A troche is a medicated lozenge designed to dissolve slowly in the mouth, allowing for gradual absorption of medication. Unlike pills, troches are specifically formulated for a unique delivery method. Troches are not intended to be swallowed; their effectiveness relies on medication being absorbed through the oral mucous membranes.
How Troches Work
Troches work by facilitating the absorption of medication directly into the bloodstream, bypassing the digestive system. When a troche is placed under the tongue (sublingual) or between the cheek and gum (buccal), the active ingredients diffuse through blood vessels in these areas. This direct entry into the systemic circulation avoids the “first-pass effect” in the liver.
The first-pass effect refers to the metabolic process where a significant portion of a drug is broken down by the liver before it can reach general circulation. By circumventing this process, sublingual or buccal absorption can lead to higher bioavailability, meaning more of the medication enters the bloodstream in its active form. This method can result in a more predictable and faster onset of action for drugs. Medications commonly formulated as troches include hormones like testosterone or estrogen, pain relief compounds, and vitamins.
What Happens If You Swallow a Troche
Swallowing a troche significantly alters its intended absorption pathway, reducing its effectiveness. Once swallowed, the medication is subjected to the acidic environment of the stomach, which can degrade active ingredients. After the stomach, the medication enters the small intestine and is absorbed into the portal vein system.
From the portal vein, the medication travels directly to the liver, where it undergoes extensive first-pass metabolism. This process substantially reduces the amount of active compound that ultimately reaches the systemic circulation. Consequently, the therapeutic effect of the troche may be diminished or entirely lost, meaning the medication might not provide the intended benefit.
Swallowing a troche might also lead to unintended side effects. If the medication is absorbed through the gastrointestinal tract, it could cause stomach upset, nausea, or other gastrointestinal disturbances not typically associated with oral mucosal absorption. Furthermore, if the medication is absorbed less efficiently, there might be a temptation to take another dose, which could lead to an accidental overdose if some of the initial swallowed dose was still absorbed. If a troche is accidentally swallowed, contact a pharmacist or prescribing healthcare provider for guidance rather than taking an additional dose.