The real as well as perceived efficacy of any course of treatment typically comes down to three factors. These are its targeted action, absorption mechanism, and the level of comfort the patient has with it. This is true for everything from drugs you can get over the counter at a Sydney pharmacy to more holistic options available at dispensaries.
In the case of oral medications, there are many scenarios where lozenges may be a better fit than tablets. What are lozenges? In this post, we go over everything you need to know: from how they work to their useful advantages over their conventional counterparts.
Key Differences at a Glance
| TABLETS | LOZENGES |
| Designed to rapidly disintegrate for absorption in the gut | Slow release over time in the mouth, aiming for absorption into the bloodstream |
| Concentrated and quick delivery | Sustained and uniform dose delivery |
| Targets the small intestine and stomach | Primary sites are the pharynx (i.e. throat) and oral cavity |
| Typically compressed via the use of disintegrants | Formulated with a sweetened base or coating in the molding process |
Prolonged, Targeted Action
Perhaps the most notable advantage of lozenges — also known as “troches” — over common tablet types is its ability to provide targeted local action. A sore throat, for example, benefits from prolonged exposure of inflamed tissues to active ingredients rather than a quick swallow of a coated pill. Troche medicines dissolve slowly in the mouth, allowing an uninterrupted five to ten minutes for benzocaine or other other compounds to soak into the affected area.
Are caplets chewable?
Because they’re typically unflavoured, chewing caplets, capsules, and tablets is generally an unpleasant experience that produces a bitter taste in the mouth. On the other hand, lozenges come flavoured, but chewing is still not recommended as it dramatically reduces exposure time to active ingredients.
Getting Around the Digestive System
In some scenarios, it’s crucial that a drug enters the bloodstream while avoiding harsh acids in the liver and stomach. This can be due to a tendency of active ingredients to cause gastric irritation — which can irritate the stomach lining — or their likelihood to degrade in endogenous acids. The latter can result in bouts of nausea or bloating, causing secondary effects like headaches and gas.
Troches allow for sublingual as well as buccal absorption, using the lining of the mouth which is rich in blood vessels and buccal mucosa. This route allows some compounds to be absorbed and integrated into systemic circulation. Avoiding the so-called “first-pass effect”, in which the liver breaks down and metabolises significant amounts of the active ingredient, allows for a more effective dose with shorter onset time.
Practicality and Patient Compliance
For obvious reasons, patient outcomes are vastly improved with consistent compliance to a prescribed course of medication. This is helped along significantly if the process isn’t unpleasant or painful for individuals taking them. In this respect, troches can help in three ways:
- Flavour masking which can help with the bitter taste of many active drugs. Lozenges are often formulated with a flavoured base, usually sweet, before being compressed like a hard candy. This covers up any unpleasantness, making doses much more palatable to patients of all age ranges.
- No need for water, or even to take the troche on a full stomach. This means they can be taken anytime and anywhere, making them a more appealing option regardless of your lifestyle.
- Circumvents dysphagia or difficulty swallowing, which is a common issue for small children and the elderly. Lozenges take the pain out of the process, creating a safer, easier, and more enjoyable delivery method for pediatric as well as geriatric patients.
Formulation Versatility and Compounding
As a bonus benefit, troches are easily compounded by pharmacists as specified or requested by clients. In particular, soft and molded ones can be tailored to contain patient-specific doses or combinations of drugs, which can be invaluable in niche treatment scenarios. Examples of this include situations where commercial options have been discontinued, or a specific ailment warrants combination therapy.
Because of their formulation versatility, lozenges can incorporate multiple active ingredients including analgesics, anesthetics, antimicrobials, and even vitamins. This means a single compounded lozenge may be a viable replacement for one or multiple pills if and when warranted.
Conventional tablets and capsules are the standard in drug therapy, and for good reason. However, individuals with special needs, lifestyle considerations, or even convenience preferences could certainly stand to benefit from the niche advantages of over-the-counter as well as compounded lozenges.
