A Guide to Drug Therapy in Patients with Enteral Feeding Tubes: Dosage Form Selection and Administration Methods

Abstract

Drug therapy may be complicated in hospitalized patients receiving nutrition via enteral feeding tubes. Dosage form selection and appropriate administration methods are crucial in patients with feeding tubes. Although hospitalized patients receive nutritional support through various routes, oral nutrition is preferred. Enteral or parenteral nutrition may be used if oral intake is inadequate or inadvisable. Patients with functional gastrointestinal tracts usually receive enteral nutrition. Administering oral medications through the enteral feeding tube can lead to complications like tube clogging or decreased drug activity. However, drug therapy need not be compromised in patients receiving enteral nutrition. Careful selection and preparation of dosage forms reduces the complications of medication administration. Flushing the feeding tube and screening for drug incompatibilities decreases the incidence of tube clogging and replacement.

Medicamentos e sondas de nutrição

“…2,6,8,9,14 We also assessed the forms of presentation (pills, capsules, coated tablets of enteric or extended release drugs) and the possibility of being pulverized. We focused mainly on the forms of presentation including acronyms related to enteric-coated drugs or extended-release drugs, since when these types of drugs are pulverized they undergo a pharmacokinetic intervention performed by the site in the digestive apparatus where the feeding tube is placed, changing its bioavailability and posing the risk of drug poisoning2,8,9 (Table 1).…”

“…These data constituted the protocol shown in Table 2. 2,6,8,9,14 In order to test if there were statistically significant differences, the Fisher's exact test was used regarding proportions and the Student's T test was used regarding means. Values lower than 5% were considered to be statistically significant.…”

Protocol Driven Approach to Optimize the Absorption of Physically Incompatible Drugs with Enteral Formulations

“…Finally, the use of liquid formulations considered more convenient and less likely to clog feeding tubes can, in contrast, have unintended consequences because of the nature of the vehicle (Tables 2 and 3) [3]. For example, sorbitol containing liquids (> 10-20 g sorbitol/day), such as carbamazepine and theophylline liquids or hyperosmolar liquid medications (i.e.…”

“…For example acidic liquids with a pH less than 4, such as brompheniramine elixir or lithium citrate syrup can denature proteins in the enteral formula while others, such as sucralfate, can form a bezoar precipitate that can clog the feeding tube [1][2][3] and delay further nutrition and drug administration as well as to their costly replacement.…”

“…Based on a study by Belknap and colleagues, as much as 74% of the hospital staff used at least 2 incorrect methods in administering drugs via the enteral route, contrary to the guidelines for their proper administration from ASPEN (American Society of Parenteral and Enteral Nutrition) and other evidence-based studies [3,[5][6][7]. Some of these issues included crushing the enteric coated or sustained released medications before administrations while others included failure to properly flush the feeding tube.…”