Laboratory of Clinical Pharmaceutics, Faculty of Pharmacy, Osaka Ohtani University, Osaka, Japan.
Department of Pharmacy, Osaka Habikino Medical Center, Osaka, Japan.
Int J Med Sci. 2022 Apr 18;19(5):789-795. doi: 10.7150/ijms.71770. eCollection 2022.
The interaction between enteral nutrients (ENs) and drugs co-administered through a nasogastric (NG) tube reportedly affects the absorption and resultant plasma concentrations of the respective drugs. However, the gastrointestinal absorption of carbamazepine (CBZ), an antiepileptic drug, co-administered with liquid ENs through an NG tube has not been clarified. In this study, we measured the recovery rate (%) of CBZ (Tegretol powder) passed through an NG tube when co-administered with distilled water or ENs (F2α, Racol NF, Ensure Liquid, and Renalen LP) of different compositions, frequently used in Japan. We also measured the plasma CBZ level in 26 rats after oral co-administration of CBZ with liquid ENs. The CBZ recovery rate was close to 100% in rats of all EN groups after passage through the NG tube. Furthermore, CBZ area under the plasma concentration-time curve from time zero to 9 h (AUC) of the Ensure liquid group decreased compared with that of control group ( < 0.05) and Renalen LP group ( < 0.01). However, the AUC of CBZ remained unchanged when co-administered with Ensure liquid 2 h after initial CBZ administration. In conclusion, the co-administration of CBZ with Ensure Liquid caused a reduction in the absorption of CBZ from the gastrointestinal tract, without adsorption on the NG tube. The administration of Ensure Liquid 2 h after CBZ is a way to prevent a decrease in plasma CBZ concentration. Our findings suggest that carefully monitoring the plasma levels of CBZ is necessary in co-administation with Ensure liquid to prevent the unintended effects of the interaction between CBZ and liquid EN.
经鼻胃管同时给予肠内营养（EN）和药物，据报道会影响药物的吸收和相应的血浆浓度。然而，通过鼻胃管同时给予液体 EN 时，抗癫痫药卡马西平（CBZ）的胃肠道吸收情况尚未阐明。在这项研究中，我们测量了通过鼻胃管给予蒸馏水或日本常用的不同配方的 EN（F2α、Racol NF、Ensure Liquid 和 Renalen LP）时，通过鼻胃管的 CBZ（Tegretol 粉末）的回收率（%）。我们还测量了 26 只大鼠口服 CBZ 与液体 EN 同时给予后血浆 CBZ 水平。所有 EN 组的大鼠在通过鼻胃管后，CBZ 的回收率接近 100%。此外，与对照组（<0.05）和 Renalen LP 组（<0.01）相比，Ensure Liquid 组的 CBZ 血浆浓度-时间曲线下面积（AUC）从 0 到 9 小时（AUC）降低。然而，当在初始 CBZ 给药 2 小时后与 Ensure Liquid 同时给予时，CBZ 的 AUC 保持不变。总之，与 Ensure Liquid 同时给予 CBZ 会导致 CBZ 从胃肠道吸收减少，而不会吸附在鼻胃管上。在 CBZ 给药后 2 小时给予 Ensure Liquid 是防止血浆 CBZ 浓度降低的一种方法。我们的研究结果表明，在与 Ensure Liquid 同时给药时，有必要仔细监测 CBZ 的血浆水平，以防止 CBZ 与液体 EN 之间相互作用的意外影响。
