{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T02:53:43Z","timestamp":1768791223251,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,1,30]],"date-time":"2012-01-30T00:00:00Z","timestamp":1327881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To determine whether the absorption of four antiretroviral agents\u2014raltegravir, etravirine, emtricitabine, and tenofovir\u2014is compromised when administered by gastrostomy tube.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Pharmacokinetic analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>University medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient<\/jats:title><jats:p>A 52\u2010year\u2010old African\u2010American man coinfected with advanced multidrug\u2010resistant human immunodeficiency virus (<jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>) and chronic hepatitis B, who was receiving treatment with raltegravir, etravirine, emtricitabine, and tenofovir, and developed ulcerative esophagitis with perforation, requiring a gastrostomy tube.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Due to the patient's esophageal perforations, all nutrition and drug therapy had to be provided by gastrostomy tube. As his antiretroviral regimen of raltegravir, etravirine, and emtricitabine\u2010tenofovir was not available in liquid or powder formulations, the oral tablets were crushed or dispersed and mixed with water, then administered by gastrostomy tube. To ensure that the absorption of the drugs was sufficient for antiretroviral response, plasma samples were collected at 2\u00a0hours and 12\u00a0hours after dosing, and drug concentrations were quantitated by using validated assays. The 2\u2010 and 12\u2010hour postdose plasma concentrations were 1220 and 446\u00a0ng\/ml for raltegravir, 212 and 274\u00a0ng\/ml for etravirine, 1148 and 164\u00a0ng\/ml for emtricitabine, and 320 and 94\u00a0ng\/ml for tenofovir, respectively. The patient's plasma concentrations were then compared with those in published pharmacokinetic studies of oral regimens administered to <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010infected persons and healthy volunteers. Overall, the plasma concentrations of the antiretrovirals administered by gastrostomy tube were similar to published values. No drug toxicities were observed in this patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These pharmacokinetic data suggest that absorption of raltegravir, etravirine, emtricitabine, and tenofovir was not compromised when the drugs were administered by gastrostomy tube. These findings provide a basis for further investigation of the pharmacokinetics, safety, tolerance, and antiretroviral response to raltegravir, etravirine, and emtricitabine\u2010tenofovir when the oral route of administration is not possible.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1015","type":"journal-article","created":{"date-parts":[[2012,9,5]],"date-time":"2012-09-05T03:54:46Z","timestamp":1346817286000},"page":"142-147","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Acceptable Plasma Concentrations of Raltegravir and Etravirine When Administered by Gastrostomy Tube in a Patient with Advanced Multidrug\u2010Resistant Human Immunodeficiency Virus Infection"],"prefix":"10.1002","volume":"32","author":[{"given":"Uriel","family":"Sandkovsky","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Swindells","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Moore","sequence":"additional","affiliation":[{"name":"the College of Pharmacy University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward P.","family":"Acosta","sequence":"additional","affiliation":[{"name":"the Division of Clinical Pharmacology University of Alabama at Birmingham Birmingham Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney V.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"the Antiviral Pharmacology Laboratory University of Nebraska Medical Center Omaha Nebraska"},{"name":"the College of Pharmacy University of Nebraska Medical Center Omaha Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,1,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0005575"},{"key":"e_1_2_8_3_1","unstructured":"National Institutes of Health Panel on Antiretroviral Guidelines for Adults and Adolescents.Guidelines for the use of antiretroviral agents in HIV\u20101\u2010infected adults and adolescents January 10 2011. 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