that the absorption is more rapid in the SL route, therefore the patient often begins to notice the benefit within 15 minutes vs. 30+ minutes via the oral route. Additionally, I have noticed that many patients will do well with, say 5mg SL, but may require a sli larger dose for the same effect when they use it po.
An example would be a case I had a couple of years ago... I received a hospice patient with lung Ca and COPD as a transfer from a Florida hospice (pt was a "snow bird"). She had been using her roxanol po mixed in a small amount of juice to help mask the bitter taste. She used it for both pain and dyspnea prn with adequate results. I asked her to try using it between "cheek and gum" and essentially used the same dosing range she was comfortable with. The very first time she used it this way she was thrilled that first, she avoided the bad taste by using the cheek/gum approach, and second, she quickly
experienced an improved
benefit...in her estimation she was more comfortable more quickly.
In my estimation this would be purely anecdotal evidence, which will not fly for most "evidence based practice" models. However, my personal practice experience is that the benefits of a number of medications, including roxanol, ativan, and haldol are quickly available in the SL delivery route and this is the route that I prefer and use for many symptomatic patients.