Resumen de Administration of antiretroviral treatment in patients with difficulties in swallowing or carrying enteral tubes
Carmen García Muñoz, Federico Pulido Ortega, Montserrat Tuset Creus, José María Miró Meda, José Miguel Ferrari Piquero
Introduction. Occasionally patients with HIV infection may have swallowing difficulties or may need the placement of enteral tubes requiring the medication administration through these devices. Usually, in the drug's summary of product characteristics, it is not collected the information on the administration in these situations. The access to this information by the clinician is difficult, thus creates the need to have updated information and based on pharmacokinetic studies to ensure that the administration of tablets and capsules of antiretrovirals will achieve drug plasma levels similar to those obtained by the intake of tablet or intact capsule.
Objective. The objective of this review is to collect the available evidence so far on the administration of ART in patients with swallowing difficulties or carrying enteral tubes or ostomies.
Method. We reviewed the summary of product characteristics of all the ART available currently. If data was not available in the summary of product characteristics we consulted the manufacturing laboratory and subsequently searched for literature in PubMed and consulted the drugs' administration guides (in this order). We collected information on the mode of administration (with or without food), the possibility of splitting or crushing the pharmaceutical form the presence of excipients of mandatory declaration or of special interest for their ability to cause adverse effects or allergic reactions and the possibility and recommended form of administration by nasogastric tube, gastrostomy, transpyloric tube and jejunostomy.
Results. We reviewed the summary of product characteristics of 22 active principles. Information was described on the datasheet in 11 of 23 solid pharmaceutical presentations, tablets or capsules.
Only in two cases,the laboratories provided bioavailability studies following administration of the capsule or tablet (atazanavir and dolutegravir).
Regarding the literature search in PubMed we found a total of 12 items related to this issue.
Discussion. After reviewing the available evidence it should be noted the lack of data in the drug's summary of product characteristics and the scarcity of bioavailability studies endorsed by the pharmaceutical industry. Moreover, most of the available studies are case series of few patients or unique clinical cases. This compels the clinician making decisions with indirect data in many occasions, so a further research is required in this field
