1
|
Reber E, Messerli M, Stanga Z, Mühlebach S. Pharmaceutical Aspects of Artificial Nutrition. J Clin Med 2019; 8:jcm8112017. [PMID: 31752291 PMCID: PMC6912726 DOI: 10.3390/jcm8112017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Artificial nutrition, including enteral (EN) and parenteral (PN) nutrition, is indicated whenever adequate oral nutrition fails to sufficiently supply the necessary nutrients to the body. It is a convenient, efficacious, safe, and well-tolerated form of clinical nutrition in the hospital and home setting. EN is administered via nasogastric tube or ostomies while PN usually requires a central venous access for administration, straight into the blood stream. The infused nutrients can then be taken up directly by the different organs. PN is targeted as a single daily portion formulated as an oil-in-water emulsion providing the necessary substrates for the catabolic and anabolic metabolism including macro- and micronutrients and fluids. PN has a complex pharmaceutical composition-all-in-one admixture-and its compounding or ready-to-use preparation. The use of PN is more challenging and more expensive compare to the use of EN, commercially available as ready-to-use formulations. EN and concomitant medication is highly challenging. Upon incorrect handling and administration, PN is associated with potentially severe or even fatal complications, mostly relating to the central venous access (e.g., catheter-related sepsis) or to a metabolic intolerance (e.g., hyperglycemia, refeeding syndrome) because of inappropriate administration. A correct order of admixing, correct dosing, and administration of the artificial is crucial for safety and efficacy; clinical and biochemical monitoring of the patient and treatment regimen adaption are necessary. The high number of reactive solutes allow only limited stability of a ready-to-use PN admixture. The potential for numerous incompatibilities and interactions renders PN admixtures generally unsuitable as drug vehicle. Laboratory compatibility and stability testing and pharmaceutical expertise are a prerequisite to define the PN composition including nutrients or even drugs admixed to define the appropriate and individualized nutrition and medication regimen. The aim of this narrative review is to present the actual state-of-the-art to deliver best quality artificial nutrition with special regard on pharmaceutical aspects such as instabilities, incompatibilities, and concomitant co-medication.
Collapse
Affiliation(s)
- Emilie Reber
- Department for Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, 3010 Bern, Switzerland;
- Correspondence:
| | - Markus Messerli
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, 4050 Basel, Switzerland;
| | - Zeno Stanga
- Department for Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, 3010 Bern, Switzerland;
| | - Stefan Mühlebach
- Department of Pharmaceutical Sciences, Division of Clinical Pharmacy & Epidemiology/Hospital Pharmacy, University of Basel, 4050 Basel, Switzerland;
| |
Collapse
|
2
|
Woodward Z, Brooks P, Morris-Smith B, Wallis M, Ogbourne SM. Adsorption and Leachable Contamination of Flucloxacillin, Cyclosporin and Amiodarone Following Delivery Through an Intravenous Administration Set. Pharm Res 2018; 35:121. [PMID: 29675679 DOI: 10.1007/s11095-018-2409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/13/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Interactions between a pharmaceutical drug and its delivery device can result in changes in drug concentration and leachable contamination. Flucloxacillin, amiodarone and cyclosporin were investigated for drug concentration changes and leachable contamination after delivery through an intravenous administration set. METHODS Flucloxacillin, amiodarone and cyclosporin were delivered through an intravenous administration set and the eluate analysed by HPLC-UV and HPLC-MS. RESULTS The average recovery of flucloxacillin was 99.7% and no leachable compounds were identified. The average recovery of cyclosporin was 96.1%, which contrasts previous findings that have reported up to 50% loss of cyclosporin. This is likely due to the use of DEHP-free administration sets in this study, as adsorption of cyclosporin is linearly related to DEHP content. The average recovery of amiodarone was 91.5%. 5-hydroxymethylfurfural was identified in the amiodarone solution following delivery through the administration set as well as the 5% glucose solution used for delivery. CONCLUSIONS Drug/administration set interactions may modify pharmaceuticals during delivery. In this study, only 90% of the amiodarone was delivered through a generic administration set. Given the growing use of generic administration sets in hospital settings, validation of the suitability of their use is required to ensure patient safety and expected levels of efficacy.
Collapse
Affiliation(s)
- Zachary Woodward
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
| | - Peter Brooks
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
| | - Bernadette Morris-Smith
- Sunshine Coast Hospital Health Service, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Marianne Wallis
- Nursing and Midwifery Cluster for Research Excellence, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Steven M Ogbourne
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia.
| |
Collapse
|
3
|
Kim CO, Song J, Min JY, Park SJ, Lee HM, Byon HJ. A comparison of the pharmacokinetic and pharmacodynamic properties of nitroglycerin according to the composition of the administration set: A preliminary study. Medicine (Baltimore) 2018; 97:e9829. [PMID: 29489681 PMCID: PMC5851736 DOI: 10.1097/md.0000000000009829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a risk of drug sorption into an intravenous administration set composed of polyvinyl chloride (PVC), polyurethane (PU), or polyolefin (PO). This has implications on the dose of the active ingredient the patient receives, and thus therapeutic success. This study aimed to determine the plasma concentration of nitroglycerin and the effect of nitroglycerin on patients based on the composition of the administration set. METHODS Using a randomized, open-labeled, 3 × 3 crossover method, 9 volunteers were assigned to 3 groups. In period I, nitroglycerin (100 μg/mL) was infused via a PVC- (group A), PU- (group B), or PO-based (group C) administration set. In period II, PU- (group A), PO- (group B), and PVC-based (group C) administration sets were used, and in period III, PO- (group A), PVC- (group B), and PU-based (group C) administration sets were used. The rate of drug administration in all periods was 12 mL/hour for 30 minutes using an infusion pump. Blood samples were collected, and the plasma concentrations of nitroglycerin were analyzed using validated high-performance liquid chromatography coupled with tandem mass spectrometry. Blood pressure was determined using a sphygmomanometer applied to the other upper arm at an interval of 5 minutes. RESULTS We observed that the mean plasma concentration of nitroglycerin over time when administered using a PO-based tube was higher than that when using a PU- or PVC-based tube. When the percent change of the mean arterial pressure from baseline at each time point was compared among groups, there were statistically significant differences between PU and PO or PVC at most points during nitroglycerin infusion. CONCLUSION Our results showed higher nitroglycerin plasma concentration and lower arterial pressure when a PO-based administration set was used than when a PVC- or PU-based administration set was used. PO-based administration sets may be more appropriate for nitroglycerin administration compared to those composed of PVC or PU.
Collapse
Affiliation(s)
- Choon Ok Kim
- Department of Clinical Pharmacology and Clinical Trials Center, Severance Hospital, Yonsei University Health System, Seodaemun-gu, Seoul
| | - Jeongyun Song
- Department of Anesthesiology and Pain Medicine, Yeoncheon Public Health Center, Yeoncheon-gun, Gyeonggi-do
| | - Ji Young Min
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | | | - Hye Mi Lee
- Department of Anesthesiology and Pain Medicine
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| |
Collapse
|
4
|
Jin SE, Park JW, Baek H, Jeon S, Park SW, Hwang SJ. Evaluation of nitroglycerin and cyclosporin A sorption to polyvinylchloride- and non-polyvinylchloride-based tubes in administration sets. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2017. [DOI: 10.1007/s40005-017-0364-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Jin SE, Jeon S, Byon HJ, Hwang SJ. Evaluation of tacrolimus sorption to PVC- and non-PVC-based tubes in administration sets: Pump method vs. drip method. Int J Pharm 2017; 528:172-179. [PMID: 28549974 DOI: 10.1016/j.ijpharm.2017.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Tacrolimus sorption to tubes was evaluated using pump and drip methods For tubes, polyvinylchloride (PVC)- and non-PVC-based (polyurethane [PU] and polyolefin [PO]) tubes were used. First, inner surface properties of tubes were analyzed using field emission scanning electron microscopy and X-ray photoelectron spectroscopy. Tacrolimus was quantitatively analyzed using high-performance liquid chromatography with UV detection. For kinetic sorption analysis, diluted tacrolimus to 10μg/mL was passed through 1-m-long tubes at 10mL/h. Samples were collected at 1-4h. The inner surface of PO-based tubes was relatively smooth and soft compared with those of PVC- and PU-based tubes. Atomic compositions of tubes matched chemical formulas of polymers excluding low-level impurity in PVC-based tubes. Tacrolimus was successfully analyzed and linearly determined at 2.5-20μg/mL. From both methods, PVC- and PO-based tubes exhibited the highest and the lowest (<10%) sorption levels to tacrolimus, respectively. Tacrolimus was stably delivered using the pump method. Results suggested that the pump method can estimate tacrolimus sorption in administration set tubes and evaluate other sorptional drugs used at low concentrations. PO-based tubes also have promising potential as an alternative for administration set tubes.
Collapse
Affiliation(s)
- Su-Eon Jin
- College of Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea; College of Medicine, Yonsei University, Seoul, 03722, Republic of Korea; Yonsei Institute of Pharmaceutical Sciences, Incheon, 21983, Republic of Korea
| | - Seungho Jeon
- Polyscientech Co. Ltd, Anseong, 17508, Republic of Korea
| | - Hyo-Jin Byon
- College of Medicine, Yonsei University, Seoul, 03722, Republic of Korea
| | - Sung-Joo Hwang
- College of Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea; Yonsei Institute of Pharmaceutical Sciences, Incheon, 21983, Republic of Korea.
| |
Collapse
|
6
|
Jin SE, You S, Jeon S, Byon HJ, Hwang SJ. Evaluation of Drug Sorption to PVC- and Non-PVC-based Tubes in Administration Sets Using a Pump. J Vis Exp 2017. [PMID: 28362410 DOI: 10.3791/55086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Administration sets are delivery tools for the direct application of drugs into the body and are composed of a spike, a drip chamber, tubes, Luer adapters (connectors), a needle cover for protection, and other accessories. Drug sorption to tubes of administration sets is a critical issue in terms of safety and efficacy. Although drug sorption is an important factor in the quality of an administration set, there are no standard evaluation methods for the regulation of drug sorption to the tubes. Here, we describe an evaluation protocol for drug sorption to tubes of administration sets. Tubes made of polyvinyl chloride (PVC)- and non-PVC-based polymeric materials were cut to 1 m in length. Diazepam and tacrolimus were used as model drugs. In the kinetic sorption study, we selected the drug concentration and flow rate based on the clinical usage of these drugs. After the dilution of each drug in a glass bottle, the diluted drug solution was delivered through tubes of administration sets using a pump. Samples were collected in amber vials at appropriate time points and the drugs were analyzed using high-performance liquid chromatography. Drug concentrations and sorption levels to tubes of the administration sets were calculated. Acceptable criteria to ensure the quality of administration sets are recommended.
Collapse
Affiliation(s)
- Su-Eon Jin
- College of Pharmacy, Yonsei University; College of Medicine, Yonsei University; Yonsei Institute of Pharmaceutical Sciences
| | - Siwon You
- College of Pharmacy, Yonsei University; Yonsei Institute of Pharmaceutical Sciences
| | | | | | - Sung-Joo Hwang
- College of Pharmacy, Yonsei University; Yonsei Institute of Pharmaceutical Sciences;
| |
Collapse
|
7
|
Lemaitre F, Hasni N, Leprince P, Corvol E, Belhabib G, Fillâtre P, Luyt CE, Leven C, Farinotti R, Fernandez C, Combes A. Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood. Crit Care 2015; 19:40. [PMID: 25886890 PMCID: PMC4335544 DOI: 10.1186/s13054-015-0772-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/23/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION As a result of drug sequestration and increased volume of distribution, the extracorporeal membrane oxygenation (ECMO) procedure might lead to a decrease in drug concentrations during a patient's treatment. The aim of this study was to evaluate sedative, antibiotic and immunosuppressive drug loss in ECMO circuit using ex-vivo and in-vitro experiments. METHODS Blood concentrations of propofol, midazolam, cyclosporine and vancomycin were measured in an ex-vivo ECMO circuit primed with whole human blood, and compared to controls stored in polypropylene tubes. In vitro experiments were also conducted to further explore the role of temperature, oxygen exposure and polyvinylchloride surfaces on propofol loss in the ECMO circuit. RESULTS Propofol concentration decreased rapidly; 70% of its baseline concentration was lost after only 30 minutes, and only 11% remained after five hours (P <0.001 for the comparison with control polypropylene tube propofol concentration). Further experiments demonstrated that oxygen exposure and contact with polyvinylchloride tubing were respectively responsible for 70% and 85% of propofol loss after 45 minutes. Midazolam concentration also rapidly decreased in the ECMO circuit, with only 54% and 11% of baseline concentration being detected at 30 minutes and 24 hours respectively (P = 0.01 versus control). Alternatively, cyclosporine concentration remained stable for the five first hours, then decreased to 78% and 73% of the baseline value after 24 hours and 48 hours, (P = 0.35 versus control). Lastly, vancomycin concentration remained stable in the ECMO circuit for the 48-hour experimental protocol. CONCLUSIONS We observed important losses of propofol and midazolam, while cyclosporine concentration decreased slowly and moderately, and vancomycin concentration remained unchanged in the ex-vivo ECMO circuit primed with whole human blood. These data might help intensive care unit physicians planning clinical trials with a final objective to better adapt doses of these drugs while treating critically ill ECMO patients.
Collapse
Affiliation(s)
- Florian Lemaitre
- Faculty of Pharmacy, EA4123 Barrières physiologiques et réponses thérapeutiques, Paris Sud University, Châtenay-Malabry, France.
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France.
- Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, Rennes, France.
- Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France.
| | - Nesrine Hasni
- Faculty of Pharmacy, EA4123 Barrières physiologiques et réponses thérapeutiques, Paris Sud University, Châtenay-Malabry, France.
| | - Pascal Leprince
- Paris 6 University Pierre et Marie Curie, 91-105 Boulevard de l'Hôpital, 75013, Paris, France.
- Cardiovascular Surgery department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Emmanuel Corvol
- Cardiovascular Surgery department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Ghassen Belhabib
- Faculty of Pharmacy, EA4123 Barrières physiologiques et réponses thérapeutiques, Paris Sud University, Châtenay-Malabry, France.
| | - Pierre Fillâtre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France.
- Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, Rennes, France.
- Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France.
| | - Charles-Edouard Luyt
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, iCAN, Institute of Cardiometabolism and Nutrition, 47, Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France.
- Paris 6 University Pierre et Marie Curie, 91-105 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Cyril Leven
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France.
- Faculty of Medicine, Laboratory of Experimental and Clinical Pharmacology, Rennes 1 University, Rennes, France.
- Inserm, CIC-P 1414 Clinical Investigation Center, Rennes, France.
| | - Robert Farinotti
- Faculty of Pharmacy, EA4123 Barrières physiologiques et réponses thérapeutiques, Paris Sud University, Châtenay-Malabry, France.
| | - Christine Fernandez
- Faculty of Pharmacy, EA4123 Barrières physiologiques et réponses thérapeutiques, Paris Sud University, Châtenay-Malabry, France.
- Pharmacy Department, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, AP-HP, 184 rue du faubourg Saint-Antoine, 75012, Paris, France.
| | - Alain Combes
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, iCAN, Institute of Cardiometabolism and Nutrition, 47, Boulevard de l'Hôpital, 75651, Paris, Cedex 13, France.
- Paris 6 University Pierre et Marie Curie, 91-105 Boulevard de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
8
|
Falsely elevated cyclosporin and tacrolimus concentrations over prolonged periods of time due to reversible adsorption to central venous catheters. Clin Chim Acta 2014; 433:62-8. [PMID: 24631133 DOI: 10.1016/j.cca.2014.02.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/12/2014] [Accepted: 02/27/2014] [Indexed: 11/20/2022]
Abstract
Falsely elevated concentrations of immunosuppressants can be caused by reversible adsorption to central venous catheter (CVC) systems. If undetected, this may lead to dose reduction resulting in underdosage which may even entail graft-versus-host disease or organ rejection. We analyzed the adsorption and release for cyclosporine A (CsA) and tacrolimus (Tac) in vitro and in vivo. Four types of CVCs were examined in vitro: two made from polyurethane (PU), one from silicone and one from PU with an incorporated silver ion-based antimicrobial agent. All 26 CVCs analyzed in vitro showed significant reversible adsorption of CsA (n=13; p=0.001) and Tac (n=13; p=0.001, Wilcoxon signed rank test). Immediately after infusing the drugs, the mean concentrations of 6420ng/mL of CsA and 250ng/mL of Tac were measured. Flushing with NaCl lowered the drug release. Besides, blood samples of fifteen patients were taken simultaneously from all lumina of the CVC and via venipuncture. The samples from contaminated lumina showed the mean elevations by a factor of 11 for CsA (n=12) and 89 for Tac (n=3). Blood sampling for immunosuppressant monitoring should thus never be performed from lumina previously used for infusing the drug even after prolonged periods of time and extensive rinsing.
Collapse
|
9
|
Clinical Validation of Dried Blood Spot Sampling in Therapeutic Drug Monitoring of Ciclosporin A in Allogeneic Stem Cell Transplant Recipients. Ther Drug Monit 2013; 35:92-5. [DOI: 10.1097/ftd.0b013e31827d76ce] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Senner AM, Johnston K, McLachlan AJ. A Comparison of Peripheral and Centrally Collected Cyclosporine A Blood Levels in Pediatric Patients Undergoing Stem Cell Transplant. Oncol Nurs Forum 2007; 32:73-7. [PMID: 15660145 DOI: 10.1188/05.onf.73-77] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To measure differences in cyclosporine A (CSA) trough concentrations from blood collected as a peripheral sample and from a CSA-uncontaminated (naive) lumen of a double-lumen central line. DESIGN Prospective, comparative study. SETTING Pediatric university teaching hospital in metropolitan Australia. SAMPLE 71 paired central and peripheral CSA blood samples from a convenience sample of 14 pediatric allogeneic stem cell transplant recipients receiving IV CSA as prophylaxis or treatment for graft-versus-host disease. Ages ranged from 2 months to 14 years, 5 months. METHODS Comparing blood samples collected from a peripheral site and a CSA-naive lumen of a double-lumen central line. Data were analyzed using a paired student t test and calculation of the 95% confidence interval of the concentration ratio from different sampling sites. MAIN RESEARCH VARIABLES Site of blood sampling and CSA trough concentrations. FINDINGS No significant difference existed between CSA concentration in samples collected from the different sites in children receiving intermittent infusions of CSA (p = 0.13). The 95% confidence interval of the CSA concentration ratio was 0.92 1.04. CONCLUSIONS When CSA is administered on an intermittent dosing schedule, comparable CSA trough concentrations can be determined from blood collected via the CSA-naive lumen of a double-lumen central line or at a peripheral sampling site. IMPLICATIONS FOR NURSING Pediatric allogeneic stem cell transplant recipients who require regular CSA trough concentrations no longer will require peripheral blood samples when receiving an intermittent dosing schedule.
Collapse
Affiliation(s)
- Anne Mary Senner
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, New South Wales, Australia.
| | | | | |
Collapse
|
11
|
Jin M, Shimada T, Yokogawa K, Nomura M, Mizuhara Y, Furukawa H, Ishizaki J, Miyamoto KI. Cremophor EL releases cyclosporin A adsorbed on blood cells and blood vessels, and increases apparent plasma concentration of cyclosporin A. Int J Pharm 2005; 293:137-44. [PMID: 15778051 DOI: 10.1016/j.ijpharm.2004.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 12/15/2004] [Accepted: 12/17/2004] [Indexed: 11/19/2022]
Abstract
We examined the influence of cremophor EL (crEL) on the disposition kinetics of CyA in rats. A dose of 10mg/kg of CyA in a volume of 750 microL containing 4.3, 16 or 30% concentration of crEL was intravenously administered over 1 min to rats. The values of distribution volume at the steady-state (Vd(ss)) and total clearance (CL(tot)) of CyA in the presence of increasing amounts of crEL were decreased to about 1/3-1/5 of those with 4.3% crEL, in a crEL concentration-dependent manner. The values of blood to plasma concentration ratio (RBP) and the apparent tissue to plasma concentration ratio (K(p,app)) of CyA with 30% crEL were both only about 1/2 of those of CyA with 4.3% crEL. Next, rats were intravenously given 30% crEL solution at 30 min after an intravenous administration of CyA (10 mg/kg) with 4.3% crEL. Subsequently, the blood and plasma concentrations of CyA rose significantly to 2.4 and 4.7 times those seen when i.v. 30% crEL was not given, respectively. In an in vitro study, we found that the uptake of CyA by red blood cells is inhibited by crEL, and that CyA adsorbed on the inner surface of blood vessels after the administration of CyA is released by crEL. The disposition kinetics of CyA is altered by i.v. administration in combination with the surfactant vehicle crEL, in a crEL concentration-dependent manner.
Collapse
Affiliation(s)
- Mingji Jin
- Department of Hospital Pharmacy, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | | | | | | | | | | | | | | |
Collapse
|