Medication Administration Through Enteral Feeding Tubes

Nancy Toedter Williams, Pharm.D., BCPS, BCNSP

Disclosures

Am J Health Syst Pharm. 2008;65(24):2347-2357. 

In This Article

Dosage Forms Not Appropriate for Administration Through a Feeding Tube

While many medications may be given through a feeding tube, some drug formulations should not be altered for enteral administration. Enteric-coated products are one example because they should not be crushed. The enteric coating allows for medication to be released in the small intestine rather than the stomach. As a result, less GI irritation occurs, and the medication is protected from destruction by gastric acid. Adverse effects may occur or the drug's effectiveness may be reduced if it is crushed. The small, crushed pieces can also clump together when wet and cause the enteral tube to clog.[9,13,19] These small chunks can be particularly problematic in occluding small-bore feeding tubes.

Buccal or sublingual preparations should also not be altered. These medications are not designed for absorption in the GI tract, and crushing them for administration via the enteral tube may result in reduced drug absorption and lack of efficacy.[9,13]

Medications with carcinogenic, teratogenic, or cytotoxic properties should also not be crushed. This may cause the release of aerosolized particles that could potentially harm health care workers.[12,13]

Although the contents of some extended-release capsules may be poured down the feeding tube, crushing extended-release tablets is not recommended. This destroys their extended-release delivery mechanism and may result in potentially toxic peaks and low troughs.[9,13] A comprehensive list of oral dosage forms that should not be crushed has been published.[25]

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