Administering esomeprazole subcutaneously via a syringe driver in the palliative demographic: A case series.
esomeprazole
hospice care
infusion pumps
inpatients
palliative care
subcutaneous infusion
Journal
Journal of clinical pharmacy and therapeutics
ISSN: 1365-2710
Titre abrégé: J Clin Pharm Ther
Pays: England
ID NLM: 8704308
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
revised:
05
11
2021
received:
28
09
2021
accepted:
23
11
2021
pubmed:
29
12
2021
medline:
24
5
2022
entrez:
28
12
2021
Statut:
ppublish
Résumé
Proton pump inhibitors are potent suppressors of gastric acid secretion, and are commonly prescribed in palliative medicine. Despite multiple relevant indications in patients at the end-of-life, their use is often precluded as oral and intravenous administration is frequently inappropriate or not possible. Limited anecdotal evidence suggests proton pump inhibitors may be administered subcutaneously. Our objective was to investigate the tolerability and effectiveness of the administration of esomeprazole as a continuous subcutaneous infusion over 24 h via a syringe driver. Case series (n = 7) design assessing sequential patients admitted to a specialist inpatient centre for palliative care, who required parenteral proton pump inhibitor therapy. Four patients reported complete resolution of dyspeptic and reflux symptoms post commencement of esomeprazole. Two patients developed upper gastrointestinal bleeding, which via observation of vomitus and stools, resolved with the initiation of esomeprazole. A single patient, deemed high risk of gastrointestinal bleeding, was commenced on esomeprazole and no bleeding events occurred. Esomeprazole when administered via a syringe driver over 24 h appears well tolerated and effective for the symptomatic management of dyspepsia and treatment of gastrointestinal bleeding. Overall, this series adds to the limited evidence base for using subcutaneous proton pump inhibitors in the palliative demographic.
Substances chimiques
Proton Pump Inhibitors
0
Esomeprazole
N3PA6559FT
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
694-698Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
Strand DS, Kim D, Peura DA. 25 years of proton pump inhibitors: a comprehensive review. Gut Liv. 2017;11(1):27-37.
Joint Formulary Committee. British National Formulary (online). BMJ Group and Pharmaceutical Press. Accessed July 16, 2021. http://www.medicinescomplete.com
Wilcock A, Howard P, Charlesworth S. Palliative Care Formulary. 7th ed. Pharmaceutical Press; 2020.
Veevers AE, Oxberry SG. Ranitidine: forgotten drug of delayed gastric emptying. BMJ Support Palliat Care. 2017;7(3):255-257.
Zhang C, Kwong JS, Yuan RX, et al. Effectiveness and tolerability of different recommended doses of PPIs and H 2 RAs in GERD: network meta-analysis and GRADE system. Sci Rep. 2017;7(1):1-2.
European Medicines Agency, 2020. Suspension of ranitidine medicines in the EU. [online]. Accessed May 12, 2021. https://www.ema.europa.eu/en/documents/press-release/suspension-ranitidine-medicines-eu_en.pdf
Agar M, Webster R, Lacey J, et al. The use of subcutaneous omeprazole in the treatment of dyspepsia in palliative care patients. J Pain Symptom Manage. 2004;28:529-531.
Desmidt T, Constans T. Subcutaneous infusion of esomeprazole in elderly patients in palliative care: a report of two cases. J Am Geriatr Soc. 2009;57(9):1724-1725.
Michelon H, Souchu H, Chauvron-Defilippi B, et al. Subcutaneous pantoprazole in an elderly, palliative care patient. BMJ Support Palliat Care. 2019:1-2. 10.1136/bmjspcare-2019-001916
Ellershaw JE, Peat SJ, Boys LC. Assessing the effectiveness of a hospital palliative care team. Palliat Med. 1995;9(2):145-152.
Zijlstra E, Jahnke J, Fischer A, et al. Impact of injection speed, volume, and site on pain sensation. J Diabetes Sci Technol. 2018;12(1):163-168.
Kim H, Park H, Lee SJ. Effective method for drug injection into subcutaneous tissue. Sci Rep. 2017;7(1):9613.
Kupiec TC, Aloumanis V, Ben M. Physical and chemical stability of esomeprazole sodium solutions. Ann Pharmacother. 2008;42(9):1247-1251.
Tillpmed Laboratories Ltd. Esomeprazole 40 mg powder for solution for injection/infusion SmPC. [Internet]. 2021 [Accessed July 4, 2021]. https://www.medicines.org.uk/emc/product/11259/smpc
Mitchell K, Pickard J, Herbert A, et al. Incidence and causes for syringe driver site reactions in palliative care: a prospective hospice-based study. Palliat Med. 2012;26(8):979-985.