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Far from being a new-age invention, the humble troche been around since at least 1000 BC when the ancient Egyptians made a type of lozenge from honey, herbs and spices to treat a sore throat. Now-days troches are used as a medicine delivery vehicle in the treatment of a range of conditions from menopause to thyroid disease. In recent years troche’s have garnered renewed interest thanks to the unique way they directly administer medicine to where it’s needed.
What exactly is a troche?
A troche is a small, hard tablet designed to dissolve slowly over 30 minutes or so when placed under the tongue, much like a long-lasting cough drop. Just like a standard pill it contains active medicinal ingredients. However the key difference between a troche and a standard pill is the way they’re processed by the body.
Medicines introduced into the body via a troche largely bypass the digestive system and instead deliver their active ingredients directly into the blood stream. Standard pills on the other hand head straight to the gut where they’re metabolised by digestive acids before heading to the liver where they’re processed further.
Medicinal troches enter the blood stream thanks to the numerous blood vessels located very close to the surface of the skin in the tissue directly under the tongue and in the walls of the cheek. The only other places on the body where the blood vessels are this close to the surface of the skin is the vagina and the rectum – however it’s not hard to figure out that troches under the tongue are much easier to administer!
It’s also not hard to figure out that not all of a troche’s active medicinal ingredients go directly into the blood stream. Some of it is swallowed as saliva and then enters the digestive system via the gut. Some report that the amount swallowed is as high as 50%, while others believe it is much lower. Whatever the correct percentage we know that at least half the medicine enters the blood stream which is still a significant amount.
Why choose a troche over a pill?
Medicines in the form of a swallowed pill head straight to the gut where they’re processed by digestive acids. In most cases this is fine, however some medications, in particular some hormones used in bioidentical hormone replacement therapy (BHRT), do not maintain their efficacy when they come into contact with digestive acids. The stomach is not the natural home of hormones – they belong in the circulatory system. This is why some medical practitioners specialising in BHRT prefer troches.
Some believe that troches are also kinder on the liver. Everything that goes into the gut ends up being processed by the liver and some medicines are harsh on this hard-working organ. This makes troches a more liver-friendly option for those with liver conditions. It should be pointed out that even medicines absorbed into the blood stream still end up in the liver however by the time this happens they have undergone more thorough processing than that conducted by the digestive system.
People who have irritable bowel syndrome often have sensitive guts that can be adversely affected by some harsh medicines. Troches may help in these cases by reducing the amount of medicine entering the digestive system.
Elderly people who have difficulty swallowing also benefit from having their medication administered via a troche rather than numerous pills.
Almost any kind of medication that comes in a pill can also be made up as a troche by a fully licensed and accredited compounding pharmacy like National Custom Compounding. For more information call us on 1300 731 755 or click here to contact us.
Video Transcript
Obviously capsules have been around for a long time and you might be familiar with them getting things like antibiotics from your doctor through a normal pharmacy. They’re often in a tablet or a capsule shape. So a capsule is basically a hard outer case containing the powders inside. It’s made in machines. We have small machines here that compound capsules. The powder goes inside, it’s compressed, the lid’s closed, so it’s clicked nice and tight. This is quite different from a troche. So a troche is actually a solid dosage form, more like a tablet, but it contains a bit of a waxy base. Now the waxy base means you can swallow it whole like a tablet, or you can actually dissolve it in what we call the buccal cavity. So that’s between the teeth and the gum. And the cool thing about that is when you dissolve a product that way, it actually gets absorbed in the body slightly differently to what a tablet would. A tablet or a capsule goes into your stomach. It’s broken down and absorbed in the upper intestine. However, if you take a troche in some situations like hormone replacement therapy, it actually absorbs between your cheek and gum. That means it gets into your body differently to those other ones I just spoke about. And it can generally with certain types of ingredients or drugs can work more effectively. So it’s one of those, um, really good opportunities that compounding pharmacies have to provide a medicine in a different dosage form. Obviously, the suitability of the the capsule or the troche is something that compounding pharmacists spend a lot of time becoming knowledgeable and experienced on. And then we work really closely with your doctor to make sure that the best dosage form is chosen to make the product that will work best for you. Keep in mind that the different absorption will mean different effects. So it’s one of those things we do have to work through takes a little bit more time than your regular pharmacy, but at the end of the day, if there are any cost differences, the benefit of having a product that works and works well can often outweigh any slight costs. So if you’ve got any dosage form questions, feel free to call our team. But we can certainly help customise a product for you.