Geriatric Department, Shmuel Harofeh Medical Center, Beer-Yaacov, Israel.
Ther Drug Monit. 2010 Apr;32(2):185-8. doi: 10.1097/FTD.0b013e3181d3fa3e.
Many medications administered to frail geriatric patients are not in a liquid form, but are crushed and dissolved in water before their administration through a nasogastric tube (NGT). Some medications are enteric coated and others are extended release. Only sparse information is available on their pharmacokinetics when administered through NGT. The aim of our study was to evaluate the pharmacokinetics of phenytoin administered through an NGT and to compare these with the pharmacokinetics of a group of patients receiving the drug orally. Twenty patients were studied in a stable clinical condition, from the long-term care ward of the Geriatric Medical Center Shmuel Harofeh. They were consistently treated with phenytoin for the prevention of seizure disorders. Patients in group 1 (n = 12) had oropharyngeal dysphagia and received feeding and medications by NGT. Group 2 (n = 8), included age-matched orally fed patients from the same department, who received phenytoin orally. Blood samples for phenytoin concentration were taken at baseline, time 0, and at 1, 3, 4, 6, and 8 hours postdrug administration; phenytoin was measured using the AxSYM assay. The mean daily dose was not statistically different between the 2 groups: 291 +/- 28 (200-300) mg/d and 300 +/- 53 (200-400) mg/d, in the NGT, and the orally fed group, respectively, in one dose. Pharmacokinetic parameters of phenytoin were not significantly different between the 2 groups; trough concentrations, 1.9 +/- 1.7 (0.5-4.9) versus 2.2 +/- 1.8 (1.0-6.5) microg/mL; Cmax, 6.6 +/- 3.4 (2.5-9.1) versus 7.3 +/- 6.7 (2.7-8.4) microg/mL; tmax, 5.1 +/- 3.1 (3.1-8.2) versus 4.6 +/- 2.7 (2.3-8.4) hours; area under the curve, 52.2 +/- 40.1 (41.1-61.2) versus 62.3 +/- 84.7 (30.2-77.2) microg/h/mL, in the NGT fed versus the oral fed, respectively. Phenytoin pharmacokinetic parameters are not significantly different between patients receiving the drug through NGT as compared with those who received it orally, but the implication of the low concentrations measured should be evaluated carefully.
许多给予体弱老年患者的药物不是液体形式，而是在通过鼻胃管（NGT）给药之前被粉碎并溶解在水中。有些药物是肠溶包衣的，有些是缓释的。当通过 NGT 给药时，关于它们的药代动力学仅有少量信息可用。我们的研究目的是评估通过 NGT 给予苯妥英的药代动力学，并将其与一组接受该药物口服的患者的药代动力学进行比较。20 名患者在 Shmuel Harofeh 老年医学中心长期护理病房处于稳定的临床状态下进行了研究。他们一直服用苯妥英预防癫痫发作。第 1 组（n = 12）患者有口咽吞咽困难，通过 NGT 进行喂养和药物治疗。第 2 组（n = 8）包括来自同一部门的年龄匹配的口服喂养患者，他们口服给予苯妥英。给药后 0 小时和 1、3、4、6 和 8 小时取血样以测量苯妥英浓度；使用 AxSYM 测定法测量苯妥英。两组之间的平均日剂量无统计学差异：NGT 组和口服组分别为 291 ± 28（200-300）mg/d 和 300 ± 53（200-400）mg/d。苯妥英的药代动力学参数在两组之间无显著差异；谷浓度分别为 1.9 ± 1.7（0.5-4.9）μg/mL 与 2.2 ± 1.8（1.0-6.5）μg/mL；Cmax 分别为 6.6 ± 3.4（2.5-9.1）μg/mL 与 7.3 ± 6.7（2.7-8.4）μg/mL；tmax 分别为 5.1 ± 3.1（3.1-8.2）h 与 4.6 ± 2.7（2.3-8.4）h；AUC 分别为 52.2 ± 40.1（41.1-61.2）μg/h/mL 与 62.3 ± 84.7（30.2-77.2）μg/h/mL。与口服组相比，通过 NGT 给予药物的患者的苯妥英药代动力学参数没有显著差异，但应仔细评估所测低浓度的意义。
