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Proton pump inhibitor administration via nasogastric tube in pediatric practice: comparative analysis with protocol

M P Ponrouch¹, V Sautou-Miranda, A Boyer

¹CHU Clermont-Ferrand, Pharmacie, Hop G Montpied, 58 rue Montalembert, F-63000 Clermont-Ferrand, France.

International Journal of Pharmaceutics

|February 6, 2010

Insights

Administering proton pump inhibitors (PPIs) via nasogastric tubes in children is challenging due to tube obstruction and poor drug recovery. Lansoprazole orally disintegrating tablets offer the most reliable delivery method through larger tubes.

Area of Science:

Pediatric Gastroenterology
Pharmacology
Medical Device Engineering

Background:

Proton pump inhibitors (PPIs) are widely prescribed for children, but their administration via nasogastric tubes is problematic due to the lack of liquid formulations.
Existing PPI formulations can lead to inefficiency and nasogastric tube obstruction, necessitating studies on optimal administration methods.

Purpose of the Study:

To evaluate the feasibility and efficacy of administering four different proton pump inhibitors (PPIs) through pediatric nasogastric tubes.
To determine the influence of variables such as water volume, flush-through volume, tube length, and diameter on PPI delivery.

Main Methods:

Four PPIs (omeprazole, esomeprazole, lansoprazole, lansoprazole orally disintegrating tablet) were administered through nasogastric tubes of varying diameters (6F and 8F) and lengths.
The study assessed the impact of different water volumes for dissolution/suspension and flush-through volumes.
Active ingredient recovery at the tube outlet was quantified using UV spectrometry.

Main Results:

All 6F nasogastric tubes were obstructed by PPIs.
In 8F tubes, recovery rates varied significantly: lansoprazole orally disintegrating tablet (86.2%), esomeprazole (36.9%), lansoprazole (7.1%), and omeprazole (3.9%).
Omeprazole and lansoprazole are not recommended for 8F tubes due to insufficient active ingredient delivery.
For esomeprazole, 5ml water and 5ml flush-through yielded partial recovery; lansoprazole orally disintegrating tablets with 5ml suspension water and 10ml flush-through achieved full dose delivery.

Conclusions:

Administration of omeprazole and lansoprazole via 8F nasogastric tubes is not advised due to poor drug recovery and potential for sub-therapeutic concentrations.
Lansoprazole orally disintegrating tablets represent the most suitable PPI formulation for administration through 8F nasogastric tubes, ensuring complete dose delivery under specific conditions.
Further research into optimized administration protocols for other PPIs may be warranted.

Read full analysis

Abstract:

Proton pump inhibitors (PPIs) are largely prescribed to children because their efficacy and tolerance are now well-established. One disadvantage resides in the absence of liquid form which causes problems for their administration in nasogastric tubes. Indeed, the absence of use recommendations involves many misuses responsible for inefficiency and/or tube obstruction. We tried to evaluate if PPIs can be administered through pediatric nasogastric tubes. We administered four PPIs (Omeprazole, esomeprazole, lansoprazole and lansoprazole orally disintegrating tablet) through nasogastric tubes. For each PPI a study plan was drawn up to assess the influence of different variables: the volume of water to dissolve or put in suspension the PPIs (2ml or 5ml), the volume of tube flush-through water post-PPI administration (2ml, 5ml or 10ml), the length (50cm or 125cm) and the diameter (6 or 8 French) of the polyurethane tubes. For each assay an analysis of each active ingredient at the tube outlet by UV spectrometry was carried out. All 6 F tubes were obstructed by PPIs. Through 8 F tubes, we observed a mean recovery of active ingredient of 86.2% for lansoprazole orally disintegrating tablet, 36.9% for esomeprazole but only 7.1% for lansoprazole and 3.9% for omeprazole. It is disadvised using omeprazole and lansoprazole through 8 F nasogastric tubes because no condition ensures the transit of an efficient concentration of active ingredient. For esomeprazole, the best conditions of administration were a water volume of 5ml and a rinse volume of 5ml but only a half of the microgranules administered were recovered. The most satisfactory results were obtained with lansoprazole orally disintegrating tablet. A 5ml volume of water diluent for suspension and a 10ml volume of flush-through water made it possible to deliver the full lansoprazole dose administered.

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