Pharmacy & Therapeutics - March 2009 - (Page 147) PPIs in Enteral Nutrition Table 3 Alternative Methods of Enteral Tube Administration of Proton Pump Inhibitors (PPIs): Recipes and Efficacy continued Study Doan et al. 19 Tube Nasogastric PPI Lansoprazole Recipe 1. Place contents of 30-mg capsule in 10 mL of 8.4% sodium bicarbonate solution. 2. Administer immediately after preparation. 3. Flush tube with 30 mL of water. 1. Empty contents of 30-mg capsule into 60-mL cathetertipped syringe. 2. Draw 40 mL of apple juice into syringe. 3. Gently mix. 4. Administer contents through tube by tilting and gently tapping syringe. 5. Flush tube with 40 mL of apple juice; repeat once. 6. Total volume of apple juice to be used = 120 mL. 1. Insert ¼ of 30-mg capsule contents into syringe. 2. Add water; slowly administer granules. 3. Repeat until all granules are administered. 4. Flush tube with 15 mL of water. 1. Grind 40-mg tablet into fine powder. 2. Transfer powder to glass container. 3. Rinse mortar and pestle with 5 mL of 4.2% sodium bicarbonate solution; repeat once; add obtained suspension to glass container. 4. Mix contents of glass container for 10 minutes until suspension forms. 5. Transfer suspension to polypropylene syringe. 6. Rinse glass container with 5 mL of 4.2% sodium bicarbonate solution; repeat once; add obtained suspension to syringe. 7. Administer contents; flush tube with 20 mL of water. Efficacy Suspension was bioequivalent to capsule; size 8 French tube was used. Efficacy was maintained and produced similar effects as IV pantoprazole; size 16 French tube was used. Freston et al.20 Nasogastric Lansoprazole Tsai et al.22 Nasogastric Lansoprazole Effectively reduced gastric acidity in critically ill patients; size 16 French tube or larger was used. Cmax is comparable to that of tablet; bioavailability of suspension is 25% lower than that of tablet; size 16 French tube used; may prepare suspension 4 hours before administration; protect from light. Ferron et al.23 Nasogastric Pantoprazole Shah et al.28 Nasogastric Esomeprazole Tap water suspension In vitro administration gastrostomy 1. Add 25 mL of tap water to catheter-tipped syringe. resulted in delivery rates 2. Empty contents of 40-mg capsule into syringe. of about 99%. 3. Replace syringe plunger; with syringe tip up, shake gently until all pellets move throughout the syringe (approx. 15 seconds). 4. Leaving 5 mL of air between plunger and contents, administer contents using a side-to-side shaking method if necessary. 5. Add 25 mL of tap water to syringe; shake vigorously for 15 seconds, and flush tube. 30% Ora-Plus Suspension 1. Add 17.5 mL of tap water to catheter-tipped syringe. 2. Empty contents of 40-mg capsule into syringe. 3. Draw 30% Ora-Plus suspension into syringe until 25mL mark is reached. 4. Replace syringe plunger; with the syringe tip up, shake gently until all pellets move throughout syringe (approx. 15 seconds). 5. Leaving 5 mL of air between plunger and contents, administer contents using a side-to-side shaking method if necessary. 6. Add 25 mL of tap water to syringe; shake vigorously for 15 seconds, and flush tube. continued on next page Vol. 34 No. 3 • March 2009 • P&T® 147
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