How long before administering medications via enteral tube must you stop a continuous feeding?

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Medication Administration Timing

To reduce drug–nutrient interactions, it is important to consider timing of drug delivery in relation to EN. This is affected by both the frequency of medication administration and the enteral feeding delivery method. Once-daily drug dosing and intermittent or bolus feedings are easier to work with than multiple-daily drug dosing and continuous feeding regimens. When administering medications with continuous feedings, the EN may need to be interrupted repeatedly, depending on the frequency of the medication regimen. It may be necessary to adjust the feeding rate to compensate for the time EN was held for drug delivery so the patient still receives the desired amount of protein and calories.[13]

Some medications should be taken on an empty stomach. A variety of recommendations have been proposed to improve drug absorption with continuous enteral feedings. Gilbar[12] suggested that EN be stopped 30 minutes before administering the drug to allow gastric emptying. After the medication is given, EN may be restarted 30 minutes later, thus allowing time for drug absorption to occur before the feedings resume. This practice is only applicable for gastric feeding and not small bowel access because enteral feedings are not retained in the duodenum or jejunum. Gora et al.[9] recommended stopping the continuous feedings just 15 minutes before drug delivery. For optimal absorption, it may be necessary to hold feedings for an hour before and two hours after medication administration.[10] For patients receiving intermittent or bolus gastric feedings, medications may be easily administered between feedings.

Am J Health Syst Pharm. 2008;65(24):2347-2357. © 2008  American Society of Health-System Pharmacists

Cite this: Medication Administration Through Enteral Feeding Tubes - Medscape - Dec 15, 2008.

• Abstract and Introduction
• Enternal Access Sites and Delivery Methods
• Feeding Tube Size and Placement Site
• Other Options for Medication Administration
• Medication Administration Considerations With EN
• Dosage Forms Not Appropriate for Administration Through a Feeding Tube
• Mixing Medications With EN Formulations, Flushing Enteral Feeding Catheters, and Diluting Liquid Medications
• Medication Administration Timing
• Specific Drug–nutrient Interactions
• Obstructed Feeding Tubes
• General Recommendations and Conclusion
• References
• Appendix A
• Appendix B
• Appendix C

Authors and Disclosures

Nancy Toedter Williams, Pharm.D., BCPS, BCNSP, is Associate Professor, Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University.

Disclosure: The author has declared no potential conflicts of interest.

Appendix A

Partial List of Liquid Medications That Have an Osmolality of ≥ 3000 mOsm/kg[17]

• Acetaminophen elixir, 65 mg/mL

• Acetaminophen with codeine elixir

• Amantadine hydrochloride solution, 10 mg/mL

• Chloral hydrate syrup, 50 mg/mL

• Cimetidine solution, 60 mg/mL

• Dexamethasone solution, 1 mg/mL

• Dextromethorphan hydrobromide syrup, 2 mg/mL

• Diphenoxylate hydrochloride–atropine sulfate suspension

• Docusate sodium syrup, 3.3 mg/mL

• Ferrous sulfate liquid, 60 mg/mL

• Hydroxyzine hydrochloride syrup, 2 mg/mL

• Lactulose syrup, 0.67 g/mL

• Lithium citrate syrup, 1.6 mEq/mL

• Metoclopramide hydrochloride syrup, 1 mg/mL

• Multivitamin liquid

• Potassium chloride liquid, 10%

• Potassium iodide saturated solution, 1 g/mL

• Promethazine hydrochloride syrup, 1.25 mg/mL

• Sodium phosphate liquid, 0.5 g/mL

Appendix B

Partial List of Liquid Medications That Contain Considerable Amounts of Sorbitol With Typical Daily Dosing[20,21]

• Acetaminophen liquid

• Amantadine hydrochloride solution

• Aminocaproic acid syrup

• Charcoal liquid, with sorbitol

• Cimetidine solution

• Guaifenesin/dextromethorphan syrup

• Isoniazid syrup

• Lithium citrate syrup

• Metoclopramide hydrochloride syrup

• Phenylephrine hydrochloride/brompheniramine maleate elixir

• Phenylephrine hydrochloride/chlorpheniramine maleate elixir

• Pseudoephedrine syrup

• Pseudoephedrine/triprolidine syrup

• Sodium polystyrene sulfonate suspension

• Tetracycline hydrochloride suspension

• Theophylline oral solution

Appendix C

Partial List of Liquid Medications Physically Incompatible With Most Enteral Nutrition Products[19,23]

• Brompheniramine (Dimetane elixir, Wyeth, Madison, NJ)

• Calcium glubionate (Rugby, West Hempstead, NY); pH = 4

• Ferrous sulfate (Feosol elixir, GlaxoSmith-Kline, London, England); pH = 2.2

• Guaifenesin (Robitussin liquid, Wyeth, Madison, NJ)

• Lithium citrate (Cibalith-S syrup, CIBA Pharmaceuticals, Summit, NJ); pH = 4.7–4.8

• Monobasic sodium phosphate (Fleet Phospho-Soda, C.B. Fleet Co. Inc., Des Moines, IA)

• Potassium chloride liquid (Wyeth, Madison, NJ)

• Pseudoephedrine hydrochloride (Sudafed syrup, Pfizer Inc., Brooklyn, NY); pH = 2.5

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