Pharmacy & Therapeutics - March 2009 - (Page 146) PPIs in Enteral Nutrition Table 3 Alternative Methods of Enteral Tube Administration of Proton Pump Inhibitors (PPIs): Recipes and Efficacy Study Larson et al.11 Phillips et al.12 Tube Nasogastric PPI Omeprazole Recipe 1. Remove granules from capsule; place in small cup. 2. Flush 6–10 granules at a time with 10–20 mL of water. 1. Remove granules from capsule; place in empty 10-mL syringe with plunger removed. 2. Replace plunger; draw 8.4% sodium bicarbonate solution into syringe (10 mL for 20 mg; 20 mL for 40 mg) 3. Allow about 30 minutes for granules to dissolve; agitation is helpful. 4. Shake before use; do not administer with acidic substances. 10 mg of omeprazole in 10 mL of water used. Efficacy No differences in reduction of acid output compared with capsule. Reduced bleeding associated with stress-related mucosal damage; effective in raising baseline pH. Nasogastric Omeprazole Tuleu et al.13 Nasogastric Omeprazole Case report of critically ill pediatric patient; degradation product found in stomach aspirate. 50% of critically ill pediatric patients experienced late or no response. Effectively raised and maintained baseline pH; Cmax and AUC greater after multiple dosing intervals. Effectively raised and maintained baseline pH. In vitro administration resulted in variable delivery rates; dispersion vehicle or volume did not affect delivery rates; size 14 French tube was used. Haizlip et al.14 Nasogastric Omeprazole See recipe by Phillips et al.31 Olsen et al.15 Nasogastric Omeprazole 1. Add granules of a 20-mg capsule to 10 mL of 8.4% sodium bicarbonate solution. 2. Allow 15–30 minutes for granules to dissolve; gently agitate. 3. Administer via tube; flush with water; clamp tubing for 30–60 minutes. An 8.4% sodium bicarbonate solution was used. 1. Remove granules from capsule; place in small cup. 2. Mix with 30 mL of tap water, 15 mL of tap water, or 15 mL of apple juice. 3. Attach 60-mL catheter-tipped syringe with plunger removed to tube. 4. Flush tube with water (10 or 15 mL) or apple juice (15 mL). 5. Place dispersion into syringe; replace plunger (maintain 5 mL of air between plunger and dispersion). 6. Administer dispersion over 10–15 seconds. 7. Remove plunger. 8. Rinse cup with 10 or 15 mL of liquid; administer remaining granules. 9. Flush tube with 10 or 15 mL of liquid. 1. Empty contents of a 30-mg capsule into 60-mL catheter-tipped syringe with plunger removed. 2. Add apple juice to syringe; replace plunger. 3. Remove all air from syringe; draw apple juice into syringe to make 40 mL. 4. Gently shake syringe. 5. Administer contents over 3–5 minutes. 6. Flush tube with 40 mL of apple juice; repeat once. 7. Total volume of apple juice to be used = 120 mL. Kaufman et al.16 Dunn et al.17 Nasogastric Nasogastric Omeprazole Omeprazole Lansoprazole Chun et al.18 Nasogastric Lansoprazole No differences in pharmacokinetic parameters when compared with capsule; size 16 French tube was used. 146 P&T® • March 2009 • Vol. 34 No. 3
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