Severe gastroparesis may impact absorption of an orally administered drug.
Impact of gastroparesis:
(1) decreased drug absorption from an orally administered dose
(1a) accumulation of tablets in the stomach (including pharmacobezoar)
(1b) drug decomposition in the stomach
(1c) drug incompatibility with food in the stomach
(2) erratic drug absorption and blood levels
(3) drug-induced damage to the gastric mucosa
A drug may be well-absorbed by the oral route, even in the presence of severe gastroparesis. The impact of gastroparesis can only be determined by monitoring the patient.
Recommendations:
(1) Monitor drug levels in blood.
(2) Consider use of a prokinetic drug to aid gastric emptying.
(3) Consider an alternative means of drug delivery.
Alternative means of drug delivery:
(1) drug admininstration through an enteral feeding tube
(2) transdermal
(3) buccal
(4) suppository or drug enema
(5) parenteral (subcutaneous, intravenous or intramuscular injection)
