粉砕法による経管投与における薬剤量損失に対する簡易懸濁法の有用性についての検討

【目的】従来の薬剤経管投与法である粉砕法は薬効の減少につながる薬剤量の損失が指摘されている。そこで粉砕法による薬剤量損失に対する簡易懸濁法の有用性について検討した。 【方法】頻繁に粉砕指示がなされる5種類の薬剤を用いて粉砕・分包による薬物含量減少、薬剤調製時の懸濁性および実際の経管投与を想定した薬物含量について2つの方法を比較した。 【結果】薬剤を粉砕・分包するとそれぞれの薬物含量は減少した。またワーファリン®錠を粉砕して水に溶解すると完全には懸濁せず、小さな塊が生じたが、簡易懸濁法では均一に懸濁した。ワーファリン®錠の経管投与を想定した実験において粉砕法では薬物含量が大幅に減少したが、簡易懸濁法では、ほとんど損失が認められなかった。【結論】簡易懸濁法は粉砕法に比べて薬剤損失の面で有用性が高いことが示唆され、ワーファリン®錠のように安定性が悪い薬剤では特に適正な薬物投与に貢献出来ると考えられる。

Objective: In the past, a conventional crushing method was used for the administration of tablets or capsules by tube in patients with dysphagia. However, this method has several problems, such as a loss of the drug amount and tube clogging. Recently, tube administration by a simple suspension method was developed to solve these problems in the conventional crushing method. Methods: In the present study, we investigated to what extent the dosage amount is lost using the simple suspension method compared to crushing method, employing 5 drugs which are frequently administered by tube in Okayama University Hospital. Results: Drug weights of the 5 agents decreased by 70 ～ 90% in the grinding and packaging processes because of drug adhesion to the mortar, packaging machine, and drug package paper. The suspension of all drugs using the simple suspension method was uniform, while only the suspension of Warfarin® ground using the crushing method was shown to be showed inhomogeneous, which is expected to lead to a loss of drug. The drug content on assuming clinical a setting after tube passage was compared between the two methods. The recovery of warfarin®, characterized as unstable using the crushing method, was nearly 50%, but loss was prevented by 80% with the use of bags of medicine. For the simple suspension method, the recovery of warfarin® was almost 100%. Conclusion: The results of this study suggest that the simple suspension method is particularly effective for the tube administration of drugs characterized as unstable.

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