Sources of InformationData SheetThe summary of productcharacteristics (SPC) should containsome information about theformulation

ManufacturerAdministration of a drug via afeeding tube usually falls outsidethe terms of its product licence andtherefore some manufacturers maybe unwilling to provide information.However, most manufacturers dohave some information on file andmay be able to offer assistance.

Ask your Local PharmacistMost pharmacists will be familiarwith the formulations available, andcommunication between GP andCommunity pharmacist should beencouraged to ensure that thepatient’s treatment is not delayed.

Medicines InformationDepartmentMost acute hospitals and somecommunity hospitals have amedicines information departmentwithin the pharmacy departmentthat will be able to assist you.

Who produced theguidelines?These guidelines were produced by amulti-disciplinary team, with thesupport of BAPEN and the BPNG.

BAPENThe British Association for Parenteraland Enteral Nutrition was founded in1992 from the association of severalprofessional groups representingcliniciansl, nursing, dietetics,pharmacy, industry and patients. Theaim of this group is to promote goodpractice in all areas of nutritionsupport.

BPNGThe British Pharmaceutical NutritionGroup, founded in 1988, is anorganization with a professionalinterest in pharmaceutical nutritionsupport. The members of this groupare pharmacists, technicians andscientists from the health service,academia and industry.

Produced by the British Association for Parenteral and Enteral Nutritionwww.bapen.org.uk Registered Charity 1023927

andThe British Pharmaceutical Nutrition Group

www.bpng.co.uk

Drug AdministrationVia

Enteral Feeding Tubes

A Guide for GeneralPractitioners and

Community Pharmacists

Types of Feeding TubesMost patients on home enteralfeeding in the community have agastrostomy e.g. (PEG) tube. Althoughnasogastric (NG) and jejunostomytubes are also used.

General ConsiderationsPatient’s medication should bereviewed regularly and anyunnecessary medicines stopped.Using the feeding tube to administera drug should be considered a lastresort, and whenever possible analternative route should be used.Changing drugs within the sametherapeutic group may benecessary e.g. changing oralisosorbide mononitrate totransdermal GTN.Where possible a once dailypreparation should be used toreduce the number ofmanipulations, but this must be byusing long acting drugs notsustained release preparations.Bioavailability may vary betweensolid and liquid dosage forms. It maybe necessary to adjust the dose.Avoid changing the brand ofproduct used. Formulations of thesame drug may vary betweenmanufacturers.Liaison between doctor andpharmacist is often benificial.

Preferred FormulationsLiquids or soluble tablets are thepreferred formulation for administrationvia feeding tubes. However, it should be noted that someliquid preparations are in factsuspensions of small granules andtherefore not suitable for administeringvia an Enteral Feeding Tube e.g.Lansoprazole suspension.

• Some liquid preparations containsortbitol which can act as a laxative

• The cost of liquid preparations cansometimes be considered prohibitivehowever the cost of replacing afeeding tube is far greater.

• Soluble tablets are a usefulalternative.

Drug InteractionsInteractions between enteral feedsand drugs can be clinicallysignificant.As a general rule if the absorptionof a drug is affected by food orantacids, it is also likely to beaffected by enteral feed.

Clinically Significant InteractionsPhenytoin CiprofloxacinTheophylline TetracyclinesDigoxin Rifampicin

(This list is not exhaustive).

Why are theseguidelines necessary?The use of enteral feeding tubes as aroute of drug administration isbecoming increasingly common. Thisguidance has been produced inresponse to the increasing demandsfor information on the practicalaspects of drug administration via thisroute.

Legal ImplicationsMost drug administration via feedingtubes falls outside the productlicense for that drug, as doescrushing tablets and openingcapsules not specifically designed forthis purpose. In these circumstancesthe prescriber and practitioneraccept any liability for any adverseeffects resulting from theadministration of that drug.

Tube BlockageInadequate flushing andmedication administration are thetwo most common causes offeeding tube blockage. Tubeblockage is a serious problem thatcan deprive the patient of essentialfluid, nutrition and drug therapy. Thismay necessitate replacement ofthe feeding tube potentiallysubjecting the patient to aninvasive procedure.

• Adequate flushing should preventthis.

• If blockage occurs, aspiration toremove curds/particulate matterfrom the tube can be tried. Thisshould be followed by attempt toflush with warm water.

• Excessive pressure should not beapplied due to the risk of tubefracture.

• The patient should have a point ofcontact for advice in thiseventuality.