Medication Administration Through Enteral Feeding Tubes

Authors and Disclosures

Nancy Toedter Williams, Pharm.D., BCPS, BCNSP, is Associate Professor, Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University.

Disclosure: The author has declared no potential conflicts of interest.

Sidebar

Guidelines for Enteral Administration of Medications^{[9,10,18,27,49]}

Administer medications via the oral route when possible.

Determine the enteral feeding tube size (e.g., small bore or large bore), insertion site (e.g., nasal or percutaneous), tip location (e.g., stomach or jejunum), and enteral nutrition delivery method (e.g., continuous or bolus).

Liquid dosage formulations are preferred.

• Elixirs and suspensions are generally favored over syrups.

• Check the sorbitol content if gastrointestinal distress occurs.

• Dilute hypertonic medications with at least 10 30 mL of water.

If a solid dosage form is used, make sure the tablets can be crushed or the capsules opened.

Feeding tubes should be flushed with 15–30 mL of water before and after drug delivery.

• When several medications are being given at the same time, each one should be administered separately. The feeding tube should be flushed with at least 5-10 mL of water between medications.

Medications should not be directly mixed with the enteral feeding formulas.

Watch for drug–nutrient interactions with continuous enteral feeding.

• Consider holding tube feeding for at least one to two hours before and after medication administration if drug absorption may be affected.

Appendix A

Partial List of Liquid Medications That Have an Osmolality of ≥ 3000 mOsm/kg^[17]

• Acetaminophen elixir, 65 mg/mL

• Acetaminophen with codeine elixir

• Amantadine hydrochloride solution, 10 mg/mL

• Chloral hydrate syrup, 50 mg/mL

• Cimetidine solution, 60 mg/mL

• Dexamethasone solution, 1 mg/mL

• Dextromethorphan hydrobromide syrup, 2 mg/mL

• Diphenoxylate hydrochloride–atropine sulfate suspension

• Docusate sodium syrup, 3.3 mg/mL

• Ferrous sulfate liquid, 60 mg/mL

• Hydroxyzine hydrochloride syrup, 2 mg/mL

• Lactulose syrup, 0.67 g/mL

• Lithium citrate syrup, 1.6 mEq/mL

• Metoclopramide hydrochloride syrup, 1 mg/mL

• Multivitamin liquid

• Potassium chloride liquid, 10%

• Potassium iodide saturated solution, 1 g/mL

• Promethazine hydrochloride syrup, 1.25 mg/mL

• Sodium phosphate liquid, 0.5 g/mL

Appendix B

Partial List of Liquid Medications That Contain Considerable Amounts of Sorbitol With Typical Daily Dosing^[20,21]

• Acetaminophen liquid

• Amantadine hydrochloride solution

• Aminocaproic acid syrup

• Charcoal liquid, with sorbitol

• Cimetidine solution

• Guaifenesin/dextromethorphan syrup

• Isoniazid syrup

• Lithium citrate syrup

• Metoclopramide hydrochloride syrup

• Phenylephrine hydrochloride/brompheniramine maleate elixir

• Phenylephrine hydrochloride/chlorpheniramine maleate elixir

• Pseudoephedrine syrup

• Pseudoephedrine/triprolidine syrup

• Sodium polystyrene sulfonate suspension

• Tetracycline hydrochloride suspension

• Theophylline oral solution

Appendix C

Partial List of Liquid Medications Physically Incompatible With Most Enteral Nutrition Products^[19,23]

• Brompheniramine (Dimetane elixir, Wyeth, Madison, NJ)

• Calcium glubionate (Rugby, West Hempstead, NY); pH = 4

• Ferrous sulfate (Feosol elixir, GlaxoSmith-Kline, London, England); pH = 2.2

• Guaifenesin (Robitussin liquid, Wyeth, Madison, NJ)

• Lithium citrate (Cibalith-S syrup, CIBA Pharmaceuticals, Summit, NJ); pH = 4.7–4.8

• Monobasic sodium phosphate (Fleet Phospho-Soda, C.B. Fleet Co. Inc., Des Moines, IA)

• Potassium chloride liquid (Wyeth, Madison, NJ)

• Pseudoephedrine hydrochloride (Sudafed syrup, Pfizer Inc., Brooklyn, NY); pH = 2.5