General

Troches: An Innovative Drug-Delivery Option

Getting medications or supplements from outside your body to your bloodstream, where they can have an effect, should be pretty easy. Swallowing a pill, chewing a tablet, using a suppository, applying a medicated patch, implanting a pellet, applying a cream, or injecting a drug directly into a muscle or the bloodstream are all options.

Each of these options has benefits and drawbacks. For example, swallowing a pill is a simple way to take a medication; however, stomach acid and digestive enzymes change the properties of many medications, and first-pass metabolism in the liver increases required dosages, which makes using the gut as a means to absorb a drug into our bloodstream a poor option for some medications.

Troches combine the convenience of a pill with a method to increase absorption directly into the bloodstream. While troches are noninvasive and do not require needles, they must be taken correctly or the medication is swallowed and enters the gut, where it is metabolized and absorbed through the gut lining.

What is a troche?

A troche is a medicated lozenge that is placed between the gum and cheek or under the tongue. It takes almost half an hour for troches to be fully absorbed. Think cough drop.

Your mouth is lined with a thin mucous membrane. Just below this membrane is a network of small blood vessels. A troche is designed to slowly dissolve so medication is gradually absorbed through the mucous membranes lining the mouth and into blood vessels. A troche placed under the tongue dissolves more quickly and is more rapidly absorbed than one placed between your cheek and gum.

If you chew a troche, suck on it, or swallow it, the medication enters your stomach and travels through your digestive tract. Some of it will eventually be absorbed through the lining of your gastrointestinal tract and enter your bloodstream, but much of it may be digested or lost in your stool. Placing a troche on your tongue allows it to dissolve more quickly but it cannot be as easily absorbed. Much of the medication will be dissolved in your saliva.

Troches are carefully designed and dosed based on where they should be placed in the mouth. Contact your doctor or pharmacist if you are unsure whether your troche should be placed under your tongue or between your cheek and gum.

What medications are available as a troche?

Troches are typically a combination of an active ingredient plus other excipients that stabilize the drug, control how quickly it is dissolved, and improve the taste and texture.

Troches are commonly used for:

Pain relief: a troche can deliver pain medications directly to an inflamed mouth or sore throat.
Hormone replacement therapy: some hormones are not easily absorbed through the gut, are unstable, or undergo significant metabolism while passing through the liver. Troches provide a means to deliver hormones to the bloodstream without using an injection and avoid the need to use higher doses to accommodate for medication loss in the gut and first-pass liver metabolism.¹
Antifungal: troches can be used to deliver antifungal medication to the lining of the mouth or throat.
Smoking cessation: troches can be used to deliver controlled doses of nicotine into the bloodstream, allowing for increased bioavailability, reduced stomach irritation, and lower first-pass metabolism.²
Weight loss: LDN Boost combines three medications—naltrexone, oxytocin, and vitamin B12—in a single troche, allowing for better absorption and better dosage control.
Sexual health: Passion + combines multiple medications (oxytocin, PT-141, and tadalafil) in a single troche.

What’s the difference between an orally dissolving tablet (ODT) and a troche?

An orally dissolving tablet (ODT) and a troche are both solid medication pellets that are designed to dissolve in the mouth.

Orally dissolving tablets (ODT)

An ODT is a compressed tablet that is placed on the tongue and dissolved into saliva. It is a convenient way for people who have difficulty swallowing medications to take a tablet. It is also convenient when you lack access to water or another liquid to take your medication with.

ODTs should not be chewed or swallowed. They are intended to disintegrate in the mouth and be absorbed through the mucous membrane lining the mouth, esophagus, and stomach.³

ODTs dissolve quickly, typically between a few seconds to a minute. The majority of ODTs dissolve within about 30 seconds.

Troche

Troches are larger than ODTs and take longer to dissolve. They are placed between the cheek and gum or under the tongue (location is based on the medication formulation) and slowly absorbed across the mucous membrane and into the bloodstream. Troches generally take about 30 minutes to completely dissolve, meaning the medication enters your bloodstream slowly and steadily.

What are the benefits of using a troche to deliver medications?

Troches, as a medication delivery option, have many benefits, including:³

Rapid onset of action
Avoids first-pass metabolism in the liver
Reduces sudden spikes in medication dosage
Reduces the risk of stomach upset and other side effects
Has enhanced bioavailability
Increases patient compliance since there is no need to swallow a pill or inject a medication
Makes it easy to custom-design dosages and formulations
Provides ease of administration
Can be flavored to taste

How should you take a troche?

Troches come in various shapes and sizes and are scored depending on the dosage. Troches are gelatin-based and are stored on a troche tray. Depending on the prescribed dosage, you may use one-fourth, one-half, or the entire troche.

Recommended steps when taking a troche:

Wait for 10 to 15 minutes after eating before using a troche.
Read and follow the instructions to check your dose.
Wash your hands before touching your medication.
Rub your finger over the troche to raise a corner and peel it out.
If your prescribed dose is less than a full troche, cut the troche using scissors or a knife.
Drinking a warm drink 15 minutes before taking the troche may speed up absorption.
Place the troche between your upper gum and cheek.
Push the medication as far back toward your jaw as it can go.
Place a finger on the outside of your mouth to put pressure on the troche inside your mouth for 30 to 60 seconds. The troche should stick to your cheek or gum.
The troche should dissolve in 15 to 30 minutes.
Do not eat, drink, or brush your teeth while the troche is in your mouth or for 15 to 30 minutes afterward.
Do not swallow the medicated troche.
Alternate sides of the mouth (buccal) or sides of the underneath surface of the tongue (sublingual) for each dose.

Your medication may be prescribed as buccal or sublingual. If you are unsure where to place your troche, contact your doctor or pharmacist to verify the correct placement, as this may influence how the medication is absorbed. Keep your troche in a cool, dry place away from sunlight to keep them from melting.

Troches and orally dissolving tablets are specifically formulated for best absorption. If you are unsure whether you have a quick-dissolving ODT or a slowly absorbed troche, talk to your doctor or pharmacist. For best results, it is essential to follow all dosing and administration guidelines.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References:

1. Andersen LE & Webb SC. (nd). FAQ Troches & Bio-Identical Hormones. extension://oemmndcbldboiebfnladdacbdfmadadm/https://obrienrx.com/wp-content/uploads/2021/06/OBP-011_FAQ-—Troches-and-Bio-Identical-Hormones-2.pdf

2. Pothu, Renuka & Shayeda, & Yamsani, Madhusudan. (2014). Development and in-vitro evaluation of nicotine troches for smoking cessation. 7. 68-75.

3. Sevda Şenel & Tansel Comoglu (2018) Orally disintegrating tablets, fast-dissolving, buccal and sublingual formulations, Pharmaceutical Development and Technology, 23:5, 431, DOI: 10.1080/10837450.2018.1462471