Esomeprazole administered through a nasogastric tube provides bioavailability similar to oral dosing

Abstract

Summary Aim : To determine if nasogastric tube administration of the enteric‐coated pellets from an opened esomeprazole capsule provides bioavailability similar to oral dosing with the intact capsule. Methods : A randomized, single‐centre, open‐label, two‐period crossover pharmacokinetic study consisting of two 5‐day dosing periods separated by a 7‐ to 14‐day washout period was conducted. Healthy subjects between the ages of 18 and 50 years received esomeprazole 40 mg once daily either orally as an intact capsule, or as a suspension of the enteric‐coated pellets from an opened capsule in water through a nasogastric tube. Results : In 47 evaluable subjects, the 90% confidence intervals were 0.87–1.08 and 0.93–1.25 for the geometric mean of the ratio of nasogastric tube administration relative to administration of the intact capsule for the area under the plasma concentration–time curve and for maximum plasma concentration, respectively, on day 1, demonstrating bioequivalence. Oral and nasogastric administration also demonstrated similar bioavailabilities on day 5. Esomeprazole was well tolerated regardless of the mode of administration. Conclusions : Nasogastric tube administration of the enteric‐coated pellets from an opened esomeprazole 40 mg capsule provides bioavailability similar to oral dosing. Administration of the contents of an opened esomeprazole 40 mg capsule in water through a nasogastric tube is a practical alternative for patients with feeding tubes who require effective gastric acid suppression, but cannot swallow an oral preparation.

Therapeutic concerns when oral medications are administered nasogastrically

“…NGT administration of the enteric-coated pellets from an opened esomeprazole 40-mg capsule assures complete delivery of drug in that the values of the area under the curve (AUC) and C max were similar to those after oral dosing with the intact capsule. 18 Hence, NGT administration of esomeprazole is a reasonable alternative to intravenous administration of proton pump inhibitors (PPIs) for patients with functional gastrointestinal tracts. 21 Errors contributing to the patient's death occurred at multiple levels.…”

The bioavailability of bromazepam, omeprazole and paracetamol given by nasogastric feeding tube

“…The problem was more difficult for omeprazole, and various methods of administration were examined. Because our hospital uses Freka 8Fr tubes, the 30-s instillation technique described by Sostek et al [40] using 16Fr tubes could not be applied. Omeprazole was therefore instilled over a 2-min interval.…”

Delivery of esomeprazole magnesium through nasogastric and gastrostomy tubes using an oral liquid vehicle as a suspending agent in vitro

“…4,5,9 The one group (water through a size 8 French tube) that had less than 99% delivery was predicated on one tube run that had an exceptionally high retention rate. When that run was excluded, the group yielded greater than 99% delivery.…”