目的:通过饲管给药被认为是一个具有许多不确定性的过程。这篇综述旨在全面概述有关饲管应用的可用数据,并对通常用于中风患者的药物进行风险评估。
方法:通过回顾性分析卒中单元的出院字母,确定了经常通过饲管给药的药物。物理化学,药代动力学,在欧洲药典中系统地搜索了这些药物的稳定性和有关药物-肠内营养相互作用的数据,Hagers制药实践手册,Birchers临床药理学数据汇编,和Martindale完整药物参考,以及来自包括DrugBank在内的数据库,DrugDex,PubChem,谷歌学者,和PubMed。
结果:在当前卒中患者队列中最常用的通过饲管给药的药物中,比索洛尔,坎地沙坦,和雷米普利可以被认为是最不关键的,因为它们的总体有利特性。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,和托拉塞米基于pH值或光依赖性不稳定或建议的食物影响而构成风险。通过饲管给药的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和大量食物影响下显示出相关的不稳定性;后两者甚至具有狭窄的治疗指数。然而,关于药管和药物配方相互作用的信息很少。
结论:饲管给药是一个非常复杂的过程,有几个未解决的风险。因此,迫切需要使用临床相关模型系统系统地评估这些危险因素的研究.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.