A Patient's Guide to Getting Medicine Through a Feeding Tube

The A.S.P.E.N. Nutrition Support Patient Education ManualA Patient’s Guide to Getting MedicineThrough a Feeding TubeGetting the nutrition you need through a feedingtube can improve quality of life. Frequently, thetube is also used for giving medicine. Here aresome general tips and specific information about afew common medicines that you may find helpful.You should consult your pharmacist, physician,dietitian or nurse for specific information aboutthe medication that you take.Giving medications through feeding tube• Medicines may clog a feeding tube. Followthese guidelines to decrease the chanceof a clog and to get the most benefit fromyour medicine.• Use a syringe to give diluted medicationsthrough the feeding tube.• Never mix medication with tubefeeding formula.• Never mix medications together unless yourdoctor advises you differently.• Do not crush time-released medications orenteric-coated medications. The letters CD,CR, CRT, LA, SA, SR, TR, XL, or XR usuallyindicate time release medications. The wordsChronotab, Duratab, Extentab, Gradumet,Repetab, Sequel, Spansule, Tembid, Timecaps,or Timespan also indicate time release. Theletters EC stands for enteric coated.• Only some sublingual medicine, medicinethat is absorbed from the cheeks or lozengetype medicine may be suitable to go through afeeding tube, check first.• Ask your doctor where the tip of the feedingtube resides. This is important for drugadministration. The stomach can tolerate moredrugs than areas in the intestine, jejunumor duodenum.• Use liquid medications when possible, butthese may need to be diluted (1 part medicineto 4–5 parts water) before infusing to avoidstomach upset or diarrhea. If the tip of the tubeis past the stomach, dilute with 8 to 10 partswater.• Many liquid medications are thick and cling tofeeding tube walls. Rinse well before and afterto prevent this from happening.• Crush tablets to a fine powder and mix wellin 10 to 15 ml of warm water. If the tip of thetube is past the stomach, dilute with 20 to 30ml of water. Let the mixture sit for two minutesprior to putting it down the tube and mix againbefore giving the medicine.• Clear feeding tube by rinsing with 1–2Tablespoonfuls (20 to 30ml) of warm waterbefore and after each medication.• Ask your doctor or pharmacist if themedication needs to be given on a full or emptystomach. This is only important if you aregiving yourself tube feedings several times aday using a syringe as a funnel (bolus). Thenconsider the tube feeding to be a meal.Take the following medication atthe same time as a food bolus.Advil Cytotec MevacorNaprosyn Sinemet TiclidVantin Aspirin FeldeneMexitil Potassium SteroidsTonocard Vibramycin CeftinMacrodantin Motrin ParlodelTagamet Toradol VoltarenAmerican Society for Parenteral & Enteral Nutrition • www.nutritioncare.org Page 1

A Patient’s Guide to Getting Medicine, Cont.Take the following medicationsan hour before a food bolus.Bumex Lorabid ZithromaxCarafate Hismanol TetracylineDyazide Lasix FosamaxErythrocin(E.stearate)Recommendations for specific medicationsand tube feeding (tf)• If holding tube feeding for medication,check with the dietitian, physician, nurseor pharmacist about increasing your tubefeeding rate to get all your nutrition.Cipro (ciprofloxacin)• Administration of this medication througha feeding tube, using a syringe, may producedifferent results than taking it by mouth.• Rinse your feeding tube well before and afteradministration of ciprofloxacin.• Do not allow drug to have contact with othermedications or tube feeding.Dilantin (phenytoin)Penicillin &derivatives• Do not use opened capsule.Isoniazide (INH)Ciprofloxacin• Decreased absorption with enteral feeding mayresult in decreased serum levels (50–75%).• Your health provider needs to check druglevels. They may ask you to hold enteral feedingfor 1–2 hours before and after phenytoin oradjust your dose.• If you have a jejunostomy tube, your phenytoinmay be administered as a suspension.Tegretol (carbamazepine)• Because you have a feeding tube, your dose ofthis medication may need to be adjusted morefrequently. Especially if you have a jejunostomytube.Coumadin Tablets (Warfarin)• Warfarin requires careful and consistentmedication administration to maintainlevels. Monitoring of blood clotting is alsonecessary. It is important that the method ofadministration is the same every time to keepthe amount absorbed the same. Small changesin amount of medication absorbed can producedecreased benefit from the medication andincrease side effects.• Warfarin is most often prescribed as a tabletand must be crushed and mixed into slurry foradministration into a feeding tube.• It is extremely important to flush yourfeeding tube following warfarin to minimizeinteraction with the tube. Special care isneeded to reduce this interaction.• Some experts advise holding nutritionformulas for 1–2 hours before and afterwarfarin to avoid interactions. Not all expertsagree in the nature of the interaction or theneed to hold nutrition. In many cases adequatedilution and rinsing will avoid this interaction.Synthroid, Levothroid (levothyroxine)• An animal study suggested that protein intakealters serum levels of levothyroxine. Yourdoctor should check your thyroid functionperiodically.There may be interactions and incompatibilitiesbetween your prescribed medications and anyherbal products, over the counter medicationsor nutrition supplements that you are taking.Check with your physician or pharmacist priorto continuing to use them.Developed by Eric H. Frankel, MSE, PharmD, BCSNP West Texas Clinical Pharmacy Associates, Inc., Lubbock, TXand Mark G. Klang, MS, RPh, BCNSP Sloan-Kettering Institute New York, NYAmerican Society for Parenteral & Enteral Nutrition • www.nutritioncare.org Page 2 of 2