Pharmacy & Therapeutics - March 2009 - (Page 145) PPIs in Enteral Nutrition Table 2 Nasogastric Administration of Proton Pump Inhibitors (PPIs) as Suggested by Manufacturers PPI Esomeprazole Instructions Delayed-release capsules 1. Empty intact granules into a 60-mL catheter-tipped syringe. 2. Mix with 50 mL of water. 3. Replace plunger; vigorously shake for 15 seconds. 4. Check for granules in the syringe tip; if none, attach syringe and administer contents. 5. Flush tube with water. 6. Do not administer if granules have dissolved or have disintegrated. 7. Administer immediately after preparation. Delayed-release oral suspension 1. Add 15 mL of water to a catheter-tipped syringe. 2. Empty contents of packet into syringe (10, 20, or 40 mg). 3. Shake syringe; allow 2–3 minutes for suspension to thicken. 4. Shake syringe again and administer. 5. Draw 15 mL of water into syringe; shake and flush tube. 6. Administer in a French size 8 tube or larger. 7. Administer within 30 minutes of preparation. 1. Place tablet in syringe; draw up correct amount of water (15 mg = 4 mL; 30 mg = 10 mL) 2. Gently shake. 3. Administer via tube within 15 minutes. 4. Refill syringe with 5 mL of water; flush tube. Lansoprazole Solu-Tab Omeprazole delayed-release 1. Add appropriate amount of water to a catheter-tipped syringe; add contents of packet oral suspension packets (2.5 mg = 5 mL; 10 mg = 15 mL). 2. Shake syringe; allow 2–3 minutes for suspension to thicken. 3. Shake syringe again; administer contents. 4. Refill syringe with an equal amount of water to flush tube. 5. Administer in a French size 6 tube or larger. 6. Administer within 30 minutes of preparation. Omeprazole and sodium bicarbonate powder for suspension Pantoprazole delayed-release oral suspension packets 1. Constitute suspension in 20 mL of water. 2. Stir well. 3. Using a syringe, administer immediately. 4. Flush tube with 20 mL of water. 1. Remove plunger from 60-mL catheter-tipped syringe; attach syringe to tube. 2. Empty packet contents into syringe. 3. Add 10 mL of apple juice. 4. Gently shake syringe to empty contents into tube. 5. Flush syringe and tubing with 10 mL of apple juice. 6. Repeat flush at least two additional times or until no granules remain in syringe. 7. Administer in a French size 16 tube or larger. 8. Hold tubing upright during administration to prevent bending of tube. No information available. Rabeprazole Data from package inserts for Nexium,5 Prevacid,6 Prilosec,7 Zegerid,8 Protonix,9 and Aciphex.10 the first omeprazole dose (78 ± 25%).14 Nine patients (50%), were classified as late or nonresponders; these patients maintained a goal pH of only 43 ± 19% and 20 ± 25% of the time during the 12 hours after the first omeprazole dose. In addition to the disadvantage of an open-label study with a small number of participants, the authors stated other limitations that might have resulted in such a high failure rate. Differences in patient populations, premature activation of omeprazole, and a lack of pharmacokinetic evaluations further limited this study. Olsen et al.15 Conversely, omeprazole has been quite effective in pediatric transplant patients. Omeprazole suspension was given via nasogastric tube in 11 postoperative patients who had undergone liver or intestinal transplantation (or both). Evaluated outcomes included changes in pH, time spent at a pH above 4, and pharmacokinetic and pharmacodynamic parameters. Patients received omeprazole 0.5 mg/kg twice daily, for a maximum of 20 mg. Continuous pH monitoring indicated that the baseline pH was 1.0 ± 0.8. After omeprazole was administered, the mean text continued on page 148 Vol. 34 No. 3 • March 2009 • P&T® 145
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