A Simple Suspension Method for Valganciclovir Administration ― Stability of Valganciclovir Mixed with Other Medicines ―

Abstract

A simple suspension method has been developed for the administration of tablets and capsules through a nasogastric tube. Tablets or capsules were suspended in hot water (55℃) without grinding or opening. Valganciclovir hydrochloride (VALIXA\textregistered{}), a drug often prescribed to protect patients from cytomegalovirus infection after organ transplantation, was dispensed via a crushing method to recipients unable to take food or liquids by oral administration. The interaction of VALIXA\textregistered{}tablets with other medicines in a simple suspension has not been investigated, even though VALIXA\textregistered{}is commonly used in combination with immune-suppressant drugs and several other medicines. Thus, we sought to examine the effect of co-administering suspensions of drugs combined with VALIXA\textregistered{}tablets prescribed for transplant recipients. Valganciclovir hydrochloride was mixed with a variety of other therapeutics including prednisolone (PREDONINE\textregistered{}tablets), ursodeoxycholic acid (URSO\textregistered{}granules), sulfamethoxazole--trimethoprim (BAKTAR\textregistered{}granules), mycophenolate mofetil (CELLCEPT\textregistered{}capsules), tacrolimus (PROGRAF\textregistered{}capsules), sucralfate (ULCERLMIN\textregistered{}fine granule), and fluconazole (DIFLUCAN\textregistered{}capsules), and the residual content of valganciclovir was evaluated by a high performance liquid chromatography assay. Our results indicated that over 90％ of the original valganciclovir remained in the drug mixture suspension. In a practical test of delivering such suspensions by nasogastric tube, we observed that suspensions did not block either the catheter or injection syringe, and upon flushing, no residual drug suspension remained in the device. In conclusion, this study suggests that VALIXA\textregistered{}tablets in combination with a variety of other medicines may be administered to patients by a simple suspension method.