Am J Health-Syst Pharm
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American Journal of Health-System Pharmacy, Vol. 63, Issue 19, 1882-1887
Copyright © 2006 by American Society of Health-System Pharmacists
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Practice Reports

Delivery of esomeprazole magnesium through nasogastric and gastrostomy tubes using an oral liquid vehicle as a suspending agent in vitro

Sachin A. Shah, Stephen Sander, Craig I. Coleman and C. Michael White

SACHIN A. SHAH, PHARM.D., is Cardiovascular Pharmacology Fellow, School of Pharmacy, University of Connecticut (UC), Storrs; and Cardiovascular Pharmacology Fellow, Drug Information Center (DIC), Hartford Hospital (HH), Hartford, CT. STEPHEN SANDER, PHARM.D., is Cardiovascular Pharmacology Fellow, School of Pharmacy, UC; and Cardiovascular Pharmacology Fellow, DIC, HH. CRAIG I. COLEMAN, PHARM.D., is Assistant Professor, School of Pharmacy, UC, and Director of Pharmacoeconomics and Outcomes Studies Group, Department of Pharmacy, HH. C. MICHAEL WHITE, PHARM.D., is Associate Professor, School of Pharmacy, UC, and Director of Cardiovascular Pharmacology Research, Department of Pharmacy, HH.

Address correspondence to Dr. White at the Department of Pharmacy, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102-5037 (cmwhite{at}harthosp.org).


Purpose. The optimal delivery medium for esomeprazole magnesium enteric-coated pellets dispersed in various concentrations of Ora-Plus suspension through commonly used nasogastric and gastrostomy tubes using a previously used standardized in vitro protocol was studied.

Methods. The study was conducted in two phases. In phase A, 60 size 14 French nasogastric tubes were used to compare esomeprazole pellet delivery via tap water or 30, 50, or 70% Ora-Plus concentrations (15 tubes for each). In phase B, tap water and the concentration that yielded the best pellet delivery from phase A were used with the narrower size 8 and shorter size 20 French tubes. In both phases, the appropriate volume of water was added. All capsules were assumed to have 1240 pellets. At the end of each administration, pellet retention counts were performed.

Results. The results showed excellent delivery of esomeprazole pellets using water as a medium for tube delivery. When compared with tap water as a delivery medium, no differences in pellet retention were observed when 30% and 50% Ora-Plus were used; thus, these Ora-Plus concentrations are feasible alternatives to tap water for nasogastric tube delivery of esomeprazole pellets.

Conclusion. Administration of esomeprazole magnesium enteric-coated pellets dispersed in tap water or Ora-Plus through size 14 French nasogastric tubes in vitro delivered over 99% of capsule contents, regardless of the Ora-Plus concentration used. For immediate bedside administration, Ora-Plus at 50% concentration is a feasible alternative to water when delivering the pellets through size 14 French tubes, while 30% Ora-Plus is an alternative to water for all tubes studied.

Index terms: Concentration; Drug administration; Esomeprazole magnesium; Gastrointestinal drugs; Ora-Plus; Pellets; Size; Suspending agents; Tubes

 





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