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What Is a Troche?

A troche is a lozenge that delivers medicine directly to the mucus membranes of the mouth when it dissolves between the tongue and gums.
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  • Written By: Mary McMahon
  • Edited By: Kristen Osborne
  • Last Modified Date: 24 September 2014
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A troche is a lozenge designed to deliver medications directly to the mucus membranes of the mouth by dissolving slowly when placed between the tongue and gums. A number of medications, including over-the-counter drugs, can be delivered this way. While placed in the mouth, these lozenges are not designed to be swallowed. They may be flavored to make taking the medication more pleasant.

The term for this form of medication delivery is derived from the Greek word for “wheel,” and troches are traditionally round in shape. The size of the medication can vary, depending on what is being delivered. This form of delivery is used when medications cannot be ingested because the digestive juices will damage or compromise the medication. An alternative might be a medication rubbed on the mucus membranes of the mouth, or a transdermal patch applied to the skin.

As the troche breaks down, the drug seeps through the porous mucus membranes in the mouth and rapidly enters the bloodstream. This allows for extremely rapid delivery of medications, which can be useful with medications like analgesic drugs. The blood levels of the drug will rise rapidly and then stabilize. Depending on the medication, doses can be repeated at varying levels to keep the level as stable as possible.

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Several medications come packaged in this format and can be ordered this way by request. In other cases, a compounding pharmacy may need to make up the medication by order. Not all pharmacies offer this service, and patients with unique prescription needs may want to call around to find one that will meet their needs. There may also be a longer lead time when it comes to filling prescriptions that need to be compounded, something people should consider when submitting prescriptions to be filled.

When taking a troche, patients are generally advised to tuck the medication under the tongue or between the cheek and gums to allow it to dissolve slowly. It is important to avoid chewing the lozenge and to wait to eat or drink until it has completely dissolved, to keep the medication out of the digestive tract. Since timing doses carefully is often needed to keep levels of medication in the blood stable, patients should set up a schedule that will be easy to adhere to in order to avoid missing doses or taking them late.

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anon270261
Post 10

A troche is a specific form of drug delivery. The exact placement of the troche (sometimes referred to as a lozenge) is critical. We use troches for their rapid delivery, high blood concentrations, and to avoid what is called first pass metabolism by the liver.

Some of the antifungals are dissolved on the tongue to treat "thrush," a form of oral yeast infection. Typically a troche is best absorbed, and therefore the patient will receive the most benefit, by placing the troche between the inner part of the cheek and the gum, not always between the tongue and the gum. It is not the same as an oral disintegrating tablet.

It is important to discuss your medications with your pharmacist in order to achieve optimal outcomes from your medications. Pharmacist are easy to access and are the drug experts in both pharmcotherapy (treatment) and pharmaceutics (delivery). If a patient has been diagnosed by a licensed professional (pharmacists are not diagnosticians) then the pharmacist will more often than not, be able to assist in tailoring a specific therapy and delivery vehicle for the patient by working with the provider.

Use your pharmacist to maximize the benefits from your drug therapy.

I am a pharmacist and like most RPh's…we thrive on helping patients with their drug therapies. Please use us as a resource; generally, the information we provide is free of charge anyway. Our drug information is some of the most respected among the health professions.

myharley
Post 9

My daughter had to take Mycelex to also clear up an infection. She doesn't like to swallow pills, so I thought this would be a better alternative for her.

It ended up being just as much of a hassle as trying to get pills down her. She wanted to chew the lozenge and swallow it down right away.

It was hard for her to be patient and let it slowly dissolve in her mouth. I know there is no way she would have been able to do this if they hadn't added some flavoring for her.

LisaLou
Post 8

When I had an oral yeast infection I was given a prescription for the Clotrimazole lozenges. I had this filled at a compounding pharmacy. I had heard of them before, but this was the first time I used one.

Fortunately there was one of these pharmacies in my town, so I didn't have to drive far to find one. They are becoming more popular and I like the fact they can compound these medications for you. One of my friends uses a compounding pharmacy for medications to help keep her hormones balanced.

I didn't really mind taking the lozenges. I would just put one in my mouth before sitting down to watch a TV show and let it dissolve. At least this way I wasn't as tempted to snack on something.

bagley79
Post 7

I had to take Nystatin lozenges for a fungal infection. Before this, I had never heard of a troche before. This was also the first time I had to take a prescribed medication as a lozenge.

I thought I would be able to handle the taste OK, but I had to get them flavored in order to get them down properly.

These lozenges are supposed to completely dissolve in your mouth, and sometimes it can take up to 20 minutes for that to happen.

It is not nearly as convenient as swallowing a pill or capsule, but this was the best way to treat my infection.

I made sure and took all of it so the infection wouldn't come back. I really hope I don't have to take something like that again.

wavy58
Post 6

My aunt is battling breast cancer right now, and she takes a fentanyl troche to deal with excessive pain. This is a type of analgesic, and she only uses it when the pain becomes too great for her regular pain pills to handle.

Normally, the painkiller she takes on a regular basis keeps her going. Sometimes, though, cancer patients will experience what is called “breakthrough pain.” It is so strong that even the pills could not keep it away, and this is what the troche is used to treat.

Her doctor told her that she shouldn't worry about becoming addicted to the troche medication, since she is using it for actual intense physical pain. He promised to wean her off of it and the pills when her pain finally begins to decrease, so she can return to a normal life without withdrawal symptoms.

kylee07drg
Post 5

@lighth0se33 – Nystatin is another antifungal medicine available as a troche. This is what I started taking after I experienced an allergic reaction to tioconazole.

Since clotrimazole is related to the drug that I was allergic to, my doctor thought it best to try something totally different. Nystatin was just as good as the “azole” family at treating yeast infections, but I could tolerate it without any bad side effects.

The new troche worked the same as the old one. I had to take one every few hours, but I didn't mind, because they were flavored to disguise the taste. I was relieved to find something that worked.

Oceana
Post 4

I have heard that there is a troche that can help you get the feeling back in your mouth after you have had it numbed for dental work. I think this is a great idea.

As a child, I had to have a lot of cavities filled and teeth pulled. I hated the numbness in my mouth, because it lasted for hours afterward. I couldn't eat or drink until it was gone, and it was the most annoying thing in the world to me.

I would have loved to have such a troche back then. I haven't needed any dental work lately, but if I ever do, I will ask my dentist about this type of troche. I don't want to deal with a numb face any longer than necessary.

lighth0se33
Post 3

Clotrimazole is another medication available in troche form. My sister had to take clotrimazole troches when she got an oral yeast infection.

Clotrimazole is an antifungal medicine, and since the infection was in her mouth, delivery through a troche was ideal. It could work directly on the source of the problem, rather than having to go through her bloodstream.

She said it took about half an hour for a troche to dissolve in her mouth. The medicine was supposed to last for three hours, and after that, she would take another one.

I had never heard of a troche before she got this infection. It seems like a great idea for treating infections of the mouth, especially.

everetra
Post 2

@nony - I suppose B12 as an oral medicine would be okay. Most of the troches I believe are used for medicinal purposes as the article points out. One of the most common is a Mycelex troche.

This is medication that treats infections in your mouth and throat, and so I think the troche method of delivery is ideal. It targets fungi in your oral cavities and goes to destroying them on contact.

This makes more sense in my opinion than simply swallowing a tablet and waiting for the medicine to enter your body and attack the fungus that way. Either way will work but I prefer the instant contact method.

nony
Post 1

I heard that if you take a B12 vitamin supplement that this is the way to go. A B12 troche will deliver a stronger burst of energy to your bloodstream than simply swallowing some tablets.

I think the next closest thing is a B12 injection but for that you have to go the doctor of course and I don’t need my B12 that badly. I need it first thing in the morning so that it delivers an instant release into my system, and hopefully it will last all throughout the day.

That way I can dispense with the coffee or the energy drinks. B12 is better for you anyway.

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