What is a translingual route? (+1 facts)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss the translingual route and its advantages over other route of administration. We will also discuss the dosage form available for the translingual route.
What is a translingual route?
The translingual route refers to the administration of a drug on the surface of the tongue. The translingual route belongs to the class of the transmucosal drug delivery system. It is a preferred route of administration when rapid drug absorption is required.
They are often prepared as spray and mist for direct drug administration on the tongue. The translingual route does not allow the drug to go into the stomach, rather the drug quickly becomes available in the bloodstream to reach the site of action.
The translingual route is different from other transmucosal routes, especially sublingual (under the tongue), and buccal (attached to the buccal mucosa of the cheek). The translingual route is not a preferred route for most of the drugs because of variable bioavailability.
How is a translingual route different from other routes?
The translingual route is different from other routes of drug administration, including solid dosage form (tablets, pills, and capsules), transdermal and parenteral route (intravenous, intramuscular, and subcutaneous).
| Route | Dosage form | Advantages | Disadvantages |
| Transmucosal | Translingual, sublingual, and buccal |
Rapid drug absorption through the tongue and mucosal membrane. Useful for quicker drug availability at the desired site. The first-pass effect is avoided. Can be given to unconscious patients. |
Not suitable for every drug, especially those with are bitter. Variable bioavailability due to saliva and risk of swallowing. |
| Oral, taken by mouth | Tablets, pills, capsules, granules, and pellets |
Suitable for most of the drugs especially with high solubility and high permeability. It is a preferred route of administration for patients who have a phobia of needles. |
Some drugs like insulin get degraded in the stomach. Some drugs like Ibuprofen (a nonsteroidal anti-inflammatory drug) may cause a gastric ulcer. Some drugs like Effexor (antidepressant) may cause stomach pain. Cannot be given to comatose patients. |
| Topical and transdermal route |
Topical creams, ointment, lotion, and lininments. Transdermal patches and microneedles. |
Useful for skin diseases like psoriasis, topical infection, blisters, and lesions. Sometimes transdermal route can be used to give vaccinations and painkillers. |
Not suitable for drugs with high molecular weight (more than 500 Daltons), or with low skin permeability. Skin condition, hydration, and stratum corneum may hinder the drug passage across the skin. |
| Parenteral route | intravenous (IV), intramuscular (IM), and subcutaneous |
Rapid absorption and drug response. IV route is believed to give 100% bioavailability. Can be given to unconscious patients. No first-pass effect. |
The drug cannot be retrieved once administered. Needle phobia. |
What does research suggest?
In recent scientific research, cranial nerves V, nerve VII and associated neuronal projection present in the tongue have been used to correct degenerative neurological diseases using noninvasive translingual neurostimulation.
Translingual neurostimulation has also been studied for gait correction, multiple sclerosis, head injury, stroke and spinal cord injury (2). In one of the studies, 20 patients with multiple sclerosis showed improvement in gait within 14 weeks (3).
Researchers have also used the translingual route for diagnostic purposes. In one of the studies, dogs were administered a translingual venogram to observe the blood flow in the veins (1). Using similar experimental conditions, research was conducted on humans.
A translingual venogram was administered to 18 men to observe venous circulation in the blood. Out of 18 patients, the experiment was successful in 15 men. The method was expected to be safe, easy, and simple (2).
What dosage form is available for a translingual route?
Nitroglycerin translingual sprays are available in the market for angina pain. They are available at 0.4 mg/spray strength. One to two sprays are recommended after every 3-5 minutes until the pain subsides.
Do not use 3 sprays within 15 minutes. They can be used on or under the tongue as prescribed by the doctor. Nitroglycerin translingual spray may cause hypotension, lightheadedness, nervousness, flushing, vomiting, and dry mouth as a side effect.
More adverse effects may include prolonged bleeding time, fainting, unstable angina, low blood platelet count, and hypertension. Do not exceed the dose of nitroglycerin translingual spray. In case of an overdose, consult your doctor immediately.
What are the general considerations for a translingual route?
You should always read the literature (leaflet) provided with dosage forms to understand the proper way of using drugs, especially drugs taken through the translingual route. Some general considerations include:
- Do not rinse your mouth after taking the drug through a translingual route.
- Do not drink or eat anything immediately after taking the drug.
- You should not inhale the spray while applying it on the tongue.
- Count the number of sprays to keep track of the dose.
- Some sprays are meant to be applied under the tongue, rather than on it. But it would still be considered as a translingual route (1).
As a pharmacist, I recommend that you should always keep sublingual tablet of nitroglycerin if you have angina pains. However, the sublingual tablets must be stored at 25°C. As an alternative, you can buy translingual nitroglycerin sprays.
They are esasier to apply and delivers accurate dose of the drug. In case of an emergency, your partner may spray nitroglycerin on your tongue for instant pain relief if you are not able to actuate the spray yourself.
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References
1.-
EASY I. Ins and outs of giving drugs transmucosally. https://journals.lww.com/nursing/citation/2003/03000/ins_and_outs_of_giving_drugs_transmucosally.50.aspx
2.-
Tyler M, Skinner K, Prabhakaran V, Kaczmarek K, Danilov Y. Translingual neurostimulation for the treatment of chronic symptoms due to mild-to-moderate traumatic brain injury. Archives of Rehabilitation Research and Clinical Translation. 2019 Dec 1;1(3-4):100026. https://www.sciencedirect.com/science/article/pii/S259010951930028X#bib32
3.-
Tyler ME, Kaczmarek KA, Rust KL, Subbotin AM, Skinner KL, Danilov YP. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. Journal of neuroengineering and rehabilitation. 2014 Dec;11:1-0. https://link.springer.com/article/10.1186/1743-0003-11-79
4.-
Jennings PB, Matsumoto T, Hardaway RM. Sublingual Venography: Evaluation of a New Method To Study Cervical Venous and Superior Vena Caval Blood Flow: I. Experimental Animal Studies. Angiology. 1968 Jan;19(1):36-47. https://journals.sagepub.com/doi/abs/10.1177/000331976801900104
5.-
Damascelli B. Study of the cervical veins by the translingual route in man. The American Journal of Medicine. 1969 Sep 1;47(3):392-4. https://www.sciencedirect.com/science/article/abs/pii/000293436990223X
