Consideration for Medicines Administration via Enteral Feeding

Issue	Notes
Size of tube	·       Narrow and long tubes are likely to become blocked by larger drug particles or viscous solutions (2).
Tube site	·       Tubes which terminate in the jejunum cause a particular concern for drug administration as the tube may bypass the site of drug absorption and the drug will be in the GI tract for a reduced amount of time. ·       Drugs such as antacids, sucralfate, and bismuth are unlikely to work as they have a local effect in the stomach (1). ·       Drugs such as ketoconazole, which require an acidic environment to be absorbed optimally, may have a reduced bioavailability (1). ·       Conversely, increased bioavailability of some drugs such as opioid analgesics, beta-blockers, and tricyclic antidepressants, may occur due to reduced first-pass hepatic metabolism (1).
Tube Function	·       Tubes which are being used for aspiration or drainage should not be used for drug administration purposes. ·       This is particularly important for multi-lumen tubes as care must be taken to ensure drugs are administered into the correct lumen.
Feed timing	·       Feeds may interact with drugs to reduce bioavailability.
Drug Administration Route	·       Can the drug be administered by a different route? E.g. intravenous, transdermal, buccal etc. ·       Is the drug essential? ·       For a list of injections which may be given orally, see Q&A number 175.
Drug formulation	·       Modified release formulations should not be given via a feeding tube. ·       More viscous liquids e.g. syrups may clog tubes, as may larger drug particles.
Legal Implications	·       For most medications, administration through an enteral feeding tube is outside product licences.

References

1.     Toedter Williams N. Medication administration through enteral feeding tubes. Am J Health Syst Pharm 2008; 65: 2347-2357.

2.     White R and Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes. (online). London: Pharmaceutical Press; [Accessed via www.medicinescomplete.com on 02/01/2014] 4-8.

3.     Mason P et al. Nutrition-Supporting Pharmacy Services. CPPE open learning programme. Outset Publishing: 2007, 80-85

4.     National Institute for Health and Clinical Excellence. Clinical Guideline 32. Nutrition Support in Adults: oral nutrition support, enteral tube feeding and parenteral nutrition. 2006, page 30-31. Accessed via http://www.nice.org.uk/nicemedia/live/10978/29979/29979.pdf

5.    Stroud M, Duncan H and Nightingale J. Guidelines for enteral feeding in adult hospital patients. Gut 2003; 52: vii1-vii12.