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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. Introduction: Drug therapy can be com-plicated in hospitalized patients requir-ing an enteral feeding tube (EFT). Some medications may be given via an EFT while others are unsuitable for this form of administration. Inappropriate drug selection for EFT administration can cause potential toxicity, reduced efficacy, and tube obstruction. 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 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. Riss et al. [37] described the administration of extended-release carbamazepine capsules through the feeding tube in children. 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 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 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. Gabapentin (Neurontin® , Gabapentin) Available as tablets or capsules. Capsules, Tablets Available as soluble tablets? 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. Gabapentin capsule contents can be dispersed and stirred in 15ml water immediately prior to taking (unlicensed use)1. Administration in enteral feeding tube Gabapentin Colonis and Rosemont oral solution can be administered via NG or PEG tube (Rosemont: silicone, polyurethane or PVC. 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 Gabapentin Capsules package insert / prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions and pharmacology. 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. 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 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 The following liquid medicines manufactured by Rosemont Pharmaceuticals have recently received UK licenses for administration via nasogastric (NG) or percutaneous endoscopic gastronomy (PEG) tube: Furosemide Oral Solution 20mg/5mL, 40mg/5mL and 50mg/5mL Ramipril Oral Solution 2.5mg/5mL Metoclopramide Hydrochloride Oral Solution 5mg/5mL Clonazepam Oral Solution 0.5mg/mL, 2mg/mL Gabapentin Oral 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. 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
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