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| Step One |
Other methods of administration
| Rectal | e.g. aspirin, diclofenac, and paracetamol suppositories |
| Parenteral | e.g. intravenous, intramuscular and subcutaneous injections |
| Transdermal | e.g. hyoscine, glyceryl trinitrate, and hormone replacement therapy patches |
| Sublingual / buccal | e.g. prochlorperazine 3mg tablets |
| Step Two |
e.g. mefenamic acid tablets changed to diclofenac suppositories.
e.g. isosorbide mononitrate tablets changed to glyceryl trinitrate patches.
| For patients who will only have enteral feeding tubes in situ for a short time, it may not be appropriate to change certain types of chronic medication, e.g. psychiatric or epileptic medication, to alternative treatments, when the difficulty in administration will only last for a short period. Consider the stability of the patient's chronic condition before making medication changes. |
| Step Three |
When medications have to be given by enteral feeding tube, liquids / dispersible tablets are the preferred formulations. Tablets should only be crushed as a last resort.
Many sugar-free liquids contain sorbitol, an artificial sweetener, which is a laxative and at total daily doses of 7.5g and upwards can result in abdominal cramping and diarrhoea.116,245 Sorbitol has a cumulative effect and it is therefore important to minimise the intake of sorbitol where possible. Diarrhoea in enteral tube-fed patients has been attributed to sorbitol intake in up to 48% of cases.2 Cost implications occur when the drug is only available in paediatric preparations and large volumes will be required.
| Step Four |
If changing from modified-release tablets / capsules to liquid it may to necessary to decrease the dose and increase the frequency of administration.
Some drugs have a different bioavailability when being changed from a tablet to a liquid, e.g. digoxin. Other drugs contain a different salt of the drug in the liquid and tablet form, e.g. phenytoin. See recommendations under individual drug monographs, or contact Pharmacy for advice.
| Step Five |
Many medications interact with enteral feeds. This can result in increased or decreased absorption, altered therapeutic effects and adverse effects, and sometimes blockage of the enteral feeding tube. Medications may have to be given during a feeding break, which may necessitate pausing the enteral feed (and therefore increasing the feed rate at other times to ensure that adequate nutrition is achieved)
In order to reduce the number of feed breaks required, drug frequency may have to be adjusted. See recommendations under individual drug monographs.
Contact Pharmacy and the Nutrition team for advice on patient management.