What is a translingual route? (+1 facts)

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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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


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


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


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


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