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Appendix 10: Administering drugs via feeding tubes Administering drugs via feeding tubes is generally an unlicensed activity. There is little published data and most recommendations are theoretical and/or based on local policy. An alternative licensed option may therefore be preferable, e.g. rectal or parenteral formulations. However, if given by tube, there is a range of possibilities (Figure Please be aware the administration of medication to patients with enteral feeding tubes can be problematic and information can at times be lacking. In the first instance, the ongoing need for the medication should be reviewed by the prescriber. Any adverse effects, including problems with feeding tubes, should be reported to the prescriber and pharmacist immediately. 4 GENERAL PRINCIPLES When administering medication via enteral tube consideration needs to be taken regarding drug formulation, interactions with feed, type of tube, site of placement, and site of drug absorption. Before taking medications through your feeding tube Ask your healthcare provider if you can take your medications through your feeding tube. Most medications that you normally take by mouth can be taken through your feeding tube. Medications must be in liquid form or crushed into a powder to prevent your feeding tube from getting clogged. A total of 3686 tablets and 432 capsules that are frequently used in Japan were tested. Using SSM, 3377 (91.6%) tablets and 359 (83.1%) capsules disintegrated within 10 min and passed through the tube without clogging it in the tube passage test. With the conventional crushing method, 2117 tablets (57.4%) and 272 capsules (63.0%) could be crushed. Where alternative routes/formulations are not available, the monographs make recommenda-tions for safe administration via the enteral feeding tube. Any decisions on appropriate drug therapy must be made with the complete clinical condition and wishes of the individual patient in mind. See “How to Crush Medications” below Capsules approved by your pharmacist may be opened and mixed with 1 syringe of water NOTE: allow a few minutes for the medication to dissolve in the water Do NOT add medications directly to your tube feeding formula It is best to put one medication at a time in your PEG Administering Medications through Feeding Tubes (GT, NG, JT, NJ, etc.) This content was developed by: Adrian Turner, Pharm.D.- Cook Children’s Medical Center, Ft. Worth, TX Marry Vuong, Pharm.D.- Nicklaus Children’s Health System, Miami, FL Veronica Hood, PhD- Dravet Syndrome Foundation, Cherry Hill, NJ This information should not replace guidance from a health care professional managing Gabapentin (Neurontin® , Gabapentin) Available as tablets or capsules. Capsules, Tablets Available as soluble tablets? the enteral feeding tube. Pulsatile flushing can create turbulence within the feeding tube. This can“clean” theinner walls and help keep thetube from clogging. Water is the best fluid to flush tubing. Sometimes, warm water may help prevent clogging. Anecdotally, soda and soda water have beenused to unclog enteral tubes. However, caution must be Gabapentin Rosemont Oral Solution 50mg/mL Instructions for administration via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes. Gabapentin Rosemont Oral Solution is suitable for use with the following type of NG and PEG tubes: Ensure that the enteral feeding tube is free from obstruction before administration. Clogged Feeding Tubes: Medications cause obstruction in about 15% of patients receiving enteral tube feedings. To prevent clogging, viscous liquids should be diluted prior to administration. NEEMMC GUIDELINES FOR TABLET CRUSHING AND ADMINISTRATION VIA ENTERAL FEEDING TUBES KEY TO DRUG ADMINISTRATION GUIDELINES Please follow the guidelines in order, as shown in the chart (i.e. number 1 is the first choice of which form to administer the drug in). A Tablet will disperse in 1-2 minutes. B Tablet will disperse in greater than 2 minutes. C Liquid preparation available. D Dilute A potential complication with pouring capsule contents through any enteral access device is that tube occlusions may occur, so large-bore feeding tubes (≥14 French) are preferred. Gabapentin Capsules package insert / prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions and pharmacology. Medications What medications can be given through the G-tube? Only liquid medications can be given through the G-tube. If the medication comes in a capsule, open the capsule and mix the content in 5mL of warm water. If the medication comes as a pill, please ask your pharmacist if it can be crushed and mixed with water. Tips for giving medications Each medication must be given separately. Do This comparative-effectiveness study uses data from 2 clinical trials to evaluate whether the use of gabapentin for pain management is associated with less opioid use and feeding tube placement among adult patients with head and neck cancer receiving Patients with a feeding tube for nutrition will require oral medications administered by the same route. Most oral medications have not been evaluated for feeding tube administration. To administer an oral medication through a feeding tube, the formulation must be in a liquid form. If a suitable liquid product is not available, a liquid can be extemporaneously compounded by opening the capsule Key points Gabapentin capsules can safely be opened, and the contents of the capsule sprinkled onto food or dissolved in a drink for immediate consumption. Riss et al. [37] described the administration of extended-release carbamazepine capsules through the feeding tube in children.
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