Oral Medications with Special Administration Method

Introduction

Beyond standard swallowing, some oral medications require specific methods for optimal absorption and effectiveness.

Sublingual

Sublingual tablets are placed under the tongue until completely dissolved for a rapid absorption, bypassing the liver first-pass metabolism.

• Asenapine (Saphris) - Do not split, crush, chew or swallow. Avoid eating or drinking for at least 10 minutes after administration.
• Desmopressin (Minirin) - Minirin oral lyophilisate 60 mcg is calculated to correspond to Minirin 0.1 mg tablet.
• Glyceryl Trinitrate - Do not chew, crush, or swallow sublingual tablet.

Orodispersible Tablet

Orodispersible tablets are solid unit dosage forms similar to conventional tablets, but they contain super disintegrants, which help them dissolve readily in saliva within a minute in the mouth, eliminating swallowing difficulty.

• Bilastine 10 mg (Bilaxten ODT) - The orodispersible tablet disperses rapidly in saliva and can be easily swallowed. Alternatively, it may be dispersed in water before administration (avoid grapefruit juice and other fruit juices).
• Donepezil (Aricept ODT)
• Mirtazapine (Remeron SolTab) - Tablet dissolves rapidly in saliva; water is not needed. Do not chew, crush or split tablet.
• Olanzapine orodispersible tablet (Zyprexa Zydis) - May be placed on the tongue and allowed to dissolve, or dispersed in water, orange juice, apple juice, milk, or coffee.

Chewable Tablet

Chewable tablets are designed to be broken down by chewing, leading to faster absorption.

• Magnesium Hydroxide, Aluminium Hydroxide and Simethicone Tablet (Actal Plus, Alucid, Maalox Plus)
• Lanthanum (Fosrenol) - Chew the tablets thoroughly before swallowing (reduces the chance of serious gastrointestinal effects). Crush the tablets if chewing is difficult.
• Sucroferric Oxyhydroxide (Velphoro) - Chew thoroughly before swallowing. Crush tablets if chewing is difficult. Take with a meal.

Miscellaneous

Calcium Polystyrene Sulphonate Powder (Kalimate, Resincalcio)

• Prepare a suspension or paste by mixing each 1 gram of resin with 3 to 4 ml of water or sweetened beverage (avoid fruit juices such as orange juice, carbonated beverages, or potassium-rich beverages; avoid honey in infants).

Dioctahedral Smectite Powder for Oral Suspension

• Children: Mix the contents of the sachet with 50 ml of water in a feeding bottle, given in intervals throughout the day, or mix with semi-liquid food, such as broth, compote, puree, baby food.
• Adults: Mix the contents of the sachet with 50 ml of water.

Macrogol Powder

• Fortrans - Dissolve 1 sachet in 1 L of water. 3-4 L of oral solution are required for effective lavage.
• Forlax - Dissolve contents of each sachet in a glass of water.

Monobasic Sodium Phosphate 48%, Dibasic Sodium Phosphate 18% (Fleet Phospho-soda)

• 45 ml diluted with half a glass (120 ml) of water, followed by one full glass (240 ml) of water to be taken depending on the time of the procedure.

Montelukast 4 mg Oral Granules (Singulair)

• Administer directly into the mouth, dissolved in 5 ml of cold or room temperature baby formula or breast milk, or mixed with a spoonful of cold or room temperature applesauce, carrots, rice, and ice cream (avoid other liquids or foods); administer within 15 minutes of opening the packet; liquids may be taken subsequent to administration.

Nystatin 1000000 units/ml Suspension

• Oropharyngeal infection: Best to use after a meal or drink. Swish the liquid around the mouth for as long as comfortable before swallowing.
• Infants: Use dropper to place one-half of the dose in each side of mouth and avoid feeding for 5 to 10 minutes.

Oral Rehydration Salt

• N-ORS - Dissolve contents in 250 ml of boiled, cool water and to be taken orally. Unused solution should be stored in a refrigerator and discarded 24 hours after preparation.
• ORS B Plus and ORS Plus - Dissolve contents of one sachet in 250 ml of cool, boiled water. To be taken orally.
• UphaLyte - Add 250 ml of boiled, cooled water to the contents of 1 sachet and stir or shake well for 2 to 3 minutes to dissolve.

Potassium Citrate 3 g/10 ml and Citric Acid Mixture (Mist Possit)

• Dilute prior to administration to minimize injury due to high concentration of potassium.
• Administer after meals and at bedtime to prevent saline laxative effect.
• May follow dose with additional water if necessary.
• Dose may be chilled to improve palatability.

Sodium Bicarbonate, Citric Acid, Sodium Citrate and Tartaric Acid - 4 g per sachet (Ural, Utix)

• Dissolve 1-2 sachets in a glass of water.

Thymol Compound Gargle

• Dilute 1 part with 3 parts warm water before use or use as directed.
• Do not swallow.

Zuclopenthixol 20 mg/ml Drops (Clopixol)

• The drops are easily administered mixed in e.g. water, orange juice or apple juice.

Summary

Remember, this guide is not an exhaustive list and it is crucial to seek guidance from a healthcare professional for specific instructions.