Kotake T, Takada M, Goto T, Komamura K, Kamakura S, Morishita H
Department of Pharmacy, National Cardiovascular Center, Suita-city, Osaka, and Department of Pharmacy, Nagoya University Hospital, Aichi, Japan.
J Clin Pharm Ther. 2006 Jun;31(3):237-43. doi: 10.1111/j.1365-2710.2006.00730.x.
Hospitalized patients unable to ingest anything by mouth require nutritional support by enteral feeding and administration of drugs through a nasogastric tube inserted into the digestive tract. Nasogastric administration of amiodarone may not always be equivalent to oral administration of amiodarone.
We collected 162 observations of serum amiodarone and desethylamiodarone metabolite concentrations from 93 patients within 60 days of starting treatment with amiodarone. Eight patients were given the drug nasogastrically and 85 patients, orally. The two groups, were compared in terms of their serum concentration/(dose/weight) (C/D) value. A ratio of serum amiodarone concentration to serum desethylamiodarone concentration (AMD/DEA) was calculated for each sample. In addition, the percentage drug recovery after nasogastric administration of amiodarone was analysed.
Significant differences were observed in C/D values of amiodarone and desethylamiodarone and in AMD/DEA values of patients given amiodarone orally when compared with those given the drug nasogastrically. The C/D values of patients who received their medication nasogastrically were approximately 30% of the C/D values of patients who received their medication orally. Approximately 70% of the drug was recovered after it had passed through the nasogastric tube.
To achieve similar concentrations, an approximately 3-fold increase in dosage of amiodarone was required when patients were given the drug nasogastrically rather than orally. This suggests that the absorption of amiodarone following nasogastric administration is poor when compared with oral administration. Therapeutic drug monitoring is necessary to optimize dose particularly during the early stages of amiodarone therapy.
无法经口摄入任何食物的住院患者需要通过肠内喂养和经插入消化道的鼻胃管给药来获得营养支持。鼻胃管给予胺碘酮的效果可能并不总是等同于口服胺碘酮。
我们收集了93例患者在开始使用胺碘酮治疗60天内血清胺碘酮和去乙基胺碘酮代谢物浓度的162份观察数据。8例患者通过鼻胃管给药，85例患者口服给药。比较两组的血清浓度/（剂量/体重）（C/D）值。计算每个样本的血清胺碘酮浓度与血清去乙基胺碘酮浓度之比（AMD/DEA）。此外，分析了胺碘酮鼻胃管给药后的药物回收率。
与鼻胃管给药的患者相比，口服胺碘酮的患者在胺碘酮和去乙基胺碘酮的C/D值以及AMD/DEA值方面存在显著差异。鼻胃管给药患者的C/D值约为口服给药患者C/D值的30%。药物通过鼻胃管后，约70%的药物被回收。
为达到相似的浓度，鼻胃管给药的患者所需胺碘酮剂量比口服给药时大约增加3倍。这表明与口服给药相比，鼻胃管给药后胺碘酮的吸收较差。在胺碘酮治疗的早期阶段尤其需要进行治疗药物监测以优化剂量。
