roxanol

[calliesue]

I have a question about roxanol. I am new to hospice and was orientating on a continuous care case. The rn who came out to do the 24 hr visit told me and the other lvn there that roxanol is only effective/ absorbed in the stomach . This is contrary to what I have always been taught, Called pharmacist later who said that was not correct.

Any one have any insight to offer? Is there new research or findings about roxanol?

[tencat]

Hmmm....not that I know of. The directions from our pharmacy indicate that it can be absorbed through the mucous membranes, so if it's placed under the tongue or in the cheek it can still be absorbed.

[leslie :-D]

roxanol is given either po or sl.

these nurses need to refresh their knowledge base.

leslie

[shrinky]

I agree that it is absorbed through sub lingual use as well as oral, only through my experiences with using it for so many years and seeing the effects of using it in patients who cannot swallow. Our pharmacist would also agree with me.

[aimeee, BSN, RN]

Yes, it is absorbed through the mucous membrane...that's the whole point of using it after the patient can no longer swallow medications.

[calliesue]

Thanks everyone. This is what I thought too. I just wondered if there was some little known study or something that backed up her position.

I figured this was the place to come to get good info.:specs:

[NurseAlwaysNForever]

Roxanol, non sugar based can also be used as a neb to relax the lining of the lungs and decrease respiratory discomfort. It can be mixed with Albuterol, Atrovent, combination of the two, Xopenex, or plain old Saline. Works very well.

[garyd11]

My father-in-law is taking Roxanol liquid. The posts seem to indicate that there is no difference between taking it SL or PO and the literature says it can be taken with or without food, but my question is: Is there any difference between giving medication with food and mixing it into food? Thanks.

[MissIt]

My father-in-law is taking Roxanol liquid. The posts seem to indicate that there is no difference between taking it SL or PO and the literature says it can be taken with or without food, but my question is: Is there any difference between giving medication with food and mixing it into food? Thanks.

I guess that would depend on whether he's actually eating. If you mix it into the food and he doesn't eat it all, he'll miss some of his dose. As far as absorption goes, it's all ending up in the stomach anyway so I don't think it would make a difference if you take it in between bites or within a bite, kwim?

[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?

[tewdles, RN]

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.

[caliotter3]

kwim = know what I mean?