What is wrong with sublingual epinephrine?

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Specializes in retired from healthcare.

Okay, I give up!

It was years ago that I was told about sublingual epinephrine tablets for bee stings. I learned that they're part of any good first aide kit.

As I browse the web, I notice an obsession with making patients carry an injectable dose of epinephrine instead of tablets.

So what if some people do not know how to give a shot!

So what if some are afraid of the needle!

News about the EpiPen from Mylan and the inflated price is all over the web.

How a senator’s daughter became CEO of the company at the center of the EpiPen controversy - The Washington Post

I did some research on Google and read that sublingual tablets are just as good as the shots.

All they would have to remember is to keep them under their tongue and yet this is not even being talked about. Instead, I see this constant obsession with giving shots.

I keep asking people what would be wrong with tablets and get no real answer.

I'm wondering how many companies must sell the sublingual tablets and also wonder if patients and their families would not save money this way.

Can someone please explain this to me? Am I missing something?

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I did some research on Google and read that sublingual tablets are just as good as the shots.

[...]

Sources? What I've seen says it might be a acceptable alternative if SQ injectable is not available.

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Specializes in retired from healthcare.
Sources? What I've seen says it might be a acceptable alternative if SQ injectable is not available.

I knew someone would ask.

Sublingual administration of epinephrine 40 mg from this tablet formulation resulted in EPPCs similar to those obtained after epinephrine 0.3 mg intramuscular injection in the thigh.”

"CLINICAL IMPLICATIONS"

For treatment of anaphylaxis in the community, self-injectable epinephrine is underused.”

UNDER USED? REALLY?

This novel, fast-disintegrating epinephrine tablet formulation for sublingual administration is a feasible alternative that warrants further development.”

Here is the source. Sublingual epinephrine tablets versus intramuscular injection of epinephrine: dose equivalence for potential treatment of anaphylaxis. - PubMed - NCBI

Sublingual epinephrine was available for first aide kits back in the 1970s but now they're acting like there is no such thing. I know that an EpiPen is expensive but is epinephrine expensive when not an injectable?

Also, if an injection costs $600 this might automatically make it unavailable and therefore bring the need for a sublingual tablet.

Want to Reduce the Price of EpiPens? Approve Some Competition! - Hit & Run : Reason.com

Can you offer a source that says to only use the sublingual tablet if the injection is not available? Is there only one source or several?

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
UNDER USED? REALLY?

Perhaps it was 10 years ago when the article you cite was written.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I found something more current: http://www.jacionline.org/article/S0091-6749(12)01661-2/fulltext?mobileUi=0

Apparently there were issues with taste and absorption, as well as appropriate dosing (looks like 40mg for the SL route to be equivalent to 0.3mg SQ or IM). This might be something we see in the near future. Interesting!

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Specializes in Complex pedi to LTC/SA & now a manager.

Perhaps because the only formulations available in the US & Canada is injectible (IM/IV,SC) and racemic solution (for inhalation. Commonly used in emergency croup treatment)? There is no SL epic available OTC or to prescribe

ODT/SL epinephrine is in pre-phase 1 trials it seems (no human testing only electronic and animal models) which means even if fast tracked 10-15 years before available and while epipens cost

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Specializes in retired from healthcare.
Perhaps because the only formulations available in the US & Canada is injectible (IM/IV,SC) and racemic solution (for inhalation. Commonly used in emergency croup treatment)? There is no SL epic available OTC or to prescribe

ODT/SL epinephrine is in pre-phase 1 trials it seems (no human testing only electronic and animal models) which means even if fast tracked 10-15 years before available and while epipens cost

This doesn't explain why camps had access to sublingual epinephrine in the 1970s.

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Specializes in Complex pedi to LTC/SA & now a manager.
This doesn't explain why camps had access to sublingual epinephrine in the 1970s.

I cannot speak to camps in the 1970's. I wasn't around. I can only explain that now it's in pre-phase 1 trials and not available in North America.

there are many drugs that were used in the 70's 80's and 90's that are no longer available. Seldane, Vioxx, AnaKit and others.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Drugs in various modes of delivery are pulled from the market for many reasons, so this is probably one of those situations. If they are just figuring out the proper dosage now, it could be that the old SL tablets didn't work quite as well as the injectables, which have their own issues with vasoconstriction at the site delaying absorption (but the SL tabs do the same thing, apparently).

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I am highly allergic to bee stings as was my father ending up in emergency rooms on several occasions in the mid sixties. We were given pills which I am assuming are the ones talked about here. One was sublingual with a second to follow by mouth. These were small and easy to carry and were used several time with no serious reaction resulting from the stings. They worked! I've asked my doctors several times over the years but all I hear about is the pen. One doctor told me they aren't available because they are too toxic. If the alternative is dying I'll live with toxic. Why can't we get them?

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
I am highly allergic to bee stings as was my father ending up in emergency rooms on several occasions in the mid sixties. We were given pills which I am assuming are the ones talked about here. One was sublingual with a second to follow by mouth. These were small and easy to carry and were used several time with no serious reaction resulting from the stings. They worked! I've asked my doctors several times over the years but all I hear about is the pen. One doctor told me they aren't available because they are too toxic. If the alternative is dying I'll live with toxic. Why can't we get them?

They aren't currently for sale in this country. Not sure if anyone is making them.

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I knew someone would ask.

Sublingual administration of epinephrine 40 mg from this tablet formulation resulted in EPPCs similar to those obtained after epinephrine 0.3 mg intramuscular injection in the thigh.”

"CLINICAL IMPLICATIONS"

For treatment of anaphylaxis in the community, self-injectable epinephrine is underused.”

UNDER USED? REALLY?

This novel, fast-disintegrating epinephrine tablet formulation for sublingual administration is a feasible alternative that warrants further development.”

Here is the source. Sublingual epinephrine tablets versus intramuscular injection of epinephrine: dose equivalence for potential treatment of anaphylaxis. - PubMed - NCBI

Sublingual epinephrine was available for first aide kits back in the 1970s but now they're acting like there is no such thing. I know that an EpiPen is expensive but is epinephrine expensive when not an injectable?

Also, if an injection costs $600 this might automatically make it unavailable and therefore bring the need for a sublingual tablet.

Want to Reduce the Price of EpiPens? Approve Some Competition! - Hit & Run : Reason.com

Can you offer a source that says to only use the sublingual tablet if the injection is not available? Is there only one source or several?

Epinepherine itself is cheap.

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