Michael Hodgman1,2,3, Michael G Holland4,5, Ulrich Englich6, Susan M Wojcik4, William D Grant4, Erich Leitner7. 1. Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA. hodgmanm@upstate.edu. 2. Upstate New York Poison Center, Department of Emergency Medicine, Upstate Medical University, 750 E. Adams St, Syracuse, NY, 13501, USA. hodgmanm@upstate.edu. 3. Emergency and Trauma Services, Bassett Medical Center, Cooperstown, NY, USA. hodgmanm@upstate.edu. 4. Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA. 5. Upstate New York Poison Center, Department of Emergency Medicine, Upstate Medical University, 750 E. Adams St, Syracuse, NY, 13501, USA. 6. Forensic and National Security Sciences Institute and Department of Chemistry, Syracuse University, Syracuse, NY, USA. 7. Institute of Analytical Chemistry and Food Chemistry, Graz University of Technology, Graz, Austria.
Abstract
INTRODUCTION: Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350 g/mol is used for WBI. PEG electrolyte lavage solution has been shown in vitro to hasten the dissolution of acetaminophen. The impact of PEG on the pharmacokinetics of extended release pharmaceuticals is unknown. Lower average molecular weight PEG mixtures are used as solvents and excipients. We sought to investigate the impact of PEG on the release of morphine from several extended release morphine formulations. METHODS: An in vitro gastric model was developed. To test the validity of our model, we first investigated the previously described interaction of ethanol and Avinza®. Once demonstrated, we then investigated the effect of PEG with several extended release morphine formulations. RESULTS: In the validation portion of our study, we confirmed an ethanol Avinza® interaction. Subsequently, we did not observe accelerated release of morphine from Avinza® or generic extended release morphine in the presence of PEG. CONCLUSION: The use of PEG for gastric decontamination following ingestion of these extended release morphine formulations is unlikely to accelerate morphine release and aggravate intoxication.
INTRODUCTION: Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350 g/mol is used for WBI. PEG electrolyte lavage solution has been shown in vitro to hasten the dissolution of acetaminophen. The impact of PEG on the pharmacokinetics of extended release pharmaceuticals is unknown. Lower average molecular weight PEG mixtures are used as solvents and excipients. We sought to investigate the impact of PEG on the release of morphine from several extended release morphine formulations. METHODS: An in vitro gastric model was developed. To test the validity of our model, we first investigated the previously described interaction of ethanol and Avinza®. Once demonstrated, we then investigated the effect of PEG with several extended release morphine formulations. RESULTS: In the validation portion of our study, we confirmed an ethanol Avinza® interaction. Subsequently, we did not observe accelerated release of morphine from Avinza® or generic extended release morphine in the presence of PEG. CONCLUSION: The use of PEG for gastric decontamination following ingestion of these extended release morphine formulations is unlikely to accelerate morphine release and aggravate intoxication.
Entities:
Keywords:
Delayed release preparations; Gastric decontamination; In vitro drug release; Modified release morphine; Morphine/pharmacokinetics; Whole bowel irrigation