Abstract
SummaryObjectiveHydrocortisone via nasogastric (NG) tube is used in sick children with adrenal insufficiency; however, there is no licensed formulation for NG administration.MethodsWe investigated hydrocortisone recovery after passage through NG tubes in vitro for three formulations: liquid suspension, crushed tablets mixed with water, and hydrocortisone granules designed for oral administration to children. Cortisol was measured by LC‐MS/MS.ResultsHydrocortisone content was variable and recovery low after preparation in syringe and prior to passage through NG tubes. For doses, 0.5 and 2.0 mg mean percentage recovery was as follows: liquid suspension 57% and 58%; crushed tablets 46% and 30%; and hydrocortisone granules 78% and 71%. Flushing the administering syringe increased recovery. Hydrocortisone recovery after passage with flushing through 6‐12Fr gauge NG tubes was variable: liquid suspension 61%‐92%, crushed tablets 40%‐174%, hydrocortisone granules 61%‐92%. Administration of hydrocortisone granules occluded 6 and 8Fr NG tubes; however, administration using a sampling needle to prevent granules being administered gave a recovery of 74%‐98%.ConclusionsThe administration of hydrocortisone through NG tubes is possible; however, current methods deliver a variable dose of hydrocortisone, generally less than that prescribed. Attention should be placed on the technique used to optimize drug delivery such as flushing of the administering syringe. Hydrocortisone granules block small NG tubes but behaved as well as the commonly used liquid suspension when prepared with a filtering needle that filters out granules.
Highlights
Long‐term treatment with hydrocortisone is required in chil‐ dren with adrenal insufficiency and treatment starts from birth in neonates with congenital adrenal hyperplasia
For hydrocortisone administration via the NG route, the preparations most commonly used in paediatric practice are liquid suspensions available as special unlicensed formulations and tablets crushed into a fine pow‐ der and mixed with water.[9,10,11,12]
This study investigated the in vitro recovery of hydrocortisone after pas‐ sage through NG tubes of varying bore for three different hydrocor‐ tisone preparations; a liquid suspension (Rosemont Pharmaceuticals Ltd, Braunton, UK), crushed hydrocortisone tablets mixed with water (Auden McKenzie (Pharma Division) Ltd, Barnstaple, UK) and hydro‐ cortisone granules (Alkindi, Diurnal Ltd, Cardiff, UK)
Summary
Long‐term treatment with hydrocortisone is required in chil‐ dren with adrenal insufficiency and treatment starts from birth in neonates with congenital adrenal hyperplasia. Replacement therapy with oral hydrocortisone is generally given in 3‐4 daily doses.[1,2,3] The administration of oral hydrocortisone in young children may require a nasogastric (NG) tube during inter‐current illness, and treatment. With hydrocortisone to reduce bronchopulmonary dysplasia in pre‐ mature infants is becoming more popular[4]; there are no licensed formulations for administration via NG tube. Inaccuracy in the hydrocortisone dose delivered leads to under‐ or over‐ replacement and is associated with poor disease control and potentially poor long‐term health outcomes.[6,7,8] For hydrocortisone administration via the NG route, the preparations most commonly used in paediatric practice are liquid suspensions (syrup) available as special unlicensed formulations and tablets crushed into a fine pow‐ der and mixed with water.[9,10,11,12] A multi‐particulate immediate‐release formulation of hydrocortisone has been developed for oral administration to neonates, infants and young children.[13,14] This study investigated the in vitro recovery of hydrocortisone after pas‐ sage through NG tubes of varying bore for three different hydrocor‐ tisone preparations; a liquid suspension (Rosemont Pharmaceuticals Ltd, Braunton, UK), crushed hydrocortisone tablets mixed with water (Auden McKenzie (Pharma Division) Ltd, Barnstaple, UK) and hydro‐ cortisone granules (Alkindi, Diurnal Ltd, Cardiff, UK)
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