6

1.
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
2.
2.1
2.2
2.3
3.
3.1
3.1.1.
3.1.2.
3.1.3.
3.1.4. Bulk - forming agent
3.1.5. Sodium polystyrene sulfonate
3.2
3.2.1.
3.2.2.
3.2.3.

3.2.4.
3.2.5.
3.2.6. phenytoin
1.

3 - 5


( , 2540)
1.1





(pancreatitis) (inflammatory bowel
disease)
(short bowel syndrome)

(villi)
(fistulas)

(anorexia nervosa)
(
, 2540; Janson , 1996)
1.2



(Janson,
1996)
1.3

- (nasogastric NG )
- (orogastric)
- (nasoduodenal ND)
- (nasojejunal NJ)
- (esophagostomy )
- (gastrostomy)
- (jejunostomy)
1


polyvinylchloride
gastroesophageal sphincter
(stylets)

dumping syndrome
sphincter

10

gastroesophageal sphincter sphincter

2 gastroesophageal pyloric sphincter
( , 2540)




(duodenal fistula)

Percutaneous endoscopic gastrostomy (PEG)


( , 2537)
1

11

( 6 )
- intact gag
reflex
-

-
-

-
-

-
-

-
- -

(6 )
-
- -

()
-
nasopharynge
-

- -
-

-
-

12

1 ( )

()
-

- -

intermittent ,
bolus -
continuous -
- -

()
-

: Janson , 1996

-
continuous
cyclic
-

13

1.4 ( , 2540)
3
1.4.1.

polyvinyl chloride (PVC) NG

(16 18 Fr.)
(pressure necrosis)
(endotracheal tube) PVC
gastroesophageal sphincter
gastric reflux
1.4.2.

polyurethane



12 Fr. polyurethane

polyurethane

1.4.3

silicone
polyurethane
silicone
polyurethane

1.5 ( , 2540)

1.5.1. (bolus feeding)


1.5.1.1. 30 - 45

14

1.5.1.2. 50 - 100
2 4
100 150 - 200
8 24
400
1.5.1.3.

1.5.1.4.
1.5.1.5. 4 - 6
1.5.2. (continuous feeding)



1.5.2.1 10 - 50 /
1.5.2.2
8 100

1.5.2.3 20 - 40 / 8 - 24
1 - 5
125 - 150 /
1.5 - 2 /
1.5.2.4 8 - 12

1.5.2.5




2 - 3

15

Isotonic
osmolality
osmolality
1.5.3. (intermittent infusion)

250 - 400
20 - 40 5 - 8 16 - 24

1 - 2

2 - 4
dumping syndrome

50
isotonic
isotonic
25 / 8 - 12



1.5.4. (bolus infusion)
250 400 5 - 8 2 - 3

1.6 ( , 2540)

0.5 - 1

16

8 - 12

24

1.7 ( , 2540)

peristalsis microprocessor




1.8 ( , 2540)

17

1

30 1

30
2 - 4
10


100
30 - 60
100

2.
3
2.1

6
2.1.1

decongestants (
, 2540)
2.1.2
15 - 30
4

18

50

( , 2537)
2.1.3

polyethylene polyvinyl chloride

( 8 - 14 F)
(
, 2537)
2.1.4
eustachian
1 - 2 ( , 2537)
2.1.5

2.1.5.1
2.1.5.2

2.1.5.3

2.1.5.4 24 ( , 2537)
2.1.6

30
( , 2540)
2.2. ( , 2537)

19

2.2.1

2.2.1.1
(epigastrium)


(pneumothorax)

10 - 15 30 - 50

2.2.1.2 30
30 2
25
2.2.1.3

6 - 8 75
metoclopamide
duodenum
pyloric sphincter
duodenum duodenum

duodenum
2.2.2

2.2.2.1
lactobacillus acidophilus 3 /

20

2.2.2.2

2.2.2.3 osmolality
2.2.2.4

lactose lactase
osmotic
2.2.2.5 albumin 2.7 / albumin
12.5 - 50 / 2 - 4 albumin 2.7 /

2.2.2.6

2.2.2.7 12

2.2.2.8
2.2.3 (gastric retention)
6 - 8 12
100



metoclopamide (10 6 )

2.2.4 Dumping syndrome
60
/

21

2.3.
( , 2540)

4 - 14







2 3

3.

3.1
3.2
3.1

(liquid dosage form) (Lehmann,
et al., 1991) (solid dosage form)


(Marcuard, et al., 1988) Marcuard

22

(1990) 63


(simple compressed tablets)
(hard gelatin capsule) (soft
gelatin capsule) (Lehmann, et al., 1991; Mateo,1996)

3.1.1
3.1.2
3.1.3
(Mitchell, et al., 1994;
Mitchell, 1996)
3.1.1
1 1
(dose)

8 - 12
( , 2531)

3.1.1.1 (multi - layer tablet)

3.1.1.2 (matrix)

(diffiusion) (erosion)
(hydrogel matrix)


( , 2535)

23

3.1.1.3 mixed release pellets pellets

membrane polymer
pellets pellets polymer
pellets polymer
pellet
( , 2539)

(Lehmann, et al., 1991; Estoup, 1994;
Mitchell, et al., 1994; Seifert, et al., 1995; Mitchell, 1996);
(Mitchell , 1996)
CR
Controlled release
CRT
Controlled release tablet
LA
Long acting
MR
Modified release
SR
Sustained release
TR
Time release
TD
Time delay
SA
Sustained action
XL
Extended release
XR
Extended release

chrono , durule , retard
2

24

Alfuzosin HCl

Xatral SR

Xatral

XL

Sanofi - Synthelabo

5 .

Sanofi - Synthelabo

10 .

Mack

75 .

Will Pharma/SPB Pharma

500 .

Yamanouchi

10,15 .

Ambroxol HCl

Bronchopront

Ascorbic acid

C - will

Barnidipine HCl

Hypoca

Bezafibrate

Bezalip retard Roche

Carbidopa
Levodopa

Sinemet CR

Cefaclor monhydrate

Distaclor MR

Cefaclor

Vercef MR

Clarithromycin

Klacid

Codeine
Phenyltoloxamine

Codipront

Co - dergocrine

Perenan

Diclofenac sodium

Remethan

Voltaren SR

400 .

Merck Sharp & Dohme

(carbidopa
50 .
levodopa 200 .)

E li Lilly

375 .

Ranbaxy unichem

375 .

Abbott

500 .

Mack

(codeine
300 .
phenyltoloxamine 10 .)

Sanofi - Synthelabo

2.5 .

Remedica

100 .

Novartis

75 .

25

2 ()

Diltiazem HCl

Angizem

Cardil CR

Cascor XL

Dilem SR

Herbesser 90 SR

D - norpseudoephedrine Mirapront

Felodipine

Plendil

Fluvastatin

Lescol

Gliclazide

Diamicron MR

Indapamide

Natrilix SR

Isosorbide dinitrate

ISO - MACK retard

XL

Monolin SR

Monotrate OD
Isosorbide - 5 - mononitrate

Imdur

Isoxsuprine resinate

Duvadilan

Ketoprofen

Oruvail 100

Sun Pharma

30,60 .

Orion

120 .

Ranbaxy Unichem

120,180,240 .

Douglas/TTN

60,120 .

Tanabe Seiyaku

90 .

Mack

20 .

AstraZeneca

2.5, 5 ,10

Novartis

80 .

Servier

30 .

Servier

1.5 .

Mack

20,40 .

Berlin Pharm

20,40,60 .

Sun Pharma

50 .

Astra Zeneca

,
Durule 60 .

Duphar - Interfran

40 .

Aventis Pharma

100 .

*
*

26

2 ()

Metoprolol tartrate

Metoprolol 100 mg

Stada

100 .

Metoprolol 200 mg

Stada

200 .

Morphine sulfate

Mst contnustm 10 mg

Astamedica

10 .

Nicardipine HCl

Cardepine

Nifedipine

Adalat CR

Westmont/Great Eastern 40 .

Adalat Retard

Calcigard

Fenamon SR

Nifecard retard

Nifecard T20

Nifelat R

Nyefax

Orphenadrine HCl

Norflex

Pentoxifylline

Agapurine

Flexital
Trental
Phentermine resinate

400

Phentermine trenker

Phenylephrine HCl ,
Rhinopront
Carbinoxamin maleate

*,

Bayer

30 ,60 .

Bayer

20 .

Torrent

20 .

Medochemie

20 .

Lek

20 .

Stada

20 .

Remedica

20 .

Douglas/TTN

20 .

3M Pharma

100 .

Slovakofarma

400 .

Sun Pharma

400 .

Aventis Pharma

400 .

Trenker

15,30 .

Mack

(4 + 20 . )

27

2 ()

Piribedil

Trivastal retard

Servier

50 .

Potassium chloride

Addi K

Leo

50 .

Propranolol HCl

Inderal LA

Astra Zeneca

80 ,160 .

Salbutamol

Volmax

GlaxoSmithkline

4 .

Sodium vaproate

Depakine chrono

Sanofi - Synthelabo

500 . ,

Theophylline

Aerobinmite

Pharmasan / TTN

200 .

3 M Pharma

200 , 250 .

Orion
SMB

200,300 .
,
200 ,400 .

ASTA Medica

50,100,150 .

retard

Sanofi - Synthelabo

100 .

XR

Wyeth - Ayerst

75 .

Nuelin SR

Retafylline CR
Xanthium
Tramadol HCl

Tradonal

Tramal

SR

*
*

Venlafaxine HCl

Efexor

Vitamin C ,
Bioflavonoids ,

Blackmores Naturetime Buffered C

Vitamin B1 , B2 , B6
Nicotinamide ,

Blackmores Naturetime B complex

Blackmores

Blackmores

28

2 ()

Vitamin B1 , B2 , Blackmores B complex multivitamins

B3 , B5 , B6 , B12 ,
C , D , E ,

Blackmores

: MIMS Thailand (2002)

Seifert (1995)
Oklahoma 231 50

Mateo (1996)

midwestern 235 40
Belknap (1997)

1,167
50.9 1
14.6

29

(immediate - release dosage form)
1.
2. dosing interval 1 - 2

3. 1 2 24
4. 1
theophylline SR 400 2
theophylline = 4.5
1. theophylline 400 x 2 = 800
2. dosing interval 1 - 2
1.5 x 4.5 = 6
3. 24 6 = 4
4. = 800 4 = 200 /
theophylline 400 2
200
6
(Estoup, 1994)

30

3.1.2



(
, 2531)

(Lehmann, et al., 1991; Mitchell, et al., 1994; Seifert, et al.., 1995;
Belknap, et al., 1997)

(Beckwith, et al., 1997)

3
3

Aspirin

Aspent

Aspent M

Entrarin

Seferin 5

Seferin 10

V - AS

Ranbaxy Unichem

300 .

Ranbaxy Unichem

60 .

Asiam Pharm

300 .

General Drug House

325 .

General Drug House

650 .

Progress Lab

300 .

31

3 ()

Bisacodyl

Dulcolax

Emulax

Bisacodyl

Codergocrine

Hydergine FAS

Diclofenac

Amminac

Arclonac

Demac

Diclosian

Difelene

Difenac

Difeno

Dosanac

Fenac

Infanac

Medaren

Posnac

Putaren

Remethan
Rumatab

Veenac 25,50

Voltanac

Voltaren

Voltamed
Didanosine (DDI)

Videx EC

Boehringer Ingelheim

5 .

British Dispensary

5 .

GPO

5 .* ,

Novartis

4.5 . *

MacroPhar

25 .

Condrugs

25,50 .

Osotspa

25 .

AsiaPharm

25,50 .

ThaiNakornPatana

25,50 .

TP Drug

25,50 .

Milano

25 .

Siam Bheasach

25* , 50 .

LBS

25,50 .

Biolab

25 .

Medical Supply

25 .

Pose

25,50 .

Thai PD Chemicals

25 .

Remedica

25 .

Pharmaland

25,50 .

Progress Lab

25,50 .

Pharmasant Lab

25,50 .

Novartis

25,50 .

Medifive

25 .

Bristol - Myers Squibb

250.*, 400 .*

32

3 ( )

Dimenhydrinate

Vominar

Erythromycin

Ery - tab

Esomeprazole

Nexium

Indomethacin

Metindo

Lansoprazole

Prevacid

Charoen Bhaesaj

50 .

Abbott

250 .

AstraZeneca

MUPS 20 ,40 .

Kenyaku

2 .

Takeda Chemical

15,30*.

industries

Mesalazine

Salofalk

Omeprazole Mg

Losec MUPS

Omeprazole

Miracid

Papain + pepsin

Papytazyme

Potassium chloride

Enpott

Serratiopeptidase

Danzen

Danzyme 5

Danzyme 10

Medizyme

Rodase

Seramed

Serradase

Serrapep

Serrin

ECT

Falk

250,500 .

Astra Zeneca

20 .*

Berlin Pharm

20 .*

Anglo - FrenchDrugs

(30 + 50 . )

Ranbaxy Unichem

500 .

Takeda

5 .

Progress Lab

5 .

Progress Lab

10 .

Utopian

5 .

Pond's Chemical

5 .

Medifive

5 .*

Siam Bheasach

5 .

Asian Pharm

5 .

MacroPhar

5 .

33

3 ()

Sodium vaproate

Depakine

Sulfasalazine

Salazopyrine EN

Viable organisms
of attenuated S thypi
strain Ty 21 a Berna

Vivotif Berna

Sanofi - Synthelabo

200 .*

Pharmacia

500 .

Berna/Swiss serum

MUPS multiple units pellet system

Seifert (1995) 78

Mateo (1996) 58
Belknap
(1997) 69
1 20.6

34

3.1.3


(first
pass effect)
bioavailability

(Lehmann, et al ., 1991)

(Lehmann, et al., 1991; Mitchell, et al., 1994)
4

Buprenorphine HCl

Temgesic

Isosorbide dinitrate

Hartsorb

Isordil

Isorem

Schering - Plough

0.2 .

Siam Bheasach

5 .

Wyeth - Ayerst

5 .

Remedica

5 .

35

3.1.4 Bulk - forming agents

bulk psyllium ( Metamucil)
(semisolid mass)
( , 2543; Lehmann, et al., 1991; Roy, et al., 1999)
3.1.5 sodium polystyrene sulfonate
sodium polystyrene sulfonate 2
sorbitol sorbitol

(Roy, et al., 1999)
3.2
3.2.1

15 - 30 ( 5 - 10 )
(Lenmann, et al., 1991; Varella, et al ., 1997; Roy, et al., 1999)
30 - 60 (Seifert, et al., 1995)
(Krupp,
et al., 1998)
Seifert (1995)
31 Mateo(1996)
53 Belknap (1997)
56.8
3.2.2

5 3
(Lehmann, et al., 1991; Roy, et al., 1999)

36

3 - 10 (Varella, et al ., 1997)

(Belknap, et al ., 1997)

Seifert (1995)
56.5 Mateo (1996) 62 Belknap (1997)
67.6
3.2.3

(Mirtallo, et al., 1986
Estoup,1994) 20
hypertonic
(Niemiec, et al., 1983
Estoup, 1994)
Edes (1990)
123 32 ( 26)
56
osmolality
Dickerson (1988) osmolality
58
5 8 osmolality 1,000 mOsm/kg
1,000 - 10,950 mOsm/kg osmolality
127 - 357 mOsm/kg 6
hypertonic duodenum
lumen duodenum

osmotic

37

5 Osmolality

Acetaminophen elixir, 65 mg/mL

Acetaminophen with codeine elixir
Amantadine hydrochloride solution, 10 mg/mL
Aminophylline liquid, 21 mg/mL
Amoxacillin suspension, 50 mg/mL
Ampicillin suspension, 50 mg/mL
Ampicillin suspension, 100 mg/mL
Belladonna alkaloids elixir
Calcium glubionate syrup, 0.36 g/mL
Cascara Sagrada Aromatic Fluidextract
Cephalexin suspension, 50 mg/mL
Chloral hydrate syrup, 50 mg/mL

Roxane
Wyeth
Du Pont
Fisons
Squibb
Squibb
Bristol
Robins
Sandoz
Roxane
Dista
Pharmaceutical
Associates
Smith Kline & French
Burroughs Welcome
Organon
Roxane
Parke-Davis
Burroughs Welcome
Roxane
Roxane
Pharmaceutical
Associates
Roxane
Abbott
Roxane
Scuibb
Hoechst-Roussel
Roxane
McNeil
Roerig

Cimetidine solution, 60 mg/mL

Co-trimoxxazole suspension
Dexamethasone elixir, 0.1 mg/mL
Dexamethasone solution, 1 mg/mL
Dextromethorphen hydrobromide syrup. 2 mg/mL
Digoxin elixir, 50 g/mL
Diphenydramine hydrochloride elixir, 2.5 mg/mL
Diphenoxylate hydrochloride-atropine sulfate suspension
Docusate sodium syrup, 3.3 mg/mL
Dcousate sodium syrup, 3.3 mg/mL
Erythromycin ethylsuccinate suspension, 40 mg/mL
Ferrous sulfate liquid, 60 mg/mL
Fluphenazine hydrochloride elixir, 0.5 mg/mL
Furosenmide solution, 10 mg/mL
Kaolin-pectin suspension
Haloperidol concentrate, 2 mg/mL
Hydroxyzine hydrochloride syrup, 2 mg/mL

Osmolality
5400
4700
3900
450
2250
2250
1850
1050
2550
1000
1950
4400
5550
2200
3350
3100
5950
1350
850
8800
4700
3900
1750
4700
1750
2050
900
500
4450

38

5 ()

Lactulose syrup, 0.67 g/mL

Lithium citrate syrup, 1.6 meq/mL
Magnesium citrate solution
Methyldopa suspension, 50 mg/mL
Metoclopramide hydrochloride syrup, 1 gm.mL
Milk of magnesia suspension

Roerig
Roxane
Medalist
Merck Sharp & Dohme
Robins
Pharmaceutical
Associates
Upjohn
Squibb
Roxane
Parke-Davis
Parke-Davis
Willen
Adria
Roxane
Roxane
Roxane
Upsher Smith
Ayerst
Smith Kline & French
Wyeth
PFI Pharmaceutics
Roche
Willen
Fleet
Berlex
Pharmaceutical
Associates
Merck Sharp & Dohme
Sandoz
LyphoMed

Multivitamin liquid
Nystatin suspension, 100,000 units/mL
Paregoric tincture
Phenytoin sodium suspension, 6 mg/mL
Phenytoin sodium suspension, 25 mg/mL
Potassium-sodium citrate solution
Potassium chloride liquid, 10%
Potassium chloride liquid, 10%
Potassium chloride liquid, 10%
Potassium chloride liquid, 10%
Potassium iodide saturated solution, 1 g/mL
Primidone suspension, 50 mg/mL
Prochlorperazine syrup, 1 mg/mL
Promethazine hydrochloride syrup, 1.25 mg/mL
Pyrantel pamoate suspension, 50 mg/mL
Pyridostigmine bromide syrup, 12 mg/mL
Sodium citrate liquid
Sodium phosphate liquid, 0.5 g/mL
Theophyllin solution, 5.33 mg/mL
Theophyllin solution, 5.33 mg/mL
Thiabendazole suspension, 100 mg/mL
Thioridazine suspension, 20 mg/mL
Trace element injection

: Dickerson, et al., 1988

Osmolality
3600
6850
1000
2050
8350
1250
5700
3300
1350
2000
1500
2700
3000
3300
3450
3550
10950
450
3250
3500
4350
3800
2050
7250
800
600
2150
2050
500

39

6 Osmolality

Osmolality
(mOsm/kg) *

127
282
284
349
320
285
292
357

35
22
17
40
10
10
12
37

*
: Dickerson, et al ., 1988
osmolality

(intragastric juice)


(Dickerson, et al., 1988)
(sterile water) 10 - 30
osmolality (500 - 600 mOsm/kg)
osmotic osmolality
(Estoup, 1994)

40

Osmolality
(Estoup, 1994)
()

() x mOsm ()
mOsm ( )

() - ()

10 osmolality 2000 mOsm/kg

osmolality 500 mOsm/kg
()
=
10 x 2000 mOsm/kg
500 mOsm/kg
=
40
=
=

40 - 10
30

osmolality
potassium chloride
osmolality 3000 - 4300 mOsm/kg ( )
30 150 - 228
(Dickerson , et al ., 1988)
osmolality 30
(Varella, et al., 1997; Roy, et al ., 1999)

10 - 30
(Rombeau, et a ., 1979 Seifert, et al ., 1995)
Seifert (1995)
41 Belknap
(1997) 40

41

3.2.4


sodium
chloride potassium chloride

(Lehmann, et al., 1991; Roy, et al ., 1999)



Gora (1989) Wright (1986) 15
( Belknap , et al ., 1997) phenytoin
2 (Melnik , 1990)



Seifert (1995)
4 1.9
3.2.5

3.2.5.1

15 - 30
5 - 10 (Lehmann, et al., 1991; Varella, et al., 1997;
Roy, et al., 1999)
3.2.5.2

42

15 - 30 5 - 10
(Lehmann , et al ., 1991)
3.2.5.3

15 - 30 5 - 10

(Lehmann, et al ., 1991)
3.2.6. phenytoin
phenytoin
phenytoin (post traumatic epilepsy)

(Young, et al., 1979) phenytoin

(Louis, et al., 1967; Bivins, et
al., 1978)
(Kostenbauder, et al., 1975) phenytoin
Bauer
(1982) 20
5 10
phenytoin
1000 300 7
7
2.59 10.22
(p < 0.0001) 10
phenytoin
7
7

43

9.80 2.27
(p < 0.0001) phenytoin
400 3

phenytoin (p < 0.002)
O'Hagan (1993)
13 Lennox - Gastaut Syndrome
phenytoin 250
3.3 / 500
(19.4 /)
2 28.0
300 (19.7 )
Yeung (2000)
phenytoin
MEDLINE . 1966
. 2000
(25 29 )
phenytoin

phenytoin
Yeung (2000)
phenytoin

1 - 2 (normal saline)
20 1 - 2
phenytoin
phenytoin

44

phenytoin
1 - 2 1 - 2 (Lehmann,
et al., 1991; Varella, et al., 1997; Roy, et al., 1999)
Varella (1997) 60
phenytoin