Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multicenter retrospective cohort study.

Autor: Mahmoud SH; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada., Hefny FR; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada., Panos NG; Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA., Delucilla L; Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada., Ngan Z; Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada., Perreault MM; Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada.; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada., Hamilton LA; University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA., Rowe AS; University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA., Buschur PL; OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA., Owusu-Guha J; OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA., Almohaish S; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.; College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia., Sandler M; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA., Armahizer MJ; Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland, USA., Barra ME; Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA., Cook AM; UKHealthCare, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA., Barthol CA; Department of Pharmacotherapy & Pharmacy Services, University Health, San Antonio, Texas, USA., Hintze TD; Department of Pharmacy Practice, Texas A&M College of Pharmacy, College Station, Texas, USA., Cantin A; Hartford Hospital, Hartford, Connecticut, USA., Traeger J; University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Blunck JR; Department of Pharmacy, Saint Luke's Hospital, Kansas City, Missouri, USA., Shewmaker J; Department of Pharmacy, Saint Luke's Hospital, Kansas City, Missouri, USA., Burgess SV; Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada., Kaupp K; Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, Nova Scotia, Canada., Brown CS; Mayo Clinic, Rochester, Minnesota, USA., Clark SL; Mayo Clinic, Rochester, Minnesota, USA., Wieruszewski ED; Mayo Clinic, Rochester, Minnesota, USA., Tesoro EP; College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA., Ammar AA; Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA., Ammar MA; Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut, USA., Binning MJ; Global Neurosciences Institute, Pennington, New Jersey, USA., Naydin S; Global Neurosciences Institute, Pennington, New Jersey, USA., Fox N; Premier Health Miami Valley Hospital, Dayton, Ohio, USA., Peters DM Jr; Cedarville University School of Pharmacy, Cedarville, Ohio, USA., Mahmoud LN; Department of Pharmacy, Rhode Island Hospital/Lifespan, Providence, Rhode Island, USA., Keegan SP; Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA., Brophy GM; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA.
Jazyk: angličtina
Zdroj: Pharmacotherapy [Pharmacotherapy] 2023 Apr; Vol. 43 (4), pp. 279-290. Date of Electronic Publication: 2023 Mar 16.
DOI: 10.1002/phar.2791
Abstrakt: Background: Nimodipine improves outcomes following aneurysmal subarachnoid hemorrhage (aSAH) and current guidelines suggest that patients with aSAH receive nimodipine for 21 days. Patients with no difficulty swallowing will swallow the whole capsules or tablets; otherwise, nimodipine liquid must be drawn from capsules, tablets need to be crushed, or the commercially available liquid product be used to facilitate administration through an enteral feeding tube (FT). It is not clear whether these techniques are equivalent. The goal of the study was to determine if different nimodipine formulations and administration techniques were associated with the safety and effectiveness of nimodipine in aSAH.
Methods: This was a retrospective multicenter observational cohort study conducted in 21 hospitals across North America. Patients admitted with aSAH and received nimodipine by FT for ≥3 days were included. Patient demographics, disease severity, nimodipine administration, and study outcomes were collected. Safety end points included the prevalence of diarrhea and nimodipine dose reduction or discontinuation secondary to blood pressure reduction. Predictors of the study outcomes were analyzed using regression modeling.
Results: A total of 727 patients were included. Administration of nimodipine liquid product was independently associated with higher prevalence of diarrhea compared to other administration techniques/formulations (Odds ratio [OR] 2.28, 95% confidence interval [CI] 1.41-3.67, p-value = 0.001, OR 2.76, 95% CI 1.37-5.55, p-value = 0.005, for old and new commercially available formulations, respectively). Bedside withdrawal of liquid from nimodipine capsules prior to administration was significantly associated with higher prevalence of nimodipine dose reduction or discontinuation secondary to hypotension (OR 2.82, 95% CI 1.57-5.06, p-value = 0.001). Tablet crushing and bedside withdrawal of liquid from capsules prior to administration were associated with increased odds of delayed cerebral ischemia (OR 6.66, 95% CI 3.48-12.74, p-value <0.0001 and OR 3.92, 95% CI 2.05-7.52, p-value <0.0001, respectively).
Conclusions: Our findings suggest that enteral nimodipine formulations and administration techniques might not be equivalent. This could be attributed to excipient differences, inconsistency and inaccuracy in medication administration, and altered nimodipine bioavailability. Further studies are needed.
(© 2023 The Authors. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc.)
Databáze: MEDLINE
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