Intestinal Drug Absorption After Subarachnoid Hemorrhage and Elective Neurosurgery: Insights From Esomeprazole Pharmacokinetics.

Objectives: Subarachnoid hemorrhage (SAH) may critically impair cardiovascular, metabolic, and gastrointestinal function. Previous research has demonstrated compromised drug absorption in this group of patients. This study aimed to examine the impact of SAH on gastrointestinal function and its subsequent effect on the absorption of enterally administered drugs, using esomeprazole as a probe drug.

Design: Prospective observational cohort study.

Setting: Academic hospital in Germany.

Patients: We included 17 patients with high-grade SAH and 17 controls, comparable in age, sex, body weight, and renal function, who underwent elective cranial surgery.

Interventions: None.

Measurements and main results: Both groups received esomeprazole per standard protocol to prevent acid-associated mucosal damage, either orally or through a nasogastric tube. On day 4, esomeprazole was administered IV to estimate oral bioavailability. Esomeprazole serum concentrations were measured on days 1, 3, and 4 in both groups and on day 7 in the SAH group. Patients with high-grade SAH exhibited severely impaired drug absorption. Most patients showed no improvement in intestinal drug absorption even a week after hemorrhage.

Conclusions: Following SAH, significantly reduced drug absorption may be attributed to decreased intestinal motility and compromised intestinal mucosal function. Clinicians should anticipate the reduced effectiveness of enterally administered medications for at least seven days after high-grade SAH.