Rectal Bioavailability of Sertraline Tablets in a Critically Ill Patient With Bowel Compromise

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To the Editors
Clinical situations often arise in which a patient cannot be given an oral medication in the hospital setting because of acute or chronic medical illness. Often, there are other therapeutic alternatives in a different dosage form, or the temporary cessation of a chronic oral medication is reasonable in the setting of acute illness. If a specific medication is only commercially available as an oral formulation and is a clinical necessity, then alternative mechanisms for drug delivery must be considered. One option is to extemporaneously compound oral medications into a suppository or place an oral formulation into a patient's rectum.1 However, clinicians face the problem that many medications lack sufficient pharmacokinetic (PK) data to guide the appropriate dosing or to even provide information that there is adequate absorption when medications are administered in this manner. For patients with depression and anxiety, active symptoms such as anhedonia, excessive worry, and/or worthlessness may impede medical recovery.2 Thus, the benefits of antidepressant initiation or continuation in hospitalized patients often outweigh the risks. Yet, as noted, many drug classes, including antidepressants, have limited non-oral options, which make it challenging to optimally manage neuropsychiatric conditions in patients without enteral access. Herein, we describe the case of a 55-year-old woman in whom sertraline tablets were administered rectally for depression and anxiety and where PK monitoring was performed.
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