{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:48:19Z","timestamp":1782406099509,"version":"3.54.5"},"reference-count":9,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Tirabrutinib, an oral Bruton\u2019s tyrosine kinase inhibitor, is used in the treatment of relapsed or refractory primary central nervous system lymphoma (PCNSL) and other B cell malignancies. Although this medication is also administered to older patients, those experiencing dysphagia may require nasogastric administration via a tube. The impact of different administration routes on pharmacokinetics remains a pertinent clinical concern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>An 82-year-old male patient with relapsed PCNSL initiated tirabrutinib at 320\u2005mg\/day under fasting conditions. While the patient was initially able to swallow tablets, progression of dysphagia necessitated a switch to nasogastric administration using the simple suspension method. Serum tirabrutinib concentrations were determined 11\u2005hours after administration by each route using liquid chromatography followed by tandem mass spectrometry and compared. The serum concentration increased from 83.2\u2005ng\/mL with oral administration to 191\u2005ng\/mL with nasogastric administration, representing an increase of more than 2-fold. The dose, concomitant medications, and sampling conditions were consistent. On day 19, a rash developed that was suspected to be drug induced, prompting discontinuation of tirabrutinib; however, the serum concentration with nasogastric administration was not markedly higher than the previously reported mean 12-hour concentration of around 120\u2005ng\/mL. The observed increase in tirabrutinib concentration may primarily reflect enhanced dispersion with the simple suspension method, leading to improved absorption. Potential auxiliary factors, such as changes in absorption rate or inter-individual variability, cannot be excluded. Although a rash occurred, it is unlikely to represent an adverse event due to excessive exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tirabrutinib concentrations may increase with nasogastric administration using the simple suspension method. In patients unable to ingest tablets orally, careful clinical monitoring is warranted, and therapeutic drug monitoring may be considered in select cases. The accumulation of further cases and pharmacokinetic investigations are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajhp\/zxag190","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:45:31Z","timestamp":1781783131000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of nasogastric administration using the simple suspension method on serum tirabrutinib levels: A case report"],"prefix":"10.1093","author":[{"given":"Hideaki","family":"Yashima","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine , Maebashi , , Maebashi ,","place":["Japan"]},{"name":"and Department of Pharmacy, Gunma University Hospital , Maebashi , , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Araki","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine , Maebashi , , Maebashi ,","place":["Japan"]},{"name":"and Department of Pharmacy, Gunma University Hospital , Maebashi , , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Kaneta","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Gunma University Hospital , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Takei","sequence":"additional","affiliation":[{"name":"Department of Hematology, Gunma University Graduate School of Medicine , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiko","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Hematology, Gunma University Graduate School of Medicine , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuri","family":"Miyazawa","sequence":"additional","affiliation":[{"name":"Department of Hematology, Gunma University Graduate School of Medicine , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Hematology, Gunma University Graduate School of Medicine , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Tsukamoto","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Gunma University Hospital , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Gunma University Hospital , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Handa","sequence":"additional","affiliation":[{"name":"Department of Hematology, Gunma University Graduate School of Medicine , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koujirou","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine , Maebashi , , Maebashi ,","place":["Japan"]},{"name":"and Department of Pharmacy, Gunma University Hospital , Maebashi , , Maebashi ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"8","key":"2026062512114671500_zxag190-B1","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1007\/s40265-020-01318-8","article-title":"Tirabrutinib: first approval","volume":"80","author":"Dhillon","year":"2020","journal-title":"Drugs"},{"issue":"5","key":"2026062512114671500_zxag190-B2","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.1111\/cas.13983","article-title":"Phase I study of tirabrutinib (ONO-4059\/GS-4059) in patients with relapsed or refractory B-cell malignancies in Japan","volume":"110","author":"Munakata","year":"2019","journal-title":"Cancer Sci"},{"issue":"4","key":"2026062512114671500_zxag190-B3","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1182\/blood-2015-08-664086","article-title":"A phase 1 clinical trial of the selective BTK inhibitor ONO\/GS-4059 in relapsed and refractory mature B-cell malignancies","volume":"127","author":"Walter","year":"2016","journal-title":"Blood"},{"issue":"1","key":"2026062512114671500_zxag190-B4","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1093\/neuonc\/noaa145","article-title":"Phase I\/II study of tirabrutinib, a second-generation Bruton\u2019s tyrosine kinase inhibitor, in relapsed\/refractory primary central nervous system lymphoma","volume":"23","author":"Narita","year":"2021","journal-title":"Neuro Oncol"},{"issue":"4","key":"2026062512114671500_zxag190-B5","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1007\/s13691-021-00491-1","article-title":"Experience with nasogastric tube administration of tirabrutinib in the treatment of an elderly patient with primary central nervous system lymphoma","volume":"10","author":"Yoshioka","year":"2021","journal-title":"Int Cancer Conf J"},{"issue":"2","key":"2026062512114671500_zxag190-B6","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1007\/s00455-021-10280-w","article-title":"A safe way to administer drugs through a nutrition tube\u2014the simple suspension method","volume":"37","author":"Kunieda","year":"2022","journal-title":"Dysphagia"},{"issue":"19","key":"2026062512114671500_zxag190-B7","doi-asserted-by":"publisher","first-page":"5969","DOI":"10.3390\/jcm13195969","article-title":"Comparative analysis of verapamil pharmacokinetics: evaluating the impact of simple suspension and crushing administration methods","volume":"13","author":"Kumagai","year":"2024","journal-title":"J Clin Med"},{"issue":"1","key":"2026062512114671500_zxag190-B8","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s40780-019-0155-1","article-title":"Relationship between the effects of food on the pharmacokinetics of oral antineoplastic drugs and their physicochemical properties","volume":"5","author":"Omachi","year":"2019","journal-title":"J Pharm Health Care Sci"},{"issue":"3","key":"2026062512114671500_zxag190-B9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1046\/j.1365-2982.2001.00249.x","article-title":"Gastric emptying: the validity of the paracetamol absorption test adjusted for individual pharmacokinetics","volume":"13","author":"Medhus","year":"2001","journal-title":"Neurogastroenterol Motil"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag190\/68557397\/zxag190.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag190\/68557397\/zxag190.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:11:52Z","timestamp":1782403912000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article\/doi\/10.1093\/ajhp\/zxag190\/8711514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":9,"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxag190","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"article-number":"zxag190"}}