Lansoprazole: administration of the contents of a capsule dosage formulation through a nasogastric tube

Chun, Alexander; Shi, Harry; Achari, Ramanuj; Dennis, Susana; Cavanaugh, John H.

doi:10.1016/s0149-2918(96)80043-9

Cited by 44 publications

(19 citation statements)

References 6 publications

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“…Apple juice was used as the dilution solvent as it was acidic and did not affect the enteric coating of the granules, compared with water, which tended to soften the granules and causing them to become sticky. 32 Interaction between enteral nutrition and extemporaneously prepared oral suspension. In a study, absorption of phenytoin was impaired when the drug was coadministered with an enteral formula through a NGT.…”

Section: Considerations In Nasogastric Administrationmentioning

confidence: 99%

Therapeutic concerns when oral medications are administered nasogastrically

Zhu

Zhou

2013

J Clin Pharm Ther

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Summary What is known and Objective Administering oral medications to patients with nasogastric tube (NGT) is a challenging patient‐care issue. Inappropriate prescribing behaviour and incorrect procedure for extemporaneous preparation of oral suspensions given via NGT may result in significant harm to patients. There are many drugs which have not been tested regarding oral absorption profile and bioavailability derived from NGT dosing. Although several studies and case‐reports have been reported, there is no up‐to‐date review of drug administration via NGT. The aim of this review is to increase awareness of rational drug administration via NGT and to encourage relevant research in this area. Methods Full prescribing information from each currently available oral medication was reviewed for any data indicating that the medication could not be crushed or opened. Literature was identified by searching PubMed (1988 to Aug 2012). Results and Discussion There is evidence to show that NGT dosing of some medications may bring both benefits (e.g. cost saving) and disadvantages (e.g. decrease in efficacy and/or safety). For medications with package inserts that warn that they should not be crushed or opened, alternatives are usually recommended. However, in some cases, there is evidence to support NGT dosing. Sometimes special procedures are required to avoid problems such as instability, interaction with enteral nutrition, adsorption, tube obstruction and low recovery when preparing extemporaneous oral suspensions. What is new and Conclusion Physicians, pharmacists and nurses should know the procedures for drug administration by NGT, as well as the latest evidence on such administrations. There may not be bioequivalence between oral and nasogastric administrations. Care must be taken to avoid compromising the physicochemical, biopharmaceutical and pharmacological properties of drugs given by NGT to ensure their safety and efficacy.

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Section: Considerations In Nasogastric Administrationmentioning

confidence: 99%

Therapeutic concerns when oral medications are administered nasogastrically

Zhu

Zhou

2013

J Clin Pharm Ther

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“…These agents should not be crushed but rather dissolved in fluid with an alkaline pH and then administered. [22][23][24][25][26][27][28][29] Sucralfate was also cited by LTC nurses (12%); however, in both previous surveys, the most commonly cited medication contributing to EFC obstruction was sucralfate (Oklahoma nurses ϭ 31.3%; critical care nurses ϭ 48.6%). 1,7 Several case reports in the literature describe the formation of a sucralith bezoar (a congealed mass of sucralfate trapped in the stomach) with or without esophageal obstruction when sucralfate is combined with enteral formula within the gastric acidity of the stomach.…”

mentioning

confidence: 92%

A Nationwide Survey of Long‐Term Care Facilities to Determine the Characteristics of Medication Administration through Enteral Feeding Catheters

Seifert

Johnston

2005

Nut in Clin Prac

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Previous data clearly showed profound differences in nursing practices and techniques within the state of Texas regarding the administration of medications through enteral feeding catheters (EFCs) between long-term care (LTC) facilities that predominantly serve a rural vs an urban population. This study aims to determine the incidence and characteristics of medication administration through EFCs in the LTC setting in the United States with particular emphasis on the delineation between practices in facilities that predominantly serve a rural vs an urban population. A 36-item validated survey was mailed to the Directors of Nursing of the 16,400 LTC facilities registered with the U.S. Medicare LTC facility database registry. In all, 1278 (7.8%) surveys were included in this analysis. The majority of nurses responding were RNs (93%), with extensive years of experience (19 years), working in facilities predominantly serving a rural area (58%). There were significant differences between rural and urban facilities with regard to the percent of patients receiving medications through EFCs (6.6% vs 9.0%, p < .0001), number of oral medications/day (8.3 vs 9.4, p = .0003), amount of flush before and after administering medications (64 mL vs 59 mL, p = .0127), those attending a seminar/in-service on medication administration through EFCs (45% vs 56%, p < .0001), and medication obstruction rate (6.4% vs 3.9%, p = .0227). Medication obstruction rate was significantly increased when nurses used 3 or more inappropriate techniques (8.1% vs 4.8%, p = .0171), particularly crushing enteric-coated (8.9% vs 4.6%, p = .0003) and sustained-release dosage forms (8.5% vs 4.7%, p < .0001). Medication obstruction through EFCs is significantly increased when 3 or more inappropriate techniques are utilized. Techniques, complications, and sources of information vary significantly from rural to urban facilities and various parts of the country. A universal set of guidelines to administer medications through EFCs should be adopted and widely disseminated particularly to LTC facilities in rural areas.

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“…similar pharmacokinetic parameters) to the administration of the intact capsule, and produces an equivalent pharmacodynamic response (i.e. degree of acid suppression/increase in intragastric pH) 9–17 . In addition, recent evidence has suggested that the administration of 30 mg of lansoprazole granules as a sodium bicarbonate suspension, or suspended in apple juice, via a nasogastric tube produces significantly greater pharmacodynamic effects (greater mean 24‐h pH values and higher percentages of time pH > 4) than the administration of intravenous pantoprazole, 40 mg, to healthy subjects, 18 , 19 or continuous intravenous ranitidine at a dose of 6.25 mg/h to mechanically ventilated intensive care unit patients 20…”

Section: Introductionmentioning

confidence: 99%

“…degree of acid suppression ⁄ increase in intragastric pH). [9][10][11][12][13][14][15][16][17] In addition, recent evidence has suggested that the administration of 30 mg of lansoprazole granules as a sodium bicarbonate suspension, or suspended in apple juice, via a nasogastric tube produces significantly greater pharmacodynamic effects (greater mean 24-h pH values and higher percentages of time pH > 4) than the administration of intravenous pantoprazole, 40 mg, to healthy subjects, 18,19 or continuous intravenous ranitidine at a dose of 6.25 mg ⁄ h to mechanically ventilated intensive care unit patients. 20 These bio-equivalence and pharmacodynamic studies performed with the oral administration of lansoprazole granules confirm the clinical utility of these dosage formulations.…”

Section: Introductionmentioning

confidence: 99%

Comparative pharmacokinetics and safety of lansoprazole oral capsules and orally disintegrating tablets in healthy subjects

Freston

Chiu

Mulford³

et al. 2003

Aliment Pharmacol Ther

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SUMMARYBackground: Many individuals with acid-related gastrointestinal disorders have difficulty in swallowing oral agents. Aim: To compare the bio-availability of a single dose of lansoprazole orally disintegrating tablet with that of an intact capsule. Methods: One hundred and twenty healthy subjects participated in two prospective, Phase I, open-label, two-period cross-over studies to receive lansoprazole, 15 mg or 30 mg. Within each study, subjects were randomized into two parallel cohorts consisting of 30 subjects per regimen, dispensed in opposing sequence over two periods separated by a 7-day washout period.

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Lansoprazole: administration of the contents of a capsule dosage formulation through a nasogastric tube

Cited by 44 publications

References 6 publications

Therapeutic concerns when oral medications are administered nasogastrically

Therapeutic concerns when oral medications are administered nasogastrically

A Nationwide Survey of Long‐Term Care Facilities to Determine the Characteristics of Medication Administration through Enteral Feeding Catheters

Comparative pharmacokinetics and safety of lansoprazole oral capsules and orally disintegrating tablets in healthy subjects

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