[Downloaded free from http://www.jmnn.org on Friday, July 28, 2023, IP: 66.96.243.
3]
Editorial
Way to bone health may be just under the tongue!
Sublingual vitamin D
Ranabir Salam, Manash P. Baruah1, Bharti Kalra2
Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, 1Consultant Endocrinologist, Excel Center, Guwahati, Assam,
2
Bharti Hospital and Karnal, Haryana, India
The first evidence of drug absorption via the buccal
mucosa was noted over 100 years ago. Subsequently,
in 1879, sublingual administration of nitroglycerin was
reported to successfully alleviate the symptoms of classic
angina pectoris. Since then, oral mucosal drug delivery
has drawn more and more attention because of its
potential advantages over other routes of delivery. The
concept of an aerosol originated as early as 1790, when
self‑pressurized carbonated beverages were introduced
in France. Oral spray releases medicament rapidly in
the form of micro‑sized droplets in intraoral cavity to be
absorbed by buccal mucosa, a direct and rapid dispersion
of a solution of the active agent over as large a portion
as possible of the oral mucosa, which absorbs the active
agent.
For oral delivery through the gastrointestinal (GI)
tract, the drug undergoes a rather hostile environment
before absorption. This includes a drastic change in
GI pH (from pH 1-2 in the stomach to 7-7.4 in the
distal intestine), unpredictable GI transit, the presence
of numerous digestive enzymes, and intestinal flora.
In contrast to this harsh environment of GI tract,
the oral cavity offers relatively consistent and friendly
physiological conditions for drug delivery which are
maintained by the continuous secretion of saliva.
Most studies of buccal absorption indicate that the
predominant mechanism is passive diffusion across lipid
membranes via either the paracellular or transcellular
pathways.
Access this article online
Quick Response Code:
Website:
www.jmnn.org
DOI:
10.4103/2278-019X.123427
Corresponding Author: Dr. Salam Ranabir, Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur - 795 004, India.
E‑mail: salamranabir@yahoo.co.in
Journal of Medical Nutrition and Nutraceuticals, Vol 3 / Issue 1 / Jan-Jun 2014
In sublingual administration, drug is deposited on the
tongue and drug reaches directly into the blood stream
through ventral surface of the tongue and floor of the
mouth. The drug solutes are rapidly absorbed into the
reticulated vein which lies underneath oral mucosa; and
transported through the facial veins, internal jugular
vein, and brachiocephalic vein and then drained into
systemic circulation. The sublingual route usually
produces a faster onset of action than orally ingested
tablets and the portion absorbed through sublingual
blood vessels bypasses the hepatic first‑pass metabolic
processes. The main mechanism for absorption of the
drug into oral mucosa is via passive diffusion into the
lipoidal membrane. The absorption of the drug through
sublingual route is three to ten times greater than oral
route and is only surpassed by hypodermic injection.
For these formulations, the small volume of saliva is
usually sufficient to result in tablet disintegration in
the oral cavity.
Vitamin D is a secosteroid hormone that is made in the
skin from 7‑dehydrocholesterol upon exposure of the
skin to ultraviolet B (UVB) radiation. This hormone is
important for maintaining the normal bone health and
deficiency causes rickets in children and osteomalacia in
adults. Hypovitaminosis D also causes low bone mineral
density. Several countries across the globe have reported
a high prevalence of Vitamin D deficiency to the tune
of almost 90%. Many countries have started vitamin D
fortification foods or recommend the use of vitamin D
supplements. However, several studies have reported
differences in the bioavailability of vitamin D supplements
in some populations. Decreased bioavailability may be due
to altered absorption of vitamin D from the small intestine
or it may be due to altered metabolism of vitamin D in
the body. Intestinal malabsorption disorders may cause
a decrease in vitamin D absorption due to a decreased
ability to absorb lipids.
1
[Downloaded free from http://www.jmnn.org on Friday, July 28, 2023, IP: 66.96.243.3]

Salam, et al.: Sublingual vitamin D

While sublingual absorption takes vitamin D directly into
the systemic circulation like vitamin D from skin; orally
ingested vitamin D, in contrast, is absorbed into the portal
circulation from the intestines, which takes it to the liver
first before entering into the systemic circulation. The
absorption of vitamin D from the GI tract is incomplete,
and also there is local intestinal degradation and hepatic
metabolism. Oral ingestion is not physiological and
sublingual absorption is physiological. This becomes
even more important in people who have problems
with digestion, take medications that can interfere with
intestinal absorption of vitamin D, and people with
stomach bypass surgery including those with Lap‑band
procedures.
For medical fraternity, the new millennium has started
with wake up calls to eliminate vitamin D deficiency
which is surprisingly much more common than
anticipated. The parentral route has, over the years,
given way to oral administration. But sublingual route
is arguably an acceptable way to eliminate vitamin D
deficiency. However, we will need more evidence from
future studies to see whether it is the superior way to
administer vitamin D compared to the conventional
ones and justify the notion: Way to bone health may be
just under the tongue!
How to cite this article: Salam R, Baruah MP, Kalra B. Way to bone
health may be just under the tongue! Sublingual vitamin D. J Med Nutr
Nutraceut 2014;3:1-2.

“Quick Response Code” link for full text articles

The journal issue has a unique new feature for reaching to the journal’s website without typing a single letter. Each article on its first page has
a “Quick Response Code”. Using any mobile or other hand-held device with camera and GPRS/other internet source, one can reach to the full
text of that particular article on the journal’s website. Start a QR-code reading software (see list of free applications from http://tinyurl.com/
yzlh2tc) and point the camera to the QR-code printed in the journal. It will automatically take you to the HTML full text of that article. One can
also use a desktop or laptop with web camera for similar functionality. See http://tinyurl.com/2bw7fn3 or http://tinyurl.com/3ysr3me for the free
applications.

2 Journal of Medical Nutrition and Nutraceuticals, Vol 3 / Issue 1 / Jan-Jun 2014