抗高血压药物不同缓控释剂型在鼻饲中的应用

The use of antihypertensive drugs with different sustained and controlled release dosage forms in nasal feeding

抗高血压药物的口服固体制剂在鼻饲患者中存在许多不合理用药现象。许多固体制剂因其特殊的制药技术,不能掰开、研磨后鼻饲。本文通过查阅相关文献,阐述口服药物体内的释药过程,归纳总结了几类抗高血压药物缓控释制剂的类型和结构特点,并尝试探讨药物不同缓控释类型在鼻饲使用中的特点,为全科医生在临床工作中提供合理用药参考。缓控释制剂主要有骨架型缓控释制剂、膜控型缓控释制剂、渗透泵型缓控释制剂、肠溶型控释制剂、微丸控释制剂几大类。目前常用的硝苯地平缓控释制剂主要为拜耳公司的进口原研药渗透泵型硝苯地平控释剂(拜新同,Adalet),国产硝苯地平缓释剂为亲水凝胶型骨架型缓释剂,控释片为渗透泵型控释剂。常用的美托洛尔为阿斯利康公司的进口原研药酒石酸美托洛尔片(倍他乐克)和琥珀酸美托洛尔缓释片(倍他乐克缓释片),分别为普通片剂和骨架微丸型控释剂,国产酒石酸美托洛尔主要为基于渗透压释药原理的以羟丙甲纤维素(hydroxypropyl methyl cellulose,HPMC)或乙基纤维素(ethyl cellulose ethoce,EC)为骨架的缓释制剂或胶囊剂。缓控释制剂因其研磨后,不同程度破坏其缓控释结构,药物快速入血,加之单片剂量为普通片剂数倍,带来极大副反应,禁止研磨鼻饲使用,尤其是渗透泵型控释片。有刻痕的骨架型缓释片可掰服,禁止研磨。

The oral solid preparation of antihypertensive drugs has many unreasonable uses in patients with nasal feeding.Most solid preparations cannot be broken and ground after nasal feeding due to their special pharmaceutical technology.In this paper,referring to relevant literature,we summarized the types and structural characteristics of several types of antihypertensive drugs slow and controlled release preparation.To explore the characteristics of different controlled release types of drugs in the use of nasal feeding,and to provide a reference for general practitioners to use the drugs rationally in clinical work.The main types of sustained-release formulations are skeletal sustained-release formulations,membrane controlled-release formulations,osmotic pump sustained-release formulations,enteric-release controlled-release formulations and pellet controlled-release formulations.The commonly used nifedipine controlled release preparations mainly include Bayer company’s imported original research drug osmotic pump nifedipine controlled release agent(Adalet),domestic nifedipine sustained release agent for hydrophilic gel matrix type sustained release agent,controlled release tablets for osmotic pump type-controlled release agent.Commonly used metoprolol for imported drugs which Swiss astrazeneca company tartrate metoprolol and succinic acid metoprolol(Betaloc)are ordinary tablets and skeleton type micro pill respectively controlled release agent.And the domestic tartrate metoprolol is mainly based on osmotic pressure release principle with hydroxypropyl methyl cellulose(HPMC)/ethyl cellulose ethoce(EC)as the skeleton of sustained release preparation or capsule preparation.Delayed and controlled release preparation is prohibited to be used for grinding nasal feeding,especially osmotic pump controlled release tablets,because the delayed and controlled release structure is damaged to varying degrees after grinding,the drug enters the blood quickly,and the single dose is several times that of ordinary tablets,which brings great side effects.The frame type sustained-release tablets with scratches can be snapped off and do not grind.