Evaluation of different lansoprazole formulations for nasogastric or orogastric administration

Background: Critically ill patients who require treatment with proton pump inhibitors are often unable to swallow solid dosage forms and have nasogastric (NG) or orogastric (OG) tube placement. Many of these patients will need medications in a liquid dosage form for easy administration. The aim of this study was to determine which extemporaneous preparation of lansoprazole is least likely to cause NG or OG tube blockage. Methods: Lansoprazole capsules, oral disintegrating tablets, and packets were each dissolved in apple juice, cranberry juice, orange juice, ginger ale, water, and 8.4% sodium bicarbonate (NaHCO₃). The resulting suspension was individually passed through an 18-French NG tube and collected in a graduated cylinder. The tubes were then inspected for clots. The amount of drug retrieved from the cylinder was rated as none, partial, or complete. The physical consistency and pH changes of the suspension were assessed for stability at 0, 2, 5, 10, and 15 minutes. Results: Complete drug retrieval and no clots were observed when any of the lansoprazole dosage forms were mixed with 8.4% NaHCO₃ or when the disintegrating tablet was mixed in any of the solutions. The pH of each admixture remained fairly constant over 15 minutes, but the packet-in-water combination showed a significant lowering in pH immediately after mixing. Conclusion: The use of NaHCO₃ to make suspension for any lansoprazole formulation is associated with the least likelihood of tube blockage or pH variations. Thus, it may be the preferred delivery vehicle for NG/OG administration of lansoprazole, unless the Solutab is available.