Welcome to the crushing tablets and drug administration via enteral feeding tubes section for pharmacists. This section includes links to clinical practice resources on crushing tablets for patients with dysphagia / swallowing difficulties, medication administration via enteral feeding tubes and drug-enteral feeding interactions.
Additionally for those patients where you have decided that crushing is the only option available for you to recommend we have provided information on different types of tablet, different coatings and modified formulations so that you can determine whether crushing may be appropriate or not.
The reasons for considering tablet crushing are numerous, however crushing tablets has repercussions on the licensed status of the medicine and how the medicine may affect the patient. This guide is intended to give information to aid decision making on altering a licensed medicine by crushing, opening capsules etc
The List of Oral Dosage Forms That Should Not Be Crushed, commonly referred to as the Do Not Crush list, contains medications that should not be crushed because of their special pharmaceutical formulations or characteristics, such as oral dosage forms that are sustained-release in nature.
Some adults have difficulty swallowing oral solid dosage forms such as tablets and capsules; therefore prescribers must work with the patient and/or carer(s) to address their needs. This guideline provides a framework for healthcare professionals to support their prescribing decisions in response to the increased demand, complexity and cost of some specials. This guidance was developed by Betsi Cadwaladr University Health Board and endorsed by AWMSG as an example of good practice.
A thorough search of several drug databases, a literature search of MEDLINE through Ovid, and a review of full prescribing information for each currently available antiretroviral drug, was performed to obtain insight into the bioavailability of antiretrovirals. Implications for the findings are discussed as they relate to adherence, resistance, alternative methods of administration, and the sometimes conflicting information on bioavailability that exists for various antiretroviral agents.
Drug therapy can be complicated in hospitalized patients requiring an enteral feeding tube (EFT). Some medications may be given via an EFT while others are unsuitable for this form of administration. Inappropriate drug selection for EFT administration can cause potential toxicity, reduced efficacy, and tube obstruction. Therefore, it is important to know which drugs may be altered for EFT administration as well as appropriate therapeutic alternatives that can temporarily be substituted for those that may not be given via that route.
An overview of enteral feeding tubes, drug administration techniques, considerations for dosage form selection, common drug interactions with enteral formulas, and methods to minimize tube occlusion is given.
The purpose of this paper is to serve as a tutorial to guide clinical decision making rather than a comprehensive review of the existing literature. Clinicians are strongly encouraged to review the literature concerning drug-specific management approaches that have been published and exercise good clinical judgment to individualize the patient care plan.
This article will focus on basic knowledge needed for identification and appropriate management of drug-nutrient interactions in patients requiring enteral nutrition (EN) and parenteral nutrition (PN). Drug-nutrient interactions will be divided into four categories based upon their mechanisms: 1) ex vivo biopharmaceutical inactivations; 2) interactions affecting absorption; 3) interactions affecting systemic/physiologic dispositions; and 4) interactions affecting elimination/clearance. Each category will be discussed separately and examples will be given to illustrate the use of alternative methods to assure safe drug administration.
Continuous enteral feedings has been used extensively in critically ill patients, these patients are often administered medications through their feeding tubes out of necessity. As not all oral medications may be compatible with enteral nutrition, complications associated with administration of medications through feeding tubes may arise. Moreover, improper management of these interactions may lead to therapeutic failure or adversely affect the patients.
Though the interaction between enteral tube feeding and phenytoin was first described 30 years ago, the mechanism of the interaction is still poorly understood. In the discussions below, we will highlight some drug enteral tube feeding interactions which have been found to be clinically important.
Valproic acid (VPA) and its derivatives are highly protein bound. Certain highly protein bound medications (eg, phenytoin) have specific administration instructions for patients on enteral nutrition supplements to optimize absorption of the medication. Pharmacokinetic interactions between VPA and enteral nutrition or protein supplements demonstrating impaired absorption have not been published to date.
The A3 poster is suitable for use on the ward or in clinics. The flow diagram provides a step by step guide for safe drug administration via this route. The poster also includes basic information on legal implications, health and safety and drug interactions.