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Published Online, 11 April 2006, www.theannals.com, DOI 10.1345/aph.1G126b.
 The Annals of Pharmacotherapy: Vol. 40, No. 5, pp. 997-998. DOI 10.1345/aph.1G126b
© 2006 Harvey Whitney Books Company.
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Authors' Reply

John W Devlin, PharmD FCCM FCCP

Associate Professor, School of Pharmacy, Northeastern University, 206 Mugar Life Sciences Bldg., Boston, Massachusetts 02115-5000, fax 617/373-7655, j.devlin{at}neu.edu

Keith M Olsen, PharmD FCCM FCCP

Professor, College of Pharmacy/Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, Nebraska

Published Online, April 11, 2006. www.theannals.com, DOI 10.1345/aph.1G126b

AUTHORS' REPLY: We thank Dr. Conrad for his comments. Using the best information available at the time of writing, we concluded that immediate-release omeprazole for oral suspension could be mixed in water and administered through an orogastric tube. However, we asserted that questions remained about whether tube obstruction might occur in specific situations (eg, when the product is administered through tubes with a caliber ≤8 French).

We agree that the very small particle size of the immediate-release omeprazole formulation is unlikely to result in tube occlusion. While it is interesting to learn that no patients in Dr. Conrad's study developed tube obstruction, it is important to note that PPI delivery was not formally evaluated in the study, and it remains unclear whether narrow-caliber feeding tubes (eg, ≤8 French) were used.1 The best evidence to support the administration of immediate-release omperazole through narrow-caliber feeding tubes comes from an vitro study that evaluated the ability of 16 nurses and lay people to deliver immediate-release omeprazole through an 8 French caliber tube.2 Using HPLC techniques to quantify delivery, we found that an average ± SD of 96 ± 3% of each dose of immediate-release omeprazole was delivered through the tube. In summary, we agree with the conclusions of Dr. Conrad that immediate-release omeprazole (with sodium bicarbonate) may be administered through orogastric tubes with little, if any, risk for tube occlusion.

References

  1. Conrad S, Gabrielli A, Margolis B, et al. A randomized double-blind comparison of immediate-release omeprazole oral suspension vs.intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med 2005;33:760-5.
  2. Bakshi A, Bungay K, Olsen KM, Devlin JW. An in vitro comparison of different providers to deliver four proton pump inhibitor (PPI) products through a feeding tube. Pharmacotherapy 2005;25:1449.




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