Mount Sinai Hospital, New York, NY, USA.
J Clin Pharm Ther. 2021 Apr;46(2):369-372. doi: 10.1111/jcpt.13290. Epub 2020 Oct 10.
Sevelamer is an insoluble polymer indicated for the management of hyperphosphatemia in patients with chronic kidney disease (CKD). The package inserts for both tablet formulations recommend the tablets be administered whole. Due to whole tablets being sometimes inadvertently crushed and the significantly increased cost of sevelamer packets, we evaluated the safety and feasibility of crushed sevelamer tablets for enteral feeding tube administration.
A single-centre retrospective chart review was performed. All adult ICU patients prescribed sevelamer carbonate between 1 January 2015 and 31 July 2019 were included if they received at least one dose of a sevelamer tablet or packet, whereas they had an enteral feeding tube in place. The primary outcome was the incidence of an obstructed enteral feeding tube or need for replacement, as defined as the number of occurrences over the total numbers of doses administered. The secondary outcome was the change in phosphorus levels from time of sevelamer initiation to discontinuation or patient discharge.
A total of 14 obstructions were reported, four in the tablet arm and ten in the packet arm (0.4% tablet arm, 0.5% packet arm; P = .5931). Of these, four (29%) required tube replacement and were followed by sevelamer discontinuation. Two (14%) were documented to be due to increased tube feeds and esomeprazole. Six (43%) cases required tube replacement, but no issues arose upon continuation. Only one of the obstructions resulted in a recurrent tube occlusion.
Sevelamer tablets may be crushed and administered via enteral feeding tubes, provided clear instruction on tablet preparation is included. Oral administration in dysphagic patients requires further evaluation with clear protocols for preparation and administration.
西维尔amer 是一种不溶性聚合物，用于治疗慢性肾脏病（CKD）患者的高磷血症。两种片剂制剂的说明书都建议整片服用。由于整片有时会被无意中压碎，而且西维尔amer 包的成本显著增加，我们评估了粉碎西维尔amer 片剂用于肠内喂养管给药的安全性和可行性。
进行了一项单中心回顾性图表审查。如果在 2015 年 1 月 1 日至 2019 年 7 月 31 日期间，每位接受西维尔碳酸盐治疗的成年 ICU 患者至少接受了一次西维尔片剂或包的治疗，并且有一个肠内喂养管，那么他们就符合纳入标准。主要结果是肠内喂养管堵塞或需要更换的发生率，定义为给药总次数中的发生次数。次要结果是从开始使用西维尔amer 到停止使用或患者出院时磷水平的变化。
共报告了 14 例堵塞，片剂组 4 例，包组 10 例（片剂组 0.4%，包组 0.5%；P=0.5931）。其中，4 例（29%）需要更换管，并随后停止使用西维尔amer。2 例（14%）是由于增加了管饲和埃索美拉唑引起的。6 例（43%）需要更换管，但继续使用没有出现问题。只有 1 例堵塞导致复发性管腔阻塞。
可以粉碎西维尔amer 片剂并通过肠内喂养管给药，只要包括片剂准备的明确说明。对于吞咽困难的患者，口服给药需要进一步评估，并制定明确的准备和给药方案。
