University of Greifswald, Institute of Pharmacy, Clinical Pharmacy, Greifswald, Germany.
University Medicine Greifswald, Department of Neurology, Greifswald, Germany.
Eur J Clin Pharmacol. 2024 Nov;80(11):1599-1623. doi: 10.1007/s00228-024-03723-4. Epub 2024 Jul 29.
Drug administration via feeding tubes is considered a process with many uncertainties. This review aimed to give a comprehensive overview of data available on feeding tube application and to carry out risk assessments for drug substances commonly administered to stroke patients.
Drugs frequently administered via feeding tubes were identified through a retrospective analysis of discharge letters from a stroke unit. Physicochemical, pharmacokinetic, and stability properties of these drugs and data on drug-enteral nutrition interactions were systematically searched for in the European Pharmacopoeia, Hagers Handbook of Pharmaceutical Practice, Birchers clinical-pharmacological data compilation, and the Martindale Complete Drug Reference, as well as from databases including DrugBank, DrugDex, PubChem, Google Scholar, and PubMed.
Of the drugs most commonly administered via feeding tubes in the present stroke patient cohort, bisoprolol, candesartan, and ramipril could be considered the least critical due to their overall favourable properties. Acetylsalicylic acid, amlodipine, hydrochlorothiazide, omeprazole and esomeprazole, simvastatin, and torasemide pose risks based on pH or light-dependent instability or proposed food effects. The most critical drugs to be administered via feeding tubes are considered to be furosemide, levodopa, and levothyroxine as they show relevant instabilities under administration conditions and substantial food effects; the latter two even possess a narrow therapeutic index. However, little information is available on drug-tube and drug-formula interactions.
Feeding tube administration of medications turned out to be a highly complex process with several unmet risks. Therefore, investigations that systematically assess these risk factors using clinically relevant model systems are urgently needed.
经饲管给药被认为是一个存在诸多不确定因素的过程。本综述旨在全面概述有关饲管应用的现有数据，并对常给脑卒中患者使用的药物进行风险评估。
通过对卒中病房出院记录的回顾性分析，确定了经饲管频繁给药的药物。在《欧洲药典》、《哈格斯药物实践手册》、《比尔彻临床药理学数据汇编》和《马丁代尔完全药物参考》中系统地检索了这些药物的理化、药代动力学和稳定性特性，以及药物-肠内营养相互作用的数据，此外还从包括 DrugBank、DrugDex、PubChem、Google Scholar 和 PubMed 在内的数据库中进行了检索。
在本脑卒中患者队列中，最常经饲管给药的药物中，由于其总体性质有利，比索洛尔、坎地沙坦和雷米普利可被视为最不关键的药物。基于 pH 值或光依赖性不稳定性或拟议的食物效应，乙酰水杨酸、氨氯地平、氢氯噻嗪、奥美拉唑和埃索美拉唑、辛伐他汀和托拉塞米存在风险。经饲管给药最关键的药物被认为是呋塞米、左旋多巴和左甲状腺素，因为它们在给药条件下表现出相关的不稳定性，并且具有显著的食物效应；后两者甚至具有较窄的治疗指数。然而，关于药物-管和药物配方相互作用的信息很少。
经饲管给药是一个非常复杂的过程，存在许多未满足的风险。因此，迫切需要使用临床相关的模型系统系统地评估这些风险因素的研究。
