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A Novel Method Comparing Multidose Delivery of Proton Pump Inhibitors (PPI's) Via Enteral Feeding Tubes

An In Vitro Study

42

Lufadeju, Adedamola, M.D.; Tajong, Nelson, M.D.; Katz, Philip O., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S36–S37
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Free

Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, PA.

Purpose: When patients needing PPIs are unable to take oral medications, capsules that contain enteric-coated granules can be administered via enteral tubes after mixing with water. There are no studies assessing delivery via tubes for more than a single “infusion” and no head to head comparison of PPI's.

Aim: This study compared esomeprazole (eso) and lansoprazole (lanso) via same tube for five days for (1) ease of administration via various feeding tubes, (2) percentage of drug successfully delivered, and (3) effect of daily administrations on granular delivery.

Methods: Lanso and eso granules weighed on filter paper before each daily administration through three tubes; Dobbhoff (DHT), nasogastric (NGT) and PEG. Granules were placed in 60 cc syringes, with 50 ml of water added. Drugs were each given by single pushed flush by nurse blinded to drug once daily for five days. The same tube was used for all five days. Effluent from tubes collected, the supernatant decanted and the precipitate dried for 24 hrs @ 60 C. Percent delivered from each tube calculated daily from the pre and post delivery granule weight.

Results: No difference in PPIs delivered via PEG. Eso delivered median 85% over 5 days via NGT compared to 53% for lanso. For DHT, eso delivered 78% and lanso 73% over 5 days. Delivery of both drugs diminished from baseline at day 5 with all tubes.

Conclusions: 1. We describe an easy/novel method for assessing PPI delivery via feeding tubes. 2. Delivery of PPIs via tube depends on both granule and tube size. 3. PEG tubes will likely eliminate any potential difference in drug delivery among PPIs. 4. Diminished efficacy of drug delivery over time may have clinical implications. No funding was obtained for this study.

© The American College of Gastroenterology 2005. All Rights Reserved.