Administration Paracetamol via GastroJujenal Stoma

• There are no drugs licensed for intrajejunal administration in the UK and little data on absorpion of drugs via this route.
• Other routes or alternative methods of treatment should therefore be sought wherever possible.
• Clinical response and drug levels should be monitored as a guide to treatment success
• However, based on several information, Paracetamol has a good absorption via this route.

Recommendations:

• Suppositories or injection can be considered useful alternatives
• As not many specific references exists for administration of drugs via Gastrojujenal stoma, recommendations is extrapolated from intrajejunal drug administration.
• Paracetamol is absorbed rapidly following oral administration. Administration into the jejunum achieves similar plasma concentration to oral administration
• Use tablets dispersed in 50 mL of water (for adults) for intragastric or intrajejunal administration. If the sodium content is problematic, use the liquid formulation.
• if administering intrajejunally, dilute with at least an equal quantity of water to reduce osmolarity and viscosity.

Administration considerations:

• Sterile water should be used to flush jejunostomy tubes and disperse tablets
• Use disperible tablets or finely crushed tablets dispersed in water as an alternative to liquid formulations
• Only where a drug has been shown to be compatible with enteral feed may a liquid preparation be mixed with feeding solution to reduce osmolality. In practice there is little data regarding compatibility with feeds and most feed manufacturers do not recommend this
• Rinse the measure with 10–20 mL of water and administer this also to ensure that the total dose. is given. Finally, flush with the recommended volume of water.

References:

1. Handbook of Drug Administration via Entereal Feeding Tubes
2. Guidlines for the Administration of Drugs Through Enteral Feeeding Tubes (Devoid/awaiting newer recomendations) 
3. http://palliativedrugs.com/download/appendix10.pdf