The invention discloses a water-insoluble medicine sustained-release pellet, a sustained-release orally disintegrating tablet thereof and a preparation method thereof. The water-insoluble medicine sustained-release pellet comprises a hollow pellet core, a medicine layer, an insulation layer and a sustained-release layer, wherein the sustained-release layer comprises the following ingredients: 54 to 88 percent of sustained-release materials, 2 to 30 percent of antitackiness agents and 1 to 30 percent of pore-foaming agents, wherein the percentage is the mass percentage in the sustained-release layer, wherein the sustained-release materials are one kind or several kinds of materials selected from ethyl acrylate and methyl methacrylate copolymers, polyvinyl acetate and ethyl cellulose. Through regulating the coating combinations and filling auxiliary materials to be pressed into orally disintegrating tablets, the medicine can be slowly released for more than 8 to 13 hours, so the stable blood medicine concentration can be maintained, the side effect is reduced, the medicine taking times can be reduced, and the medicine taking is convenient. The invention conforms to zero-grade release, has the advantages of high final accumulated medicine release amount, high efficacy, strong selectivity, good mouth feeling, simple production steps and high efficiency, and can be applied to large-scale production.