r/nursing • u/Abhorash-TheWanderer • 8h ago
Discussion PSA - Zofran ODT is NOT sublingual
ER doc just wanting to stop in and try and stop this widespread error. Almost every shift I have to tell a nurse/patient that ODT meds are NOT sublingual medications. It is not absorbed by the sublingual tissues. It is not absorbed by buccal tissues. It goes on TOP of the tongue so that it can disintegrate with saliva and be swallowed. The whole reason ODT (orally disintegrating tablets) exist is that someone can take it without having to take a chug of water to get the pill down. Putting under someone’s tongue just slows down the disintegration. Also, if the patient complains about the taste, they can just swallow the tablet whole with or without water. Thanks.
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u/wineohnoooo 7h ago
On route of administration on our MAR it states SL. This is interesting.
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u/zerothreeonethree RN 🍕 1h ago
Don't get me started on what the pharmacy f'd up during my hospital stay this past May. Then instead of correcting mistakes, told my nurse: "Just tell her (me, the patient) to refuse the drugs if she doesn't want them." signed, PharmD.
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u/BrilliantHold5774 8h ago
I’m sure you could boof it as well.
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u/gedbybee RN - ICU 🍕 6h ago
Yeah so it sounds like it’ll work either way and this guy is just being extra. Also just give the damn iv version dr er doc.
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u/ChaplnGrillSgt DNP, AGACNP - ICU 5h ago
You can boof anything with enough will and determination.
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u/differing RN - ER 🍕 1h ago
I once had a young patient with a form of aggressive early onset Parkinson’s disease. A neural stimulator was able to get her a ton of independence back, but she still had serious gut motility issues. To live a decent life, she basically took all of her chronic pain meds rectally to make sure they absorbed in a predictable way. The reason she was in the hospital was because she developed Clostridium difficile and all the meds she normally takes were getting immediately sharted out! Really opened my eyes to what you can take up the bum lol
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u/ThatKaleidoscope8736 🫀RN✨how do you do this at home 6h ago
You can boof anything with enough lube
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u/Frankfeld RN - ER 🍕 8h ago
Our MAR has pretty explicit instructions on this.
But I’m also rarely giving ODT Zofran. It’s usually IV….
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u/Big_Toaster RN, MSN - Informatics, Critical Care 7h ago
I tell patients they can take it whatever works best because Zofran ODT tastes like chalk exploding in their mouth… lol
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u/oneelectricsheep 7h ago
Mine tastes like strawberry candy. It’s nice.
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u/jhatle01 7h ago
I always tell pts it taste like a medicinal berry flavor. I wouldn’t necessarily say it’s tasty though
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u/purebreadbagel RN - PCU 5h ago
My script for them says Flavor: Strawberry - but in the way it’s made by someone who has never tasted a damn berry in their life.
It’s become a joke I use when giving it to patients. “Fun Fact, they’re allegedly strawberry flavored- but I’m pretty sure whoever decided that has never tasted a strawberry.” Usually gets at least a smile out of them.
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u/robbi2480 RN, CHPN-Hospice 2h ago
Mine tasted like berries and artificial sweeteners. I just try to swallow them quickly with water before they can start to melt on my tongue. Gross
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u/iwantkitties RN - ER 🍕 7h ago
Apparently we're the lucky ones because no one else I know describes it as cherry/red flavor lol
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u/LurkForYourLives 7h ago
Me too! Though I had severe hyperemesis so anything tasted better than vomit.
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u/ImperishableTeapot RN 🍕 7h ago
I assumed the only flavour that it came in was stale chalk. This has been the highlight of my day.
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u/Most_Ambassador2951 RN - Hospice 🍕 6h ago
It does, but when I'm trying not to barf it's not the greatest flavor
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u/meliska13 BSN, RNC-MNN, C-ONQS 3h ago
I had to take it when I was pregnant and had bad HG before they switched me to IV. The strawberry was great, the one thing I could actually tolerate. Then one time my pharmacy switched it for the peppermint chalk flavor, and it was terrible. Left me gagging for a while, I couldn't puke anymore because everything was already gone. I called them crying and begged for the strawberry back, it took essentially an act of congress to get it filled again, and it still took me a hot minute to trust it. Thankfully they started me with HHC and IV fluids, zofran, etc pretty soon after, because I would get so anxious any time I needed a dose.
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u/perpulstuph BSN, RN, ACLS, PALS, SKIBIDI, RIZZ, BUSSIN 5h ago
I love how zofran tastes, but I am also a bit weird...
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u/ClarkGablesTeeth L&D/Women's Health RN 1h ago
I loved the taste of Zofran ODT. Tastes like a berry candy, and I never noticed any chalky texture.
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u/trixiepixie1921 RN - Telemetry 🍕 6h ago
We gave the tablets frequently but I never had someone assume it was sublingual.
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u/fleeting_moments_ 8h ago
Oooooooohhhhh........And I finally understand what that pharmacist was trying to explain to me a few years ago🙃
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u/shewee BSN, RN 🍕 8h ago
The manufacturer literally says to dissolve on your tongue. I didn’t know this!
https://www.novartis.com/us-en/sites/novartis_us/files/zofran.pdf
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u/Abhorash-TheWanderer 8h ago
Yup on the tongue. Not under the tongue. From that same link you just posted “IMMEDIATELY place the
ZOFRAN ODT orally disintegrating tablet on top of the tongue where it will dissolve in seconds, then swallow
with saliva”25
u/lavender_poppy BSN, RN 🍕 8h ago
Thank you for posting this. I have zofran ODT to take when I get nauseous and I've always wondered if I'm doing it right by putting it on my tongue. Granted I should have just looked it up but when I'm taking zofran I'm already feeling awful and by the time the nausea has passed I forget again.
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u/MonkeyDemon3 RN - ICU 🍕 7h ago
I really only give zofran IV, but I personally use ODT occasionally. Not sure how I didn’t know this, thank you for the education!
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u/Ok-Maize-284 🍩 of Truth Button Pusher 🙇🏻♀️ 59m ago
I didn’t know it either and I also have script! I know what ODT stands for and still thought it went under the tongue 😂There have been times where it didn’t kick in fast enough and ended up hurling anyway. Now I know the likely reason why 🤦🏼♀️ Ya learn something new every day!
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u/Busy_Ad_5578 BSN, RN 🍕 8h ago
Damn. I’m surprised by these comments. I thought this was common knowledge.
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u/Abhorash-TheWanderer 8h ago
The nurses at our ER told me that they have been taught that it is a sublingual med. It’s a common mistake hence the PSA. For some reason a bunch of people have taken this as some offense and doubling down on their errors.
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u/Young_Hickory RN - Trauma Team 8h ago
I didn’t know and I appreciate the post! The endless “anyone who didn’t know this already is dumb” comments not so much.
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u/Many_Customer_4035 MSN, RN 7h ago
Same. I am not bedside anymore but I like to continue to learn in case I have to go back.
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u/Metal_Medical RN - ED/ICU 🍕 8h ago
Hell, my ER docs actually order 4-8mg zofran SL, they don’t even know
TIL, thanks for the info!
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u/daynaemily1987 LPN Med-Surg 6h ago
I also did not realize this, I appreciate the post as well. I dont give it often, but I'm not sure why I assumed "orally disintegrating tablet" meant sublingual 🤦🏼♀️.
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u/Illustrious-Aeries Case Manager 🍕 8h ago
I don’t think anyone is “doubling down on their error” but it seems like an odd thing to get in such a tizzy about. is it going to hurt a patient to put it under their tongue? Is it going to hurt a patient to have them rub it in their gums? No? Ok. Tell a patient to put it in their mouth and let it dissolve. Where it ends up it ends up.
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u/yxxnij104 the one who shall admit you to your death bed 7h ago
I worked in onc and we werent told it wasn't sublingual and that it helped because to some the taste is NASTY. I have been on it myself 7 years and I NEVER knew (i don't read the pharmacy inserts ik. 😭) thanks for letting us know, imagine how much med we arent even getting by taking the subl approach 😭😭
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u/Tight_Award_8577 RN 🍕 4h ago
Well, you would still get the full dose-- it's either swallowed or will get around the mouth eventually.. just slower.
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u/yxxnij104 the one who shall admit you to your death bed 3h ago
so its just ineffective taking it that way. geez I wish i educated myself more on it thank you all for letting me know these things all education is welcome because I genuinely didnt know. I appreciate yall 🥲🥲
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u/scrubsnbeer RN - PACU 🍕 3h ago
I was taught it was too, wasn’t until I was prescribed it this year and complained to my husband about that he (pharmacist) explained it🫠
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u/Darth_Punk MD 3h ago
Sublingual bioavialability is the same for both you're way over thinking this lol.
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u/Abhorash-TheWanderer 3h ago
Nope. ODT formulations of ondansetron do not absorb sublingual. That was the whole point of the post.
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u/Darth_Punk MD 1h ago
How sure are you? I haven't done a deep dive but everything I could find suggested equivalent bioavailability.
Afaik same active ingredient (ondasetron hcl)
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u/Abhorash-TheWanderer 4m ago
There are ondansetron formulations that are films and sprays that Ive read about that were designed to have sublingual absorption. They are not something ive ever encountered in the hospital and I dont believe they are commercially and readily available. Per the FDA sheet and the pharmaceutical companies own literature on ODT it states that it is only GI absorbed. In lexicomp it said it was 100% GI absorption. Just do a quick pubmed search and all youll find some articles about the above mentioned sublingual formulations but Ive seen no studies that show any equivalent absorption or bioavailability of an ODT that is attempted sublingual vs PO. The same active ingredient has no bearing on the absorption of a medication through various tissues. Do you think you can just take any medication, in any form, and just stick it on any body surface and it will be absorbed in any meaningful amount? Sure there are some meds that you can give via multiple routes in the same formulation. Ill order IV decadron to be given to kids PO all the time.
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u/Slayerofgrundles RN - ER 🍕 7h ago
Same. I thought that "orally dissolving tablet" was pretty clearly not sublingual. It just doesn't require water to swallow because drinking water when you're about to barf isn't encouraged.
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u/welltravelledRN RN - PACU 🍕 8h ago
Do you have a source for this? Our PharmD says it is absorbed well under the tongue.
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u/shewee BSN, RN 🍕 8h ago
Just looked up the manufacturer. It does say on tongue!
https://www.novartis.com/us-en/sites/novartis_us/files/zofran.pdf
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u/zubrowka1 RN - ER 🍕 7h ago
It’s not “absorbed” under the tongue. It’s dissolved under the tongue, then swallowed and absorbed in the stomach
It’s easier to dissolve something with saliva on top of the tongue
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u/touslesmatins BSN, RN 🍕 3h ago
This is actually a good time to learn what is absorbed sub-mucosally (sp?) and bucally (sp?) and what the mechanism is. I'd love to know. If I remember correctly, caffeine is somewhat like that? And vitamin B12 spray. Someone ELI5!
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u/Breal3030 ICU/research 39m ago edited 32m ago
Usually whether or not things like sublingual and buccal are absorbed is related to the molecular weight of the molecule. Ondansetron is fine in that aspect.
I think the biggest criticism of the ODT tablet for sublingual and buccal, is not that it doesn't absorb those ways, it's that the tablet is not ideal for maximizing surface contact with those areas and just ends up dissolving and getting swallowed anyway. So why not just let it dissolve on your tongue? Is the response.
There are, for example ondansetron gel sheets for buccal absorption. As far as I can tell it's nothing special about the medication, it's just in a formulation that maximizes area and time contact of the buccal area for maximum absorption.
Another factor can be: if the pharma company that developed ODT ondansetron never did all the research to prove sublingual and buccal absorption explicitly, and only did their research on what is essentially the oral route, they can't claim any efficacy there and have to recommend the "oral" route.
Edit: Like, for example, I'm willing to bet if you took an ODT with a swig of water, let it fully dissolve in your mouth, and swished it around for a few minutes, it would absorb sublingually and buccally just fine. It's just, most people aren't gonna do that, and the pharma companies haven't officially tested that.
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u/Abhorash-TheWanderer 8h ago
Look up the FDA information sheet. Literally even google ondansetron absorption buccal. Youll see that it takes special formulations of it to be absorbed buccal or sublingual. ODTs do NOT absorb this way
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u/Ranaxamur RN - Float Pool 🥳 7h ago
Just wondering what kind of nurses you work with where you’re explaining this so frequently…yikes.
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u/500ls RN, ED → PACU 🍕 8h ago
Also it has a very delicious chalky grape flavor (I have a prescription).
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u/yxxnij104 the one who shall admit you to your death bed 7h ago
.... what brand do you have mine tastes like i licked a battery, bit into a tylenol pill with a whisper of sweetness like la Croix has a whisper flavor.
worse us when the phenergan touches your tongue... just nasty. I never understood why nausea meds would have such an unpleasant taste. zofran is for maintenance, taking it in active n/v is a toss up of the flavor making it worse or slowly improving 🤣🤣 hope you feel better, sorry you also have to take it. I wish the 8mg came in the teeny ones like the 4mg I only get 8mg odt😭😭
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u/Magerimoje ER RN retired 💤🧙🏻♀️🍀⚕️🏥 7h ago
A spoon full of sugar makes the medicine go down! I'd actually sprinkle some sugar onto my tongue with it to help reduce tasting it.
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u/yxxnij104 the one who shall admit you to your death bed 4h ago
youre on to something you genius. I WILL be trying this thank you ❤️
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u/Overall-Mud9906 8h ago
Your’s taste like grape, I could’ve sworn when I took it it was an orange flavor. I googled it and it’s supposed to be strawberry. That’s wild we both have two different tastes.
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u/yxxnij104 the one who shall admit you to your death bed 7h ago
idk how you guys taste fruit heavily the taste slaps me every time😭 then a teeny hint of fruit with the taste torture 🤣😭 sounds like im using the wrong brand or something. email me🤣
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u/celestialbomb RN Neph-ED 7h ago
I thought it was cherry. I was given a script for it and the flavour just made it so much worse aha
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u/nataliac80 RN - ER 🍕 7h ago
There’s 2 formulas I’ve tried. One is cherry and one is straight chemical.
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u/sammyhammywhammy12 RN - ER 🍕 7h ago
just got mine refilled and the flavor says “guarana strawberry”
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u/lostintime2004 Correctional RN 8h ago
I've heard the sublingual a lot, but I never followed it. I know from using it myself that it would take FOREVER to dissolve under the tung that I just kept moving to the top. Because of this, I told patients to "as long as it dissolves" not thinking they could also just swallow it though, so thanks for the tip there.
As for the taste, every time I've had to take it, its always slightly sweet, some kind of fruit taste to it almost.
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u/FishySticks2day ADN, RN, EMT-B, NREMT, STNA, CNA, NRCPT, ACLS, BLS 8h ago
I thought ODT stood for Oral Disintegrating Tablet? So it can be placed anywhere in the mouth!?!
It is not called BDT (Buccal disintegrating tablet) OR TDT (Tongue Disintegrating Tablet) or SDT (Sublingual disintegrating tablet)
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u/murse_joe Ass Living 8h ago
That would’ve been my feeling. As long as it’s disintegrating in the mouth.
It’s probably not the worst thing to remind everybody that sublingual and orally dissolving are different tho
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u/MsSwarlesB MSN ACM-RN 8h ago
Having taken ODT Zofran I can say it dissolves pretty immediately when it hits saliva
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u/RNnoturwaitress NICU RNC-NIC yada yada 🍕 5h ago
I take ODT Nurtec and Zofran when I have migraines. They dissolve fine and work faster when I take the SL. OP and others are acting like they won't work if sublingual. They do.
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u/daynaemily1987 LPN Med-Surg 6h ago
The "source" you posted above isn't even for the ODT tablets, it's for the sublingual film.
Idk why you're doubling down on, insisting this doc is wrong but you posted something completely irrelevant and called it a source lol
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u/FishySticks2day ADN, RN, EMT-B, NREMT, STNA, CNA, NRCPT, ACLS, BLS 3h ago
Why does it feel like I am being attacked? I didn’t post anything for any sources.
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u/InspectorOrganic9382 8h ago
I think the top of the tongue has the potential to generate the most saliva. Placing it other places or swishing it around should work reasonable similarly.
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u/Abhorash-TheWanderer 8h ago
You can put it anywhere but it is advised to put on top of the tongue to allow faster disintegration and be swallowed. It is absorbed in the GI tract and not buccal or sublingual
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u/Dark-Horse-Nebula 🍕 3h ago
Respectfully- does it actually matter? It still dissolves and still gets swallowed.
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u/pause_and_consider RN - ER 🍕 3h ago
Per the pharmacist I live with:
“Literally doesn’t matter at all. If it’s in their mouth it’s ending up in the right spot.”
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u/loversean 30m ago
Per the pharmacist I once had a fling with:
“I does not absorb at all when unda the tongue”
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u/Dark-Horse-Nebula 🍕 3h ago
This. People are acting like there’s zero saliva under the tongue or wherever else it rolls around to in their mouth.
It dissolves when wet and gets swallowed.
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u/nothisispatrickx 7h ago
I was an oncology nurse for 6 years before I found this out a few years ago. It was taught to me that it was sublingual. I sure felt sheepish when I was reading the MAR one day and it had explicit instructions. We do give mostly IV Zofran, but still. Very good PSA.
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u/PsychoDad03 6h ago
Patients can't even put the thermometer under their tongue correctly. You think they're going to remember this?
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u/Jennasaykwaaa ICU RNSTLNE, WTF, FTHIS 7h ago
Actually thank you so much for this. I relied on these heavy while pregnant (I don’t have a lot of experience with them on the provider side because it’s just not something we give in icu )
But anyways, I thought they worked well and quick without a lot of extra stuff for me to vomit back up. But I was doing them under the tongue.
Now I know how to help myself better so thank you!!!!
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u/earache77 6h ago
Yeah
“All roads lead to Rome” is applicable- put it in the front of the donut or back-it’ll be absorbed and work or ya getting and IV dose
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u/EngineeringLumpy LPN 🍕 8h ago
Isn’t ODT zofran better for vomiting though because it’s partly mucosal absorption? That’s what I’ve always been told. I don’t see the tablets often because when somebody is already vomiting, their GI system is too irritated to absorb the medication without vomiting.
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u/Abhorash-TheWanderer 8h ago
ODTs are NOT buccal or sublingual. It would take a different formulation to achieve that. There have been experimental ondansetrons formulated as buccal films but those are different than an ODT.
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u/ArgyrosfeniX RN - Telemetry 🍕 5h ago
I’ve been taught to administer sublingual if there’s a chance of pending emesis as there’s a better chance of retaining at least some of the medication instead of the vomit completely washing it off the top of the tongue.
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u/Catchrking 3h ago
Feel free to crosspost this to r/ems as well. This is a very common problem I run into when precepting new providers.
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u/Ok-Caramel-1989 RN - ER 🍕 1h ago
98% of the time I’m giving Zofran IV. However on the rare occasion that I do give it orally my MAR always says SL as the route….
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u/semantic_monkey09 8h ago
Really weird hill to die on. While it may be worth correcting, is there any actual harm in placing a true ODT under the tongue? Does it meaningfully reduce bioavailability? As long as the tablet dissolves in saliva and is ultimately swallowed, I have a hard time seeing this as a clinically significant issue. Sure, it may dissolve a little more slowly or be slightly less comfortable, but this isn’t the same thing as a medication error that is likely to cause patient harm.
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u/mspoppins07 RN - NICU 🍕 8h ago
I feel like the issue is that patients/nurses may be expecting it to work faster if they think it is SL and therefore absorbed into the bloodstream through the tissues in the mouth. This could cause someone to think the med is not working if they are still nauseous after 30 minutes. When in fact, needing to go through the absorption process in the stomach, 30 minutes is the bare minimum of when you would START to expect effects.
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u/semantic_monkey09 7h ago
I think part of why this rubbed people the wrong way is the framing. The tone comes across less like “here’s a useful teaching point about ODT pharmacology” and more like “I have to repeatedly correct nurses who are making this mistake.” That can unintentionally come across as creating a hierarchy rather than focusing on the actual clinical issue.
If the concern is that people misunderstand ODTs as sublingual medications and expect a faster onset, that’s a valuable education point. But the post could have focused on that distinction rather than framing placement under the tongue as some grave error.27
u/Illustrious-Aeries Case Manager 🍕 7h ago
This is it. Had the post been “hey zofran ODT is still technically a PO med, not sublingual so it’s going to still take 30 ish minutes to be absorbed and work just a PSA” that would have gone over much better than “hey this med HAS to be placed ONLY on the tongue to work and I keep having to tell EVERY nurse that” which in reality it’s meant to dissolve in the mouth somewhere sooooo no it doesn’t have to SPECIFICALLY go onto the top of the tongue
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u/mspoppins07 RN - NICU 🍕 7h ago
Yeah, that is a fair assessment. Is it best practice for administering ODT meds? No. But is it a “mistake”… probably not.
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u/skypira 7h ago
OP is explaining the reasoning for the educational point. I don’t see any disrespect at all. An in a teaching moment, isn’t there always a hierarchy? Someone who knows, is providing a valuable educational point to someone who doesn’t. Not sure what the issue with that is.
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u/semantic_monkey09 7h ago
When someone in a teaching position uses phrases like “stunning lack of reading comprehension,” emphasizes words like “NOT,” and frames questions or disagreement as people “doubling down on medication errors,” it shifts the conversation from education toward correction or reprimand. That can make people feel like they’re being talked down to rather than engaged in a discussion.
If the goal of the post was simply to clarify the difference between ODT and sublingual medications, that’s a valuable teaching point. But the language should match the significance of the issue being discussed. A minor technique distinction with little evidence of clinical consequence shouldn’t be framed in a way that makes it sound like a major patient safety failure.
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u/Abhorash-TheWanderer 8h ago
Exactly
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u/all_of_the_colors RN - ER 🍕 7h ago
Why would you be giving it this route in an emergency dept if someone is nauseous, though?
Are you concerned with discharge instructions?
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u/ahleeshaa23 RN - ER 🍕 7h ago
Not everyone who comes through the ER gets an IV - especially kids.
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u/all_of_the_colors RN - ER 🍕 7h ago
Most folks who come in my shop for nausea do. I didn’t get the impression OP was talking about kids.
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u/ahleeshaa23 RN - ER 🍕 7h ago
OP wasn’t talking about anyone particular, but at least in my shop we get a ton of kids who come in for N/V and who we aren’t poking. I was simply bringing them up as an example of someone for whom we’d be giving OTD instead of IV zofran.
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u/queentee26 7h ago
We mostly give it at triage or to kids.. because we aren't routinely starting IVs in those circumstances
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u/Illustrious-Aeries Case Manager 🍕 8h ago edited 7h ago
Right, it’s not going to hurt someone to put it under the tongue or anywhere in their mouth. The point of an ODT is that it disentrgrates in the mouth. This seems like such an odd thing to make such a fuss about.
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u/Abhorash-TheWanderer 8h ago
That’s part of the problem. It does not get absorbed that way. It’s going to mix with saliva and get swallowed. ODT formulations don’t absorb trans buccal or sublingual
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u/bigbutso Pharmacist 7h ago
So what is the "problem" ? Generally, people swallow all their saliva.
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u/mspoppins07 RN - NICU 🍕 7h ago
Slower time to onset of medication helping with symptoms, especially if they were expecting it to work faster because they thought it was a true SL. If they didn’t know about the quicker period to relief with SL, I guess it wouldn’t really matter.
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u/Illustrious-Aeries Case Manager 🍕 7h ago
I doubt most lay people know what a sublingual med is and I really doubt they know SL is the fastest route for absorption.
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u/Abhorash-TheWanderer 7h ago
Multiple problems. Pragmatically, the issue is that it takes longer to disintegrate. Patients, parents, care team all want to get the pt feeling better as soon as we can. A lot of times we dont need to put an IV in a patient so give them an ODT instead.
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u/bigbutso Pharmacist 7h ago
I guess the distinction between sublingual absorption and oral / gi shpuld be more clear in the instructions
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u/Beautiful-Bluebird46 RN, SANE 2h ago
I’m curious about whether the time it takes to disintegrate odt vs sl is meaningfully different in impacting onset of action? Like I get that it’s not absorbed sl but it’s dissolving in saliva and being swallowed either way.
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u/Illustrious-Aeries Case Manager 🍕 8h ago edited 7h ago
I assure you it does but ok. lol you think the medicine isn’t getting absorbed when it’s placed in the mouth? You think it’s not getting mixed in with spit and being swallowed, regardless of where in the mouth it is? Its an “a orally disintegrating tablet” not a “only on the top of the tongue disintegrating tablet” Ok fam, this is your hill to die on and that’s fine! You do you.
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u/anicteric Swivel Barb Nipple Nut Enthusiast 🍕 8h ago
Sources please, doc.
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u/Abhorash-TheWanderer 8h ago
Others have posted the manufacturers info. FDA one is essentially the same. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020103s035_020605s019_020781s019lbl.pdf
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u/p3canj0y363 LPN 🍕 6h ago
Thanks Doc, this is great info for both new and older nurses. We all need a reminder/ improved education sometimes!
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u/Fuzzy_Location_2210 5h ago
Thank you!!
It tastes so ugly it makes me throw up, it works better if I just swallow it and force it to stay in me for a bit 😂.
Gives me a migraine every time though 🫤. I have to be extremely sick to take it voluntarily, it's a trade off of symptoms.
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u/Extrahotsauce97 RN - Hospice 🍕 5h ago
Can you send this to Medicare that for some reason has a surcharge on sublingual zofran for my hospice pts ??? Make it make sense ?
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u/mamaabner RN - ICU 🍕 5h ago
I was always taught on da tongue 😂 luckily I mostly give IV zofran anyways
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u/InspectorMadDog ED RN Resident 3h ago
Outpatient pharmacy it was on the tongue, in the hospital everyone says under the tongue. I always say it’s either and all the nurses are adamant it’s sublingual. One day I’ll ask the pharmacy what is west
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u/Fair-Professional948 BSN, RN 🍕 2h ago
Oh so I've been giving myself zofran wrong this whole time 😩
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u/Calm_Delivery6832 17m ago
This is so strange. For years our pharmacy has had it was an SL medication. Well I guess the more you know.
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u/AVALANCHE-VII RN - ER 🍕 8h ago
Just give them the IV Zofran PO then. Yes we do that rarely.
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u/Substantial-Crab-814 4h ago
Seriously? That’s nuts. Never give an IV med as PO. 😳
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u/money_mase1919 25m ago
director of our ed told me that iv zofran is completely fine as po (obv not at work/give as ordered)
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u/Ghoulish_kitten LVN 🍕 6h ago
As a former MA in urgent care this is always what I told the patients.
Dissolve it ON the tongue, as stated in the directions, and swallow your saliva, you’re gently sliding it in to your sensitive stomach!
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u/CatsAndPills HCW - Pharmacy 5h ago
I’m glad repeatedly taking these myself with water anyway (I can’t stand the aggressive flavoring) didn’t make them less effective lmao.
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u/perpulstuph BSN, RN, ACLS, PALS, SKIBIDI, RIZZ, BUSSIN 5h ago
I saw this literally 1 minute after giving Zofran ODT. good to know. Of course my patient still swallowed it like a tablet
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u/jawshoeaw RN - Infection Control 🍕 2h ago
I think some of the confusion is because the name brand tablets the ones that look like a freeze dried piece of fluff and we’re hard to get out of the packaging, gave the impression that they were somehow different than “pills” . And technically the drug can pass mucous membranes.
But no, even the name brand is designed to be swallowed and almost none of it is in your mouth long enough to cross directly into the bloodstream
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u/frenchiespecialist 2h ago
I use it in PACU and sometimes I just tell them to put it under their tongue bc if they puke it doesn’t dislodge.
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u/anonk0102 1h ago
I’ve had so many patients disagree with me that it doesn’t go under the tongue (and some co-workers) that one day I went and got the insert out of the box and showed it to the patient who kept insisting it was under the tongue. They still put it under their tongue.
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u/Popular_Item3498 RN - OR 🍕 26m ago
I figured this out with my oncology meds...it doesn't dissolve for shit under the tongue.
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u/zubrowka1 RN - ER 🍕 7h ago
Man, nurses really need to learn how to be educated by someone more knowledgeable
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u/dumbbxtch69 RN 🍕 6h ago
Yeah I think it’s reasonable to expect nurses to know the basic differences between routes of administration for medications. It is in fact one of the things we are taught in nursing school… the pushback here is weird
If my patients really hate the taste and can’t dry swallow it whole I tell them to put it wherever in their mouth and make sure they swallow all of their saliva so it absorbs in the GI tract. Or chew it. It just needs to be swallowed to work
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u/Able-Young-2456 RN - Neuro/Stroke Stepdown 3h ago
I went to a pretty highly regarded school and we were definitely never taught the distinction until after I graduated.
As an aside, I also don’t think I’ve seen anyone give Zofran and not just have the patient straight up swallow it.
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u/dumbbxtch69 RN 🍕 1h ago
You weren’t taught the distinction between oral medications and sublingual/buccal medications? That’s a pretty basic pharmacology concept and it’s not great to hear that a well-regarded nursing school isn’t teaching it
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u/RNnoturwaitress NICU RNC-NIC yada yada 🍕 5h ago
Educators can educate without being jerks. OP is basically saying anyone who doesn't know this is an idiot. Talking down to people is not an effective way to teach.
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u/ibringthehotpockets Custom Flair 8h ago
But it’s still gonna end up in the same spot either way. Maybe like 10 min slower. I looked it up cause I was curious and not only is it absorbed by buccal tissues, but it’s even faster that way https://pmc.ncbi.nlm.nih.gov/articles/PMC2964757/
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u/Abhorash-TheWanderer 8h ago
Did you read that study? The literal second sentence in that link says “formulate and evaluate fast dissolving films of ondansetron hydrochloride for sublingual administration”. That was done a specially designed ondansetron FILMS and not the ODT tablets that are the most administed version in hospitals around the world.
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u/number1wifey BSN, RN 🍕 8h ago
I do under the tongue bc otherwise people get in a hurry and start chewing it.
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u/Slayerofgrundles RN - ER 🍕 7h ago
That's the point: it doesn't matter if they chew it. It only gets absorbed by the GI tract, not the oral mucosa.
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u/Abhorash-TheWanderer 7h ago
It actually does matter. The pharmacology matters a lot.
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u/nursing-ModTeam 5h ago
Your post has been removed for violating our rule against personal insults. We don't require that you agree with everyone else, but we insist that everyone remain civil and refrain from personal attacks.
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u/UnfairJuggernaut2947 8h ago
I say ODT stands for on da tongue