More recently, there have been many anectodal reports about the use of the sublingual route in B1 therapy. In principle, the sublingual route offers some advantages compared with the oral route, which are similar to those of the intramuscular route. In fact, absorption of medicines developed for the sublingual route is very quick and higher levels are achieved in the bloodstream than the oral route, so that lower doses are needed. This is due to the fact that first-pass metabolism by the liver is avoided as are issues related to the gastrointestinal tract, which are very common in PwP. In these informal self-reports, one formulation containing B1 mononitrate has been used. No clinical studies have been carried out to date on the use of thiamine by the sublingual route.

More recently, another sublingual formulation has become available, containing cocarboxylase. Cocarboxylase is thiamine pyrophosphate (TPP), that is the active form of thiamine. When one takes thiamine orally, this is converted intracellularly into TPP, its active form. According to the manufacturers, cocarboxylse products, although they provide less thiamine (e.g. 16 mg of thiamine from 25 mg of cocarboxylase in some products), would have the advantage of delivering the active form of thiamine as such. There is no clinical experience (RCT) to date about the use, efficacy and safety of sublingual cocarboxylase in PD.

Text author: Sergio Pièche
Page updated - 24/04/23