Enteral Medication for the Tube‐Fed Patient: Making This Route Safe and Effective

Boullata, Joseph I.

doi:10.1002/ncp.10615

Cited by 19 publications

(33 citation statements)

References 164 publications

(361 reference statements)

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“…Limited data are available assessing the impact of vasopressors on drug absorption. Acetaminophen absorption was reduced in ICU patients with normal hepatic and renal function receiving dopamine infusions [1 ▪▪ ]. In contrast, the absorption profiles of oseltamivir in patients with H1N1 were similar regardless of the administration of vasopressors [1 ▪▪ ].…”

Section: Impact Of Critical Illnessmentioning

confidence: 96%

“…Gastrointestinal dysmotility occurs in about 50–60% of critically ill patients for various reasons, including altered neuronal and hormonal innervations, systemic and localized inflammation, hypoperfusion, smooth muscle dysfunction, drug therapies (e.g. opioid analgesics, dopamine), electrolyte and glucose abnormalities, fat and fibre-containing enteral nutrition formulations, and laying in the supine position [1 ▪▪ ,4]. Delayed gastrointestinal emptying may enhance absorption by providing greater time for dissolution and permeability to occur but more frequently hampers absorption and almost always prolongs intestinal absorption [5].…”

Section: Impact Of Critical Illnessmentioning

confidence: 99%

“…Vasopressor agents affect splanchnic perfusion and alter gastrointestinal oxygen consumption [1 ▪▪ ]. Limited data are available assessing the impact of vasopressors on drug absorption.…”

Section: Impact Of Critical Illnessmentioning

confidence: 99%

“…Jejunostomy tubes are of particular concern for clogging so only liquid formulations should be administered [8–10]. Tube placement may influence drug dispersion and absorption to affect the pharmacokinetic profile and efficacy of a particular drug [1 ▪▪ ]. Unfortunately, little data are available for most medicines to support postpyloric administration.…”

Section: Enteral Access Device Size and Placementmentioning

confidence: 99%

“…Atrophy of the intestinal mucosa from gastrointestinal hypoperfusion and nutritional insufficiency may not only hasten passive permeability but also reduce endothelial surface area to lessen drug exposure to carrier transporters. Inflammatory cytokines associated with critical illnesses reduce the expression of carrier transporters while both increasing and decreasing metabolizing enzymes [1 ▪▪ ,4].…”

Section: Impact Of Critical Illnessmentioning

confidence: 99%

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Considerations when administering medications enterally in the critically ill

MacLaren

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewEnteral administration of medications to critically ill patients may be advantageous to other routes of administration. This review summarizes key considerations for the bedside clinician when medications are administered through enteral access devices (EADs).Recent findingsCritical illness is associated with gastrointestinal dysfunction that inconsistently affects drug dispersion and absorption and may enhance or reduce bioavailability. Other factors such as the first-pass metabolism, microbiome alterations and the concomitant use of other medications (vasopressors, acid suppressants) may influence drug absorption. Concurrent administration of medications with enteral nutrition is fraught with potential errors. Drug-nutrient and drug-drug interactions may lead to tube occlusion. Although liquid formulations of medications are preferred over solid dosage forms for EAD administration, they may be hyperosmotic or contain sorbitol to cause gastrointestinal disturbances. The size and placement of the EAD tube may influence drug dispersion and absorption to affect the pharmacokinetic profile and efficacy of a particular drug.SummaryThe therapeutic effect may be diminished, or toxicity enhanced when medications are administered through EADs in the critically ill. The bedside clinician must be aware of factors impacting the bioavailability of enterally administered medications and be cognizant that the effect will differ by medication.

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Section: Impact Of Critical Illnessmentioning

confidence: 96%

Section: Impact Of Critical Illnessmentioning

confidence: 99%

Section: Impact Of Critical Illnessmentioning

confidence: 99%

Section: Enteral Access Device Size and Placementmentioning

confidence: 99%

Section: Impact Of Critical Illnessmentioning

confidence: 99%

See 3 more Smart Citations

Considerations when administering medications enterally in the critically ill

MacLaren

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Enteral nutrition: An underappreciated source of patient safety events

Citty,

Chew,

Hiller

et al. 2024

Nut in Clin Prac

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Enteral nutrition (EN) therapies are prescribed for patients not able to maintain adequate nutrition through the oral route. Medical errors and close calls associated with the provision of EN therapy leading to actual and potential patient harm have been reported. The purpose of this study was to determine the number, type, and severity of safety events related to the provision of EN therapies reported to a national database and provide workable recommendations from the literature to improve safety. An interdisciplinary team queried the National Center for Patient Safety (NCPS) Joint Patient Safety Reporting (JPSR) system using keywords related to EN therapy use. The team reviewed the number, type, and severity of reported events and safety codes as categorized by the NCPS and then thematically classified the narratives using the Medication Use Process (MUP). Our query revealed 1227 safety events related to the EN keywords. Thematic analysis of the top five event subtypes (n = 1030) revealed that there were 691 EN safety reports directly related to an MUP step, and the majority fell into the steps of administering (31%), followed by monitoring (28%), dispensing (26%), prescribing (11%), and transcription (4%), with many events involving more than one MUP step. Safety events associated with the provision of EN therapies leading to patient harm have been reported to the JPSR system. To improve safety related to EN use, modifications to prescribing, transcribing/documenting, dispensing, administering, and monitoring of prescribed EN therapies are needed.

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Drug administration via feeding tubes—a procedure that carries risks: systematic identification of critical factors based on commonly administered drugs in a cohort of stroke patients

Sommerfeldt,

Sartorius,

von Sarnowski

et al. 2024

Eur J Clin Pharmacol

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Purpose Drug administration via feeding tubes is considered a process with many uncertainties. This review aimed to give a comprehensive overview of data available on feeding tube application and to carry out risk assessments for drug substances commonly administered to stroke patients. Methods Drugs frequently administered via feeding tubes were identified through a retrospective analysis of discharge letters from a stroke unit. Physicochemical, pharmacokinetic, and stability properties of these drugs and data on drug-enteral nutrition interactions were systematically searched for in the European Pharmacopoeia, Hagers Handbook of Pharmaceutical Practice, Birchers clinical-pharmacological data compilation, and the Martindale Complete Drug Reference, as well as from databases including DrugBank, DrugDex, PubChem, Google Scholar, and PubMed. Results Of the drugs most commonly administered via feeding tubes in the present stroke patient cohort, bisoprolol, candesartan, and ramipril could be considered the least critical due to their overall favourable properties. Acetylsalicylic acid, amlodipine, hydrochlorothiazide, omeprazole and esomeprazole, simvastatin, and torasemide pose risks based on pH or light-dependent instability or proposed food effects. The most critical drugs to be administered via feeding tubes are considered to be furosemide, levodopa, and levothyroxine as they show relevant instabilities under administration conditions and substantial food effects; the latter two even possess a narrow therapeutic index. However, little information is available on drug-tube and drug-formula interactions. Conclusion Feeding tube administration of medications turned out to be a highly complex process with several unmet risks. Therefore, investigations that systematically assess these risk factors using clinically relevant model systems are urgently needed.

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Enteral Medication for the Tube‐Fed Patient: Making This Route Safe and Effective

Cited by 19 publications

References 164 publications

Considerations when administering medications enterally in the critically ill

Considerations when administering medications enterally in the critically ill

Enteral nutrition: An underappreciated source of patient safety events

Drug administration via feeding tubes—a procedure that carries risks: systematic identification of critical factors based on commonly administered drugs in a cohort of stroke patients

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