Medication absorption considerations in patients with postpyloric enteral feeding tubes

Abstract

The implications of absorption site should be considered for all patients receiving medications via postpyloric feeding tubes. Several medications cannot be administered through alternative routes because gastric acid is needed for their absorption, the medications may bind to the tubing, or drug absorption is altered at the intestinal site.

Addressing Concerns about Changing the Route of Antimicrobial Administration from Intravenous to Oral in Adult Inpatients

“…54 Feeding tubes can deliver enteral nutrition and orally administered medications directly to the stomach, duodenum, or jejunum.…”

Clinical management of post-pyloric enteral feeding in children

“…Before administering drugs into small bowel, the following elements should be considered: absorption site and potential local adverse effects, potential reaction with the feeding tube (blockade), need for gastric acid to be absorbed, and liquid form and not tablets/capsules [79]. These elements should be included in the drug information.…”

“…These elements should be included in the drug information. However, a recent paper found that despite its potential clinical significance, this information is not given [79].…”

“…The presence of devices in the small intestine can also induce duodenogastric reflux [75][76][77][78] or aspiration [74,76,78,79]. JF may eventually become GF because of the formation of a fistula between the gastric and jejunal tubes [84].…”

“…The tip of the tube was placed approximately 40 cm down the jejunum to maintain pancreatic rest. Only one patient did not tolerate feeding and needed to Leakage Narrow tubes, poor healing of the stoma, decreased volume of the gastric balloon Increase of fluid in the gastric balloon, topical treatment (barrier creams), switching to a wider tube [82] Duodenogastric reflux Short tubes, intestinal dysmotility, distal obstruction Prokinetic drugs, longer jejunal tubes, exclusion of distal obstruction [75][76][77][78] Aspiration Due to vomiting of gastric contents Antisecretory drugs, small volume of fluids with drugs, gastric decompression [74,76,78,79] Bowel perforation Migration of tube due to intestinal peristalsis (observed mainly in malrotated patients)…”