Medication Administration via Enteral Feeding

Tubes Guide
Prepared by: Dr Sara Youssef

Master Degree of Clinical Pharmacy

Reviewed By

Pharmacy and Therapeutic Committee Members

Chairman of Pharmacy and Therapeutic Committee

1
 Table of Content

Topics
Page
NO

Common Abbreviations of Extended Release Products 6

Do not crush medication list 7

Administration tips 10
Drugs to be given during a feed break 11
Drug interactions and preventive actions when giving drugs via tubes 12
Unblocking tubes 13
Acetazolamide
Acetylcystein
Acyclovir
14
Alendronate
Allopurinol
Alfacalcidiol
Amiodarone
Amitryptilin
Amlodipine
15
Amoxicillin
Apixaban
Aspirin
Ascorbic acid
Atenolol
Atorvastatin
Azathioprine 16
Baclofen
Bisoprolol
Bisacodyl
Calcium and vitamin D
Candesartan
Captopril 17
Carbamazepine
Carvedilol

2
Cefixme

Celecoxib
Cetrizine
Ciprofloxacin
18
Citalopram
Clarithromycin
Clopidogrel
Co-amoxclav
Carbidopa/levodopa
Dabigatran
19
Diclofenac
Digoxin
Domperidone
Donepezil
Doxazocin
Doxyxcyline
Enalapril
20
Erythromycin
Esomeprazole
Etoricoxib
Ferrous fumarate
Ferrous sulfate
Finasteride
Fluconazole
21
Fluoxetine
Folic acid
Furosemide
Gliclazide
Glimepiride
Hyoscine
22
Ibuprofen
Indapamide
Irbesartan
Isosrbid mononitrate
Lactulose
23
Levetiracetam
Levothyroxine

3
Levofloxacin
Lisinopril
Loperamide
Loratidine
Losartan
Movicol
24
Mebendazole
Mebeverine
Metformin
Metoclopramide
Metoprolol
Metronidazole
Miratzapine
Montelukast 25
Mycophenolate
Ofloxacin
Ondansetron
Oseltamivir
Oxybutynin
Paracetamol
Phenytoin 26
Polystyrene sulfonate resin
Potassium chloride
Pramipexole
Pyridoxine
Ramipril
Ranitidine
Risperdone
27
Rivaroxaban
Rosuvastatin
Sertraline
Simvastatin
Sodium valproate
Solifenacin
Spironolactone 28
Tacrolimus
Tamsulosin

4
Telmisartan
Thiamine
Ticagrelor
Tolterodine
Topiramate 29
Trimethoprim-sulfamethoxazole
Warfarin
REFERNCES
30

APPROVALS
31

5
 Common Abbreviations of Extended Release Products
CD Controlled Dose
CR Controlled Release
CRT Controlled Release Tablets
LA Long Acting
SA Sustained action
SR Sustained Release
TD Time Delayed
TR Time Release
XL Extended Release
XR Extended Release
Summary of Drug Formulations That Preclude Crushing
Type Reason for the formulation
Enteric Coated The coating is designed to resist gastric acid to
protect the drug and/or reduce gastric side effects.
Extended Release These are tablets or capsules that are specifically
designed to release the drug over a long period of
time. Crushing these will cause all the drug to be
released at once and may cause toxic side effects.
Sublingual Designed to dissolve quickly in oral fluids for
rapid absorption by the abundant blood supply of
the mouth
Cytotoxics and hormones These should not be crushed due to the risks to
staff from exposure to the powdered drug.

6
Do not crush medication list
Alendronate Sodium Sustained-release and mucous
ALENDRO® membrane irritant
Alfuzosin Sustained-release
XATRAL XL TAB®
Aspirin Enteric-Coated
DISPIRIN®
ASPIRIN PROTECT®
Atomoxetine Note: capsule contents can cause
STRATERRA® ocular irritation
Bisacodyl Enteric-Coated, antacids and/or
DULCOLAX® milk may prematurely dissolve the
coating of the tablet.
Bupropion Sustained-release
WELLBUTRIN®
Carbamazepine Sustained-release
TEGRETOL CR® 200 MG TAB
TEGRETOL CR®400 MG TAB
Cefaclor Prolonged release
CECLOR MR® TAB
Cefuroxime Taste (liquid dosage forms of the
ZINNAT 500 MG ® TAB product are available
Clarithromycin Slow release
KLACID XL®
CLARITT XL®
Dabigatran Breaking, chewing, or emptying
PRADAXA® contents of the capsule can result in
increased exposure
Diltiazem Hydrochloride Sustained-release
DILIZEM SR®

Doxycyline cap Irritant

TABOCIN®
Doxazosin Slow release
CARDURA XL®
Duloxetine Slow release

7
CYMBALTA®
Dutasteride Drug may cause fetal abnormalities;
AVODART ® women who are, or may become,
pregnant, should not handle
capsules; all women should use
caution in handling capsules,
especially leaking capsules
Erythromycin Bad taste
ERTHRODAR FORTE®
Finasteride Women who are, or may become,
PROSCAR® pregnant, should not handle
crushed or broken tablets.
Isosorbide Dinitrate ISOSORBIDE Sustained-release
DINITRATE 20MG, 40 MG TAB ®
Isotretinoin Mucous Membrane Irritant
ROACCUTANE CAP ®
Lamotrigine Modified release
LAMICTAL XR®
Mesalazine Sustained release
PENTASA®
Metformin Sustained release
GLUCOPHAGE XR®
Mycophenolate Teratogenic, potential
CELLECPT®
Nifedipine Sustained release
ADALAT LA®
Omeprazole tab Crushing can inactivate proton
pump inhibitors
Pantoprazole Crushing can inactivate proton
PANLOCK® pump inhibitors
Potassium chloride Sustained release
SLOW K®
Pramipexole Extended release
SIFROL ER®
Quetiapin Slow release
SEROQUEL XR®
Salfasalazine Enteric coated tab
SALAZOPYRINE®
STALEVO® Note: combining multiple tablets or
portions of tablets may lead to an

8
 overdose of entacapone
SYNJARDY XR® Slow release
Valproic acid Slow release
DEAPKENE CHRONO®
Venalafaxine Slow release
EFFEXOR XR®

Choosing medication formulation

Yes
Solutions (most appropriate)
Dispersible tablets
Effervescent tablets
Suspension-granular and non-
granular
Immediate-release tab
No
Enteric coated products
Modified release preparations
Teratogenic or cytotoxic drugs
Hormone products, prostaglandin
products
Buccal and sublingual preparations

9
Administration tips

10
Drugs to be given during a feed break
Drug class Drug Timing of administration with respect
to feed (before/after)
30 min/ 1 1 2 2
30 min hour/ hour/ hours/ hours/
1 2 1 hour 2
hour hours hours
Antibiotics Ciprofloxacin ✓
Metronidazole ✓
suspension
Trimethoprim ✓
Levofloxacin ✓
Ofloxacin ✓
Other Fluconazole ✓
antimicrobials With jevity
Digoxin (high- ✓
fibre feeds)
Warfarin (1–2 hours before, 1–
2 hours after)
Endocrine Alendronic Administer first thing in the morning
agents acid after rising and the patient should
remain sitting upright or standing for
30 minutes after the dose is given
Levothyroxine ✓
Respiratory Montelukast ✓
and allergy
Immunosuppr Tacrolimus ✓
essant

Gliclazide Give at start of feed

11
Drug interactions and preventive actions when giving
drug via tube:
Binding drugs to tubes: 1. Dilute drug with at least 30-60
1. Carbamazepine ml of water
2. Diazepam 2. Flush well and monitor clinical
3. Phenytoin response

Drug interactions with feed causing 1. Find alternative route if possible

coagulation in the tube 2. Dilute the drug as much as
1. Chloropheniramine possible to minimize drug-food
2. Promethazine interactions
3. Flush with 30-60 ml of water
Documented drug-enteral feed 1. Stop the feed for 1 hour before, 1-
incompatibilities affecting drug 2 hours after administration of
absorption the drug, (phenytoin 2 hours
1. Carbamazepine before and after)
2. Ciprofloxacin 2. Dilute the drug as much as
3. Phenytoin possible
4. Warfarin 3. Flush with 30-60 ml of water
Drugs requiring administration on 1. Stop feeding 1 hour before and
empty stomache after each dose,
1. Ketoconazole 2. Consider alternative route
2. Tetracyclines 3. Ensure sufficient flushing
3. Penicillins
Drug-feed direct interaction 1. Monitor INR and adjust
Warfarin and vitamin-K in feed anticoagulant dose if necessary
2. All tablets can be crushed and
dispersed in water
3. Stop the feed for 1–2 hours
before, 1–2 hours after dose
Drug-drug interaction 1. Alter drug timing administration
Iron or zinc+ ciprofloxacin
Levodopa Absorption is reduced by high protein
diet.
Sucralfate Giving sucralfate to patient receiving
enteral nutrition is highly discouraged

12
Unblocking tubes:
❑ Do not use guide wire for unblocking tube because of the risk of
perforation however if premeasured so as not to exceed the length of the
tube and if used with care, they can be helpful.
❑ Warm or cold water, soda water or cola

Flushing of tubes should occur:

1. Before and after each intermittent feed
2. Every 4-6 hours during continuous feeding
3. Before and after each drug administration

How to flush medicines:

1. Appropriate drug formulation
2. Stop/suspend enteral feeding
3. Flush before and after each drug administration with 15-30 ml of water
4. Rinse tablet crusher with water and draw up water into the syringe used
and flush this down the tube
5. One medication at a time
6. If more than one medicine is to be administered, flush between drugs
with at least 10 ml of water
7. Restart feed unless specific time interval is needed

13
 Drug name Form INSTRUCTIONS Feed Additional
directions information
A
Acetazolamide Tablet Disperse in 10 ml Prolonged If administered via
DIAMOX ® of water break in jejunal tube
feeding is not monitor for loss of
required efficacy or
before or after increased adverse
administration effects
Acetylcysteine 200 mg/ml Draw the injection Prolonged Intra-jejunal
injection through syringe break in administration is
and administer via feeding is not done by the same
NGT required method
before or after
administration
Acyclovir Tablet Disperse in 10 ml Prolonged Intra-jejunal
ZOVIRAX ® of water and break in administration is
administer via NGT feeding is not done by the same
required method
before or after
administration
Alendronate Tablet Disperse in 10 ml Allow long If administered via
ALENDRO® of water and break as jejunal tube
administer via possible before monitor for loss of
NGT. administration efficacy or
of drug. increased adverse
Ensure that the effects
patient is
upright or
standing for 30
minutes after
the dose.
Re-start the
feed after the
30 minutes has
passed
Allopurinol Tablet Disperse in water Give If administered via
NO-URIC® and administer immediately jejunal tube
immediately. after feed has monitor for loss of
Crush300 mg stopped efficacy or
tablets before use increased adverse
effects
Alfacalcidiol Drops Add the required Prolonged Intra-jejunal
ONE-ALPHA® number of drops in break in administration is
10 ml of water feeding is not done by the same
required method
14
 before or after
administration
Amiodarone Tablet Crush and disperse Prolonged Monitor patient
CORDARONE ® in 15-30 ml water. break in closely for
Give immediately feeding is not reemerging signs
after preparation required and symptoms of
before or after arrhythmias as
administration enteral
administration can
reduce serum
amiodarone level
Amitriptyline Tablet Crush and disperse Prolonged If administered via
AMITRIPTYLINE in water. break in jejunal tube
® Crush well to feeding is not monitor for loss of
ensure film coating required efficacy or
is broken up before or after increased adverse
administration effects
Amlodipine Tablet Disperse the tablet Prolonged Give immediately
AMLOR ® in 10 ml of water break in as amlodipine
feeding is not is light sensitive.
required before/after
before or after Tablet dispersion
administration should be used for
intrajejunal
administration,
monitor for loss of
efficacy or
increased side
effects.

Amoxicillin Oral Dilute with an Prolonged Flush well.

HYMOX® suspension equal volume of break in Can be
water before feeding is not administered via
administration required jejunal tube.
before or after
administration
Apixaban Tablets Crush and disperse Prolonged Flush well. No data
ELIQUIS ® in water, break in for administration
manufacturer feeding is not via jejunal tubes.
recommends 60 ml required
of water before or after
administration
Aspirin Dispersible Disperse in water. Prolonged Can be
Do not crush tablets break in administered via
enteric coated feeding is not jejunal tube
tablets required
before or after

15
 administration
Ascorbic acid Effervescen Add tablet in 20-50 Prolonged Can be
REDOXON® t tab ml of water, allow break in administered via
to dissolve. feeding is not jejunal tube
required
before or after
administration
Atenolol Tablets Crush and disperse Prolonged Can be
ATENO® in 10-15 ml of break in administered via
water. feeding is not jejunal tube
required
before or after
administration
Atorvastatin Tablets Disperse in 10 ml Prolonged Give immediately
ASTATIN® of water break in as tablets are light
feeding is not sensitive.
required If administered via
before or after jejununal tube,
administration monitor for
increased adverse
effects or decreased
potency.
Azathioprine Tablets Tablets disperse in Prolonged Can be
IMURAN® 10 mL water within break in administered via
5 minutes, to give a feeding is not jejunal tube
pale-yellow milky required
dispersion that before or after
flushes easily via administration
an 8Fr NG tube.
B
Baclofen Tablets Disperse in water Prolonged Can be
LIORESAL® break in administered via
feeding is not jejunal tube
required
before or after
administration
Bisoprolol Tablets Disperse in 5 ml of Prolonged If administered via
CONCOR® water, shake if break in jejunal tube
necessary. feeding is not monitor for loss of
required efficacy or
before or after increased adverse
administration effects
Bisacodyl Enteric coated tablets DO NOT CRUSH, not suitable for enteral tube
DULOCOLAX® feeding administration

C
Calcium Effervescent Effervesces in Prolonged Flush well as

16
 tablet 30-50 ml of break in calcium can bind to
water feeding is not phosphate in feed.
required Can be
before or after administered via
administration jejunal tube
Calcium and vit D Chewable Crush and Prolonged Flush well as
IDEOS® tablets disperse in 10 ml break in calcium can bind to
of water. feeding is not phosphate in feed.
required Can be
before or after administered via
administration jejunal tube
Candesartan Tablets Crush and Prolonged If administered via
ATACAND® disperse in break in jejunal tube
Shift to irbesartan water feeding is not monitor for loss of
if possible required efficacy or
before or after increased adverse
administration effects
Captopril Tablets Disperse in 10 Prolonged If administered via
ACETAB® ml of water break in jejunal tube
immediately feeding is not monitor for loss of
before use required efficacy or
before or after increased adverse
administration effects
Carbamazepine Liquid Dilute with an Prolonged If giving doses
TEGRETOL® equal amount of break in higher than 400
water. feeding is not mg/day, divide into
required 4 equal doses.
before or after Doses above 800
administration mg/day may cause
Tablet Disperse in 10 , but give in bloating due to the
ml water. consistent sorbitol content of
manner. the liquid.
Drug level If administered via
monitoring jejununal tube,
may be monitor for
recommended increased adverse
effects or decreased
potency.
Carvedilol Tablet Disperse in 10 Administer Can be
RICAVILOL® ml of water after feed. administered via
immediately jejunal tube.
before
administration.
Cefixime Oral Can be A prolonged Flush well. Can be
SUPRAX® suspension administered break in administered via
undiluted feeding is not jejunal tube.
required.

17
Celecoxib Capsules Open the
CELEBREX® capsule content
and mix with 10
ml of water
Cetirizine Oral Can be Prolonged Tablets are more
ZYRTEC® solution administered break in suitable for intra
undiluted feeding is not jejunal
Tablets Tablets can be required administration,
crushed and before or after monitor for
dispersed administration increased adverse
effects or decreased
potency.
Ciprofloxacin Tablets Disperse in 20 Withhold Flush tube after
CIPROXEN® ml water for feeding for 2 each dose with
injection hours before 65mL of water
and after the for injection.
dose A dose at the
upper range
should be used
especially for
administration
via jejunal tube.
Citalopram Tablets Crush and Prolonged If administered
LOPRAM ® disperse in break in via jejunal tube
water feeding is not monitor for
required loss of efficacy
before or after or increased
administration adverse effects
Clarithromycin Liquid Dilute with Prolonged Viscous solution.
CLARITT ® equal amount of break in May block tubes
water feeding is not smaller than 9Fr.
required An alternative
before or after macrolide should
administration be considered.
If administered via
jejunal tube,
monitor for loss of
efficacy or
increased side
effects.
Clopidogrel Tablet Crush and Prolonged Can be
PLAVIX ® disperse in break in administered via
water. feeding is not jejunal tube.
required
before or after
administration
Co-amoxclav Oral Dilute with Give Can be

18
MEGAMOX® Suspension equal amount of immediately administered via
water prior to feed. jejunal tube.
Prolonged Monitor for loss of
break in efficacy.
feeding is not
required
before or after
administration
Carbidopa/ Tablet Disperse in 10 Protein in the Can be
levodopa ml of water. diet competes administered via
SINEMET® with levodopa jejunal tube.
for absorption
and transport
into the brain.
Diets that do
not exceed 0.8
g/kg of protein
are reported to
eliminate this
problem.
Doses and feed
should be
given in the
same time
everyday
D
Dabigatran Switch to alternative anticoagulant
PRADAXA®
Diclofenac Consider changing to ibuprofen liquid.
Digoxin Tablet Crush and For high fiber Tablets should be
DIGOXIN® disperse in water content enteral used for intra
feeding as jejuna
jevity, administration
withhold feed
for 2 hours
before dosing
and 1 hour
after dosing
Domperidone Oral Dilute with Prolonged For intrajejunal
DOMPY® suspension equal volume of break in administration,
water feeding is not ensure dilution
required with at least an
before or after equal volume of
administration water.

Donepezil Tablets Crush and Prolonged Can be

DONCEPT® disperse in 10-15 break in administered via

19
 ml of water feeding is not jejuna tube
required
before or after
administration
Doxazosin Tablets Disperse tablets Prolonged Do not crush
CARDURA® in 10-15 ml of break in extended release
water. feeding is not tablets.
required Can be
before or after administered via
administration jejunal tube.
Doxycylcine Do not open the capsules as they are irritant
TABOCIN®
E
Enalapril Tablets Crush and Prolonged Can be
ENAPRIL® disperse in water break in administered via
feeding is not jejunal tube.
required Monitor for loss of
before or after efficacy.
administration
Erythromycin Oral Solution can be Prolonged Antibiotic
ERYTHRODAR ® suspension given undiluted break in absorption can be
feeding is not reduced when
required administered
before or after intrajejunally, use
administration another antibiotic.
Esomeprazole Capsules Open the Prolonged Can be
NEXIUM® capsules and mix break in administered via
the contents feeding is not jejunal tube.
with 50 ml of required
water, use before or after
immediately administration
after
preparation.
Etoricoxib Tablets Disperse the Prolonged Can be
ARCOXIA® tablets in 10 ml break in administered via
of water feeding is not jejunal tube.
required
before or after
administration
F
Ferrous fumarate Syrup Dilute with an Prolonged Flush well. If given
equal volume of break in intrajejunally,
water feeding is not absorption can be
required reduced.
before or after
administration
.

20
 Administration
after feed can
reduce GI
adverse effects
Ferrous Sulphate Convert to ferrous fumarate and administer as above.
FEFOL® Ferrous sulphate 200mg three times daily = ferrous fumarate
140mg/5mL, 10mL twice daily.
Finasteride Tablets Place tablets in Prolonged Flush well.
PROSCAR® the barrel of an break in Women who are
oral or bladder feeding is not pregnant or may be
tipped syringe. required pregnant should
Draw water up before or after not handle broken,
into the administration crushed or
syringe and . dispersed tablets.
allow the Can be
tablet to administered via
disperse. jejunal tube.
Fluconazole Capsule Open capsule For high fiber If administered via
DURACAN® and disperse in content enteral jejunal tube, dose
water. feeding as at the upper range
jevity, should be used to
withhold feed ensure adequate
for 1 hour absorption.
before dosing
and 1 hour
after dosing or
give feeding
break
Fluoxetine Capsule Open capsule Prolonged Flush well.
PROZAC® and disperse in break in Can be
water. feeding is not administered via
required jejunal tube.
before or after Monitor for loss of
administration efficacy.
Folic acid Tablets Crush and Prolonged If administered via
FOLIC® disperse in break in jejunal tube, dilute
water. feeding is not with an equal
required volume of water.
before or after
administration
Furosemide Tablets Crush and Prolonged If administered via
LASIX® disperse in break in jejunal tube, dilute
water. feeding is not with an equal
required volume of water.
before or after
administration
.

21
 G
Gliclazide Tablets Disperse in 10 Prolonged break Monitor blood
DIAMICRON® ml of water in feeding is not glucose level
and administer required before closely for change
immediately or after in efficacy.
administration. Can be
Give administered via
immediately jejunal tube.
prior to food. Monitor for loss of
efficacy.
Glimepiride Tablets Disperse in Prolonged break Monitor blood
AMARYL® water and give in feeding is not glucose level
immediately required before closely for change
or after in efficacy.
administration. Can be
Give administered via
immediately jejunal tube.
prior to food. Monitor for loss of
efficacy.
H
Hyoscine Injection Draw the Prolonged break If the tube
BUSCOPAN® injection in feeding is not exits in the
solution down required before jejunum, consider
the tube or after using parenteral
administration. therapy.
I
Ibuprofen Suspension Dilute in equal Prolonged break Can be
SAPOFEN® volume of in feeding is not administered via
water required before jejunal tube.
or after Monitor for loss of
administration. efficacy.

Indapamide Tablets Crush and Prolonged break Absorption is

NATRILIX® disperse in in feeding is not reduced when
water required before administered
or after intrajeunally, use
administration. alternative
preparation.
Do not crush MR
preparation.
Irbesartan Tablets Tablets Prolonged break Flush well.
APROVEL® disperse in 10 in feeding is not Can be
mL water required before administered via
within 2–5 or after jejunal tube.
minutes to administration. Monitor for loss of
give fine milky efficacy.
dispersion,

22
 flush
down an 8Fr
NG tube
without
blockage.
Isosorbid Tablet Disperse in 10 Prolonged break Crushing tablet can
mononitrate mL of water in feeding is not increase the rate of
within 5 required before absorption and side
minutes if or after effects.
agitated. The administration. No information
resulting about
dispersion administering it
flushes via intrajejunally.
an 8Fr NG tube Do not crush MR
without tablets
blockage
L
Lactulose Syrup Dilute 1 in 3 or Prolonged break Can be
LAXOLAC® 1 in 4 in water in feeding is not administered
DUPHALAC® required before intrajejunally.
or after
administration.
Levetiracetam Oral Administer Prolonged break Monitor closely for
KEPPRA® solution undiluted in feeding is not change in efficacy
Tablets Crush and required before or increased side
disperse in or after effects
water administration.
Levothyroxine Tablets Disperse in 15- Withhold Inhalation of
EUTHYROX® 30 ml of water. feeding one hour crushed tablets
Do not crush before and after should be avoided.
the tablets administration. Can be
administered
intrajejunally, but
monitor for
possible adverse
effects.
Levofloxacin Tablets Crush the Stop feed 1 hour Administer using
TAVANIC® tablet and before dose and the previous
disperse in 15 restart feed 2 method; use the
ml of water hours after dose. higher end of dose
range.
Lisinopril Tablets Disperse in Prolonged break Can be
LISINO® water in feeding is not administered
required before intrajejunally.
or after
administration.
Loperamide Tablets Crush and Prolonged break If administered via

23
IMODIUM® disperse in in feeding is not jejunal tube dilute
water required before with equal volume
or after of water.
administration.
Loratidine Syrup Dilute with an Prolonged break If administered via
LORINE® equal amount in feeding is not jejunal tube dilute
of water required before with water, monitor
or after for efficacy or
administration. increased side
effects.
Losartan Tablets Crush and Prolonged break Can be
SORTIVA® disperse in in feeding is not administered via
water required before jejunal tube.
or after Monitor for loss of
administration. efficacy.
M
Movicol Sachets Use of alternative laxative is preferred
Mebendazole Suspension Use the Prolonged break Can be
VERMOX® suspension in feeding is not administered via
directly required before jejunal tube.
without or after Monitor for loss of
dilution. administration. efficacy.
Mebeverine Tablets Crush and Give 20 minutes Can be
MEVA 135 MG® disperse in before feed administered via
water. jejunal tube.
Do not crush Monitor for loss of
modified efficacy.
release tablets
Metformin Tablets Crush and Prolonged break Tablets are too
GLUCOPHAGE® disperse in in feeding is not hard to crush, do
water. required before not crush near the
Do not crush or after patients bed side.
modified administration. Protective eyewear
release tablets should be
considered.
Monitor blood
glucose levels.
Can be
administered via
jejunal tube.
Monitor for loss of
efficacy.

Metoclopramide Tablets Crush and Prolonged break Can be

PRIMPERAN® disperse in 15- in feeding is not administered via
30 ml of water required before jejunal tube.
or after Monitor for loss of

24
 administration. efficacy.
Metoprolol Tablets Crush and Prolonged break Can be
LOPRESSOR® disperse in in feeding is not administered via
water required before jejunal tube.
or after
administration.
Metronidazole Oral Solution Withhold Flush well.
FLAGYL® solution should be feeding 2 hours Crush the tablets
given before and 1 well before use, use
undiluted hour after each the tablets only for
dose intrajejunal
Tablets Crush and Prolonged break administration,
disperse in in feeding is not never use the
water required before liquid.
or after
administration.
Miratzapine Tablets Crush and Prolonged break
Flush well.
MIRZAGEN® disperse in in feeding is not
Can be
water required before
administered via
or after
jejunal tube.
administration.
Monitor for loss of
efficacy.
Montelukast Chewable Disperse in Withhold Can be
SINGULAIR® tablets water feeding 2 hours administered via
before and 1 jejunal tube.
hour after each Monitor for loss of
dose efficacy.
Tablets Disperse in 10 Prolonged break
ml of water in feeding is not
required before
or after
administration.
Mycophenolate Suspension Suspension Prolonged break Can be
CELLCEPT® should be in feeding is not administered via
given required before jejunal tube.
undiluted or after Do not crush the
administration. tablets or open the
capsules
O
Ofloxacin Tablets Crush the Stop feed 1-hour
TARIVID® tablets and pre-dose and re-
disperse in start feed 2
water hours post-dose.
Ondansetron Injection Injection can Prolonged break Can be
IMATOX® be given in feeding is not administered via
undiluted required before jejunal tube.
through or after Monitor for loss of

25
 nasogastric administration. efficacy.
tube.
Oseltamivir Capsules Open the Prolonged break No available data.
OSELTA® capsules and in feeding is not
empty the required before
content in 5 ml or after
of water administration.
Oxybutynin Tablets Disperse in 10 Prolonged break Can be
ml of water in feeding is not administered via
required before jejunal tube.
or after Monitor for loss of
administration. efficacy.
Do not crush MR
tablets
P
Paracetamol Soluble Dissolve in 50 Prolonged break If patient is sodium
FEVADOL® tablets ml of water in feeding is not or fluid restricted,
Syrup Dilute with required before soluble tablets will
equal amount or after not be appropriate.
of water administration. Can be
immediately administered
before intrajejunally.
administration
Phenytoin Capsules Open and Withhold feed Flush with 30-60 ml
EPANUTIN® disperse for 2 hours of water.
Enteral powder in before and 2 Absorption is poor
administration is 10mL of hours after each intrajejunally.
water. Leave dose
difficult due to
for 5mins
inappropriate
and stir to
absorption, form a fine
consider another dispersion.
route
Polystyrene WHEN MIXED WITH WATER THE PASTE IS VERY THICK TO
sulfonate resins ADMINISTER THROUGH FEEDING TUBES, RECTAL ROUTE IS
CALCIUM PREFERRED
RESONIUM®
Potassium SLOW K MODIFIED RELAESE TABLETS, DO NOT CRUSH, NOT
chloride SUITABLE FOR NASOGASTRIC ADMINISTARTION.
SLOW K®
Pramipexole Tablets Crush and Prolonged break No specific
SIFROL® disperse in in feeding is not information for
water required before intrajejunal
or after administration
administration.
Pyridoxine Tablets Crush the Prolonged break Can be
PYRIDOXIN® tablet and mix in feeding is not administered

26
 with 15 ml required before intrajejunally.
water or after
immediately administration.
prior to
administration
R
Ramipril Tablets Crush and Prolonged break Can be
RAMIPRIL® disperse in in feeding is not administered via
water required before jejunal tube.
or after Monitor for loss of
administration. efficacy.

Ranitidine Effervescen Dissolve in 75 Prolonged break Can be

ZANTAC® t tablets ml of water in feeding is not administered via
required before jejunal tube.
or after Monitor for loss of
administration. efficacy.

Risperdone Oral liquid Can be Prolonged break Can be

RISPERDAL® administered in feeding is not administered via
undiluted required before jejunal tube.
or after Monitor for loss of
administration. efficacy.

Rivaroxaban Tablets Crush and Prolonged break RIVAROXABAN IS

XARELTO® disperse in in feeding is not NOT
water required before ADMINISTERED BY
or after JEJUNAL TUBE
administration.
Rosuvatatin Tablets Disperse the Prolonged break
CRESTOR® tablets in 10 ml in feeding is not
of water required before
immediately or after
prior to administration.
administration
S
Sertraline Tablets Crush and Prolonged break Can be
LUSTRAL® disperse in in feeding is not administered via
water required before jejunal tube.
or after Monitor for loss of
administration. efficacy.

Simvastatin Tablets Crush and Prolonged break Can be

ZOCOR® disperse in 10 in feeding is not administered via
ml of water required before jejunal tube.
immediately or after Monitor for
before administration. cholesterol level.

27
 administration
Sodium Valproate Liquid Dilute with Prolonged break Do not crush MR
DEPAKEN® equal volume in feeding is not products, if
of water required before converting from
immediately or after MR products give
before administration. the same total daily
administration dose but divide into
Film coated Crush and more frequent
tablets disperse in 10 doses.
ml of water. If administered
DO NOT intrajejunally,
CRUSH dilute the syrup 3-4
DEPAKENE times with water.
CHRONO® Monitor for loss of
efficacy or
increased adverse
effects.
Solifenacin Crushing is not recommended.
SPASMOLYT ®
Spironolactone Tablets Crush and Prolonged break Flush well.
ALDACTONE® disperse in 15- in feeding is not Can be
30 ml of water required before administered via
or after jejunal tubes
administration.
T
Tacrolimus Capsules Open the Hold the feed There are no
PROGRAF® capsule, mix for 2 hours specific data
the capsule before and if relating to jejunal
content with possible 1 hour administration of
water after the feed tacrolimus.
Administer using
the same method.
Monitor levels
closely
Tamsulosin Not suitable for tube administration, consider switching to doxazosin
OMNIC OCAS®
Telmisartan Tablets Disperse tablet Prolonged break Can be
MICARDIS® in water in feeding is not administered via
immediately required before jejunal tubes
prior to or after
administration administration.
Thiamine Tablets Crush and Prolonged break Can be
disperse in in feeding is not administered via
water required before jejunal tubes
or after
administration.

28
Ticagrelor Tablets Crush and Prolonged break Flush well tube
BRILINTA® disperse in in feeding is not before use.
water required before No information
or after about
administration. administration
through jejunal
tubes
Tolterodine Tablets Crush and Prolonged break Can be
DETRUSITOL® disperse in 10 in feeding is not administered via
ml of water required before jejunal tube.
or after
administration.
Topiramate Tablets Crush and Prolonged break Can be
IPRAMAX® disperse in 10 in feeding is not administered via
ml of water, required before jejunal tube.
administer or after
immediately. administration.
Trimethoprim/ Oral Dilute with 2-3 Prolonged break Can be
Sulfamethoxazole suspension times the dose in feeding is not administered via
BACTRIM® with water required before jejunal tube.
or after
administration.
W
Warfarin Tablets Crush and Withhold feed Flush well.
WARFARIN® disperse in for 1-2 hours Monitor INR.
water before and after Use the same
each dose preparation
consistently.
Risk of reduced
absorption if used
intrajejunally.

29
References:

1. British Association for Parenteral and Enteral Nutrition (BAPEN): www.bapen.org.uk

Administering drugs via enteral feeding tubes. A practical guide
www.bapen.org.uk/pdfs/d_and_e/de_pract_guide.pdf

2. Drug administration via enteral feeding tubes: a guide for general practitioners and
community pharmacists www.bapen.org.uk/pdfs/d_and_e/de_gp_guide.pdf

3. The NEWT Guidelines: www.newtguidelines.com

4. Swallowing difficulties website: www.swallowingdifficulties.com

5. https://www.guidelines.co.uk/dysphagia/medication-management-of-patients-with-
enteral-feeding-tubes/454634.article

6. Oral Dosage Forms That Should Not Be Crushed 2020 [wall chart]. St. Louis, MO:
Thomas Land Publishers, Inc. Copyright (C) 2020 Thomas Land Publishers, Inc.

7. White, Rebecca, and Vicky Bradnam. Handbook of drug administration via enteral
feeding tubes. Pharmaceutical Press, 2015.

8. NHSG/Guid/EnteralTubesA/MGPG1096 Guidelines for the Administration of

Medicines to Adults Via Enteral Tubes Within NHS Grampian. May 2020

9. https://www.alfredhealth.org.au/contents/resources/clinical-
resources/MedicationAdministrationAndDrugInteractions.pdf

10. https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-
guidelines/intensive-and-critical-care/enteral-tubes-administration-of-medication-
via-picu/

30
Prepared by:
Clinical Pharmacist
Dr. Sara Youssef
Reviewed by:
Chief Pharmacist
Dr. Waleed Assem
Reviewed by:
Chief Manager of Pharmacy and
Dr. Sherif Hussein Therapeutic Committee

31