Buccal administration is a method of delivering medication where a drug is placed between the gums and the inner lining of the cheek. This route allows the medication to dissolve and be absorbed directly into the bloodstream through the tissues of the mouth. Unlike oral medications that are swallowed, buccal drugs are not intended to pass through the digestive system. This form of administration is used for specific medical situations where rapid absorption or bypassing the digestive tract is beneficial. The medications for this route come in the form of small tablets, lozenges, or films designed to be held in the cheek pouch.
The Buccal Absorption Process
The effectiveness of buccal administration lies in the biology of the mouth. The inner cheek is lined with a mucous membrane rich in capillaries, which are tiny blood vessels. When a medication is placed in this area, it diffuses through the mucosal surface and enters these capillaries directly, allowing for rapid distribution throughout the body. This direct entry into the systemic circulation is an advantage for certain treatments.
This process allows the medication to avoid what is known as first-pass metabolism. When a drug is swallowed and processed through the digestive system, it travels to the liver before entering the general bloodstream. The liver metabolizes, or breaks down, a portion of the drug, which can reduce the amount that is available to have a therapeutic effect. By absorbing directly through the cheek, the medication bypasses the gastrointestinal tract and the liver, ensuring more of the active ingredient reaches its target.
Because first-pass metabolism is avoided, a lower dose of a buccal medication can produce the same effect as a higher dose of a swallowed one. This can also lead to a quicker onset of action, which is useful in situations where immediate relief is needed.
Proper Technique for Buccal Medication
Before handling the medication, it is important to wash your hands thoroughly. Taking a small sip of water can help moisten the mouth, which may aid in the dissolution of the drug, but avoid a large amount of liquid that could cause you to swallow the medication. The tablet or film should be placed in the buccal pouch, which is the space between the upper gum and the inner cheek.
To prevent irritation to the lining of the mouth, it is often recommended to alternate cheeks with each new dose. Once the medication is in place, it should be left to dissolve completely without interference. Activities such as eating, drinking, smoking, or chewing can affect the drug’s absorption and should be avoided until the medication is gone. Unnecessary talking can also dislodge the tablet or film from its position.
The time it takes for the medication to dissolve will vary depending on the specific drug. If a buccal medication is accidentally swallowed, it will be less effective because it will then be subjected to the digestive processes it was designed to bypass. Swallowing the medication reduces its intended benefit, and patients should consult their pharmacist or doctor for guidance if this happens.
Medications Commonly Administered Buccally
Several types of medications are formulated for buccal administration due to the route’s specific advantages. Opioids, such as fentanyl, are often given this way to manage breakthrough pain in patients with chronic conditions. The rapid absorption allows for quick relief from sudden and severe pain episodes.
Buprenorphine, a medication used in the treatment of opioid dependence, is also available in a buccal formulation. Sometimes combined with naloxone, its administration through the cheek lining allows for consistent absorption, which is an important factor in managing addiction. This delivery system helps maintain stable levels of the medication in the bloodstream, aiding in the reduction of cravings and withdrawal symptoms.
Other common examples include nicotine replacement therapies, like lozenges, which use the buccal route to help individuals quit smoking. The absorption through the oral mucosa provides a steady supply of nicotine to ease cravings. Additionally, some hormone therapies, such as testosterone, are administered buccally. This method allows for more predictable dosing for hormone replacement.
Comparing Buccal and Sublingual Routes
Buccal administration is often compared to the sublingual route, where medication is placed under the tongue. While both methods involve absorption through the oral mucosa directly into the bloodstream, they have distinct differences. The primary distinction is the placement: buccal is in the cheek pouch, whereas sublingual is under the tongue. This placement affects how the drug is absorbed and how it is used in medicine.
The area under the tongue is highly vascularized with a very thin membrane, which allows for faster absorption compared to the cheek area. For this reason, the sublingual route is often preferred for medications needed in acute emergencies, like nitroglycerin for angina. The buccal area, in contrast, has a larger and more stable surface, making it suitable for medications that are designed for a slower, more sustained release over a longer period.