Oral Antihypertensives Via Ryle's Tube

Medications	Comments
Amlodipine	·      Disperses in water. Give immediately as light-sensitive
Atenolol	·      Liquid preparation is available
Bisoprolol	·      Crush tablet and disperse in water.
Captopril	·      Tablets disperse in 10ml water in 2 minutes to give suspension (2)
Carvedilol	·      Crush and disperse in water
Diltiazem	·      Capsules may be opened and granules administered without crushing
Enalapril	·      Disperse slowly in water with stirring
Felodipine	·      DO NOT CRUSH as will lose sustained release properties
Frusemide	·      Has liquid preparations
Hydralazine	·      Crush and disperse in water. May be increased rate of absorption so monitor blood pressure
Irbesartan	·      Crush and disperse tablet in water
Lisinopril	·      Tablets slowly disperses in water
Losartan	·      Crush and can mix with 10ml of water to form fine suspension (2)
Metoprolol	·      Disperses slowly in water. Consider change to atenolol liquid preparation
Methyldopa	·      Suspension available(2) ·      Tablet will disperse in >2minutes (3)
Nifedipine	·      Can be given through Ryle’s tube***
Perindopril	·      Crush and disperse tablet in water
Prazosin	·      Can crush. Insoluble so ensure wash down with water (2)
Propranolol	·      Liquid preparation maybe available
Telmisartan	·      Can crush. Not very soluble but will flush via 8Fr NG tube without blockage. To be given immediately as it absorbs moisture once crushed. (2)
Valsartan	·      Open capsules and give contents in water immediately as it is not very stable
Verapamil	·      Liquid preparation  ·      Tablets will disperse in >2minutes (3)

***Full explanation is in guideline from reference source no 1.

REFERENCE

1. http://www.cddft.nhs.uk/media/183967
2. MEDICATION ADMINISTRATION IN PATIENTS WITH SWALLOWING DIFFICULTIES/DYSPHAGIA
3. NEEMMC GUIDELINES FOR TABLET CRUSHING AND ADMINISTRATION VIA ENTERAL FEEDING TUBES, http://www.stch.org.uk/