NHS FORTH VALLEY Guidelines for use of high dose Intravenous Esomeprazole in Adults (Previously called the Hong Kong Protocol)

Transcription

1 NHS FORTH VALLEY Guidelines for use of high dose Intravenous Esomeprazole in Adults (Previously called the Hong Kong Protocol) Date of First Issue 10/05/2010 Approved 16/06/2010 Current Issue Date 18/11/2015 Review Date 18/11/2017 Version Version 1.00 EQIA Yes Aug 2010 Author / Contact Pauline Morrison/Dr S Morrison Group Committee Final Approval Forth Valley Acute DTC This document can, on request, be made available in alternative formats Version th November 2015 Page 1 of 5

2 NHS Forth Valley Consultation and Change Record Contributing Authors: Consultation Process: Dr. H. Dalziel Pharmacy/GI unit DTC members Distribution: Intranet, paper uncontrolled copies to all relevant ward areas Change Record Date Author Change Version Version th November 2015 Page 2 of 5

3 Guidelines for use of high dose Intravenous Esomeprazole in Adults (Previously called the Hong Kong Protocol) (Nexium I.V. 40 mg Powder for solution for injection/infusion) Indication: Approval: Administration: Monitoring: Cautions: Post endoscopy WHEN Actively bleeding duodenal or gastric ulcer seen OR definite nonbleeding visible vessel (protuberant raised discolouration) AND Endoscopic haemostasis performed and successfully achieved. All use must be approved by a Consultant/SpR in Gastroenterology/GI surgery. The instruction to commence the Hong Kong protocol will usually be on the endoscopy report. It is not for use preendoscopy. Initial loading dose of 80mg IV esomeprazole. A solution for infusion is prepared by dissolving the content of two vials of esomeprazole 40 mg in up to 100 ml of 0.9% sodium chloride for intravenous use. The reconstituted solution for infusion is clear and colourless to very slightly yellow and should be given as a continuous intravenous infusion over 30 minutes. THEN 8mg / hour for 72 hours. This infusion is made as above ie 80mg in 100mls and run at 8mg/hr (10ml/hr) for 10 hours and then changed. The infusion is stable for 10 hours once reconstituted. THEN Continue healing dose of proton pump inhibitor orally for 8 weeks. First line is omeprazole 40mg daily and eradicate Helicobacter pylori if indicated. As for high risk upper GI bleed and IV lines. No special monitoring is needed for IV esomeprazole. Use with caution if abnormal liver function (may provoke encephalopathy). Avoid in pregnancy (teratogenic in animals) and breast feeding. Possible side effects: GI side effects (common): diarrhoea or constipation, abdominal pain, flatulence, nausea, vomiting, stomatitis, GI candidiasis. Headache (common), parasthesia, dizziness, light headedness, insomnia, vertigo, confusion (reversible), agitation, depression, hallucinations. Rash, urticaria, itch. See SPC for other adverse effects. Administration site reactions have mainly been observed in a study with high-dose exposure over 3 days (72 hours). Irreversible visual impairment has been reported in isolated cases of critically ill patients who have received omeprazole (the racemate) Version th November 2015 Page 3 of 5

4 intravenous injection, especially at high doses, but no causal relationship has been established. Drug interactions: Enhanced effects of warfarin, phenytoin, diazepam (reduced clearance), Digoxin (approx 10% increased bioavailability), tacrolimus (increased concentration).reduced effects of ketoconazole and itraconazole (reduced absorption). Theoretical interaction to reduce efficacy of clopidogrel but this does not warrant withholding IV esomeprazole therapy. Version th November 2015 Page 4 of 5

5 Publications in Alternative Formats NHS Forth Valley is happy to consider requests for publications in other language or formats such as large print. To request another language for a patient, please contact For other formats contact , text , fax or - fv-uhb.nhsfv-alternativeformats@nhs.net Version th November 2015 Page 5 of 5