Approved Formulary
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Enteral Drug Administration
| Enteral Drug Administration notes. | |||
|---|---|---|---|
| A | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Actonel - see risedronate | |||
| acyclovir (Zovirax) |
Commercially available suspension combined with Osmolite resulted in clogging 8 Fr, but not 20 Fr feeding tubes | Disperse tablet in 20 mL water. Do NOT administer suspension through feeding tube. | |
| alendronate (Fosamax) |
Do NOT crush tablets as a mucosal irritant. | Use once-weekly tablet dispersed in 60 mL of mineral-free water. Consider holding tube feeding for 30 minutes before and 30 minutes after. Patient should remain upright to prevent esophageal damage caused by reflux. | |
| amoxicillin (Amoxil) |
Avoid crushing any sustained-released product | Use the suspension from reconstituted powder and further dilute 1:1 prior to administration. | |
| atomoxetine (Strattera) |
Do NOT open capsule as contents are an ocular irritant | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| atovaquone (Mepron) |
AUC significantly greater with enteral feed compared to fasting | No dose adjustment required, but needs to be administered with tube feedings for maximal absorption | |
| Avelox - see moxifloxacin | |||
| Avodart - see dutasteride | |||
| B | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Belviq - see lorcaserin | |||
| benzonatate (Tessalon Perles) |
Do NOT alter integrity of dosage form. Mucosal irritant | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| Boniva - see ibandronate | |||
| budesonide (Entocort EC) |
Do NOT crush tablets, ER formulation | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| buprenorphine (Subutex) |
Tablets are intended for SL administration | Consider therapeutic alternative (transdermal, parenteral) | |
| buPROPion (Wellbutrin) |
Do NOT crush SR or ER tablets. | If no therapeutic alternative, use immediate-release tablet | |
| C | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Calan - see verapamil | |||
| calcium acetate (PhosLo) |
Therapeutic effect requires drug be taken with food. | Suggest scheduling 4-6 times per day for maximum effect. | |
| calcium carbonate (Tums) |
Antacids may have minimal benefit with post-pyloric tubes | Check distal tube placement | |
| captopril (Capoten) |
Avoid exposure from crushing if pregnant | Consider holding tube feeding 1 hour before and 1 hour after | |
| Carafate - see sucralfate | |||
| carBAMazepine (Carbatrol, TEGretol) |
Decreases absorption as adheres to tube, dilute with equal volume water, contains sorbitol | Suggest that total daily dose should be divided into 4 equal doses of carBAMazepine suspension. Dilute suspension with equal amounts of diluent. Monitor levels, jejunal administration may be less effective. | |
| carbidopa-levodopa (Sinemet) |
Do not need to hold tube feeds. May increase dose for desired effect | ||
| Cardizem - see diltiaZEM | |||
| cefdinir (Omnicef) |
Capsule and oral suspension are not bioequivalent. High-fat meal reduces suspension bioavailability by 30%. Iron-containing and Mg-containing preparations further reduce bioavailability | Consider holding tube feeding 1 hour before and 1 hour after | |
| cefuroxime (Ceftin) |
Tablets and oral suspension are not bioequivalent. Do NOT crush tablets (risk of sensitization), unacceptable taste | Use available suspension or disperse tablet (do not crush) in 20 mL water prior to administration | |
| celecoxib (CeleBREX) |
Not recommended for post-pyloric tubes | ||
| Cellcept - see mycophenolate mofetil | |||
| cephalexin (Keflex) |
Do not crust tablet or manipulate capsules (sensitization). Suspension may contain sorbitol. | Use available suspension | |
| ciprofloxacin (Cipro) |
Binds to divalent ions (absorption reduced by 50%) | Recommend changing to IV for severe infections. For mild/moderate infections suggest 750 mg BID. Use crushed tablets (suspension may NOT be used with any feeding tube). Consider holding continuous EN for 1-2 hours before and after | |
| Coumadin - see warfarin | |||
| Creon - see pancrelipase | |||
| Cymbalta - see DULoxetine | |||
| D | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| dabigatran (Pradaxa) |
Capsules should not be broken or opened. | Suggest using another form of anticoagulation until patient is able to take capsule whole. | |
| Depacon - see valproic acid | |||
| Depakote - see valproic acid | |||
| diazePAM (Valium) |
Commercially available solution has lower bioavailability due to binding with NG tubing | Suggest using diazepam tablets instead of solution. | |
| diclofenac (Voltaren) |
Do NOT crush modified-release capsules or tablets | If no therapeutic alternative, consider holding tube feeding for 30 minutes prior to administration if used for acute effect. | |
| digoxin (Lanoxin) |
High-fiber containing meals may reduce oral bioavailability | Separate from fiber-containing tube feeds, otherwise no need to hold beyond flush-administer-flush | |
| Dilacor - see diltiaZEM | |||
| Dilantin - see phenytoin | |||
| diltiaZEM (Dilacor, Tiazac, Cardizem) |
Food increases absorption by 28%. | Suggest dividing total daily dose into immediate release tables every 6-8 hours | |
| diltiaZEM (Dilacor, Tiazac, Cardizem) |
May open Tiazac capsule but do NOT crush the contents | Tiazac capsule may be opened contents may be emptied into feeding tube, but do NOT crush contents. | |
| Dopar - see levodopa | |||
| DULoxetine (Cymbalta) |
Capsule contains delayed release granules | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| dutasteride (Avodart) |
Do NOT manipulate capsules, mucosal irritant | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| E | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Entocort EC - see budesonide | |||
| Evista - see raloxifene | |||
| F | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| felodipine (Plendil) |
Do NOT crush - only available as ER tablet | Do NOT administer through feeding tube. Use therapeutic alternative (amLODIPine). | |
| Flomax - see tamsulosin | |||
| Fosamax - see alendronate | |||
| Fosrenol - see lanthanum | |||
| G | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| guaiFENesin (Mucinex) |
Do NOT crush Mucinex tablets. | Consider therapeutic alternative to immediate release oral solution (200 mg q4-6h PRN). Consider holding tube feeding beyond time required to flush-administer-flush | |
| H | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| HYDROcodone (Hysingla, Zohydro) |
Do NOT crush Hysingla or Zohydro (ER tablets) | Do NOT administer through feeding tube. Use therapeutic alternative (such as Lortab) | |
| I | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| ibandronate (Boniva) |
Do NOT crush (mucosal irritant) | Do NOT administer through feeding tube. | |
| Isoptin - see verapamil | |||
| itraconazole (Sporonox) |
Capsule maximally absorbed with food. Require gastric acidity for optimal absorption. Decreased bioavailability with post-pyloric tubes. Oral liquid maximally absorbed in fasting state. | Suggest administration of oral solution. Consider holding tube feeds 1 hour before and 1 hour after administration. Monitor levels. | |
| ivermectin (Stromectol) |
High-fat meal increases bioavailability | Consider holding tube feeding 1 hour before and 1 hour after | |
| J | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Jantoven - see warfarin | |||
| Juxtapid - see lomitapide | |||
| K | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Keflex - see cephalexin | |||
| ketoconazole (Nizoral) |
Drug stability is pH dependent (optimal pH 5-9) requiring gastric acidity for optimal absorption. Decreased bioavailability with post-pyloric tubes | Consider holding tube feeding 1 hour before and 1 hour after | |
| L | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Lanoxin - see digoxin | |||
| lansoprazole (Prevacid) |
Oral suspension granules - extremely viscous may cause occlusion | Substitute to esomeprazole delayed-release granules. Do NOT administer oral suspension through feeding tube. May cause occlusion. | |
| lanthanum (Fosrenol) |
Therapeutic effect requires drug be taken with food. | Suggest scheduling 4-6 times per day for maximum effect. | |
| levodopa (Dopar) |
Absorption decreased by high protein diet | Use IR or apomorphine infusion | |
| levodopa-carbidopa - see carbidopa-levodopa | |||
| levoFLOXacin (Levaquin) |
Oral levoFLOXacin tablets with food prolongs Tmax by 1h and decreases Cmax by 14%. Oral solution with food decreased Cmax by 25% | Suggest changing to IV levoFLOXacin for severe infection. No dosing changes for oral tablet. For oral solution, consider holding tube feedings 1 hour before and 2 hours after. | |
| levothyroxine (Synthroid) |
Decreased levels due to binding to feeding tubes. | For < 7days, no adjustment needed. For > 7 days, Consider holding tube feeding 1 hours before and after dose. Monitor TSH weekly | |
| linaclotide (Linzess) |
Do NOT break or chew capsule | Do NOT administer through feeding tube | |
| linezolid (Zyvox) |
Oral suspension rapidly and completely absorbed. | Change to oral suspension | |
| lomitapide (Juxtapid) |
Capsules should not be broken or opened (pregnancy X) | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| lorcaserin (Belviq) |
Do NOT crush XR product | Do NOT administer through feeding tube. Use therapeutic alternative. | |
| M | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Mepron - see atovaquone | |||
| Metamucil - see psyllium | |||
| mineral oil | Extremely viscous | Do NOT administer through feeding tube. May cause occlusion. | |
| minocycline (Minocin) |
Do not crush XR products or open pellet-containing capsules | Not recommended for post-pyloric tubes | |
| moxifloxacin (Avelox) |
Binds to divalent ions and reduces bioavailability | Consider holding tube feeding 2 hours before and after dose | |
| Mucinex - see guaiFENesin | |||
| mycophenolate mofetil (Cellcept) |
Food has no effect on AUC, but shown to decrease AUC | No dose adjustment required. Do NOT manipulate tabs/caps due to teratogenic effect. Use available suspension. | |
| mycophenolate sodium (Myfortic) |
Do not use mycophenolate tablets, which cannot be crushed, chewed or cut due to teratogenic risk. Suggest converting | ||
| N | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| nabumetone (Relafen) |
food increases bioavailability | Consider therapeutic alternative (naproxen). | |
| Nizoral - see ketoconazole | |||
| Noxafil - see posaconazole | |||
| O | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| omeprazole (PriLOSEC) |
Food may delay absorption and reduce bioavailability. Administration with liquid protein may result in a gas-producing reaction. | Substitute to esomeprazole delayed-release granules. Consider holding tube feeding for 1 hour before and after dose. Recommend alternative (esomeprazole). Hold liquid protein | |
| Omnicef - see cefdinir | |||
| P | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| pancrelipase (Creon, Pancrease) |
Occlusion -use granule formulation, use > 10 french tubes | ||
| pantoprazole (Protonix) |
Crushing DR tablet can clog tubes. | Substitute to esomeprazole delayed-release granules. No dose adjustment when using compounded suspension. Do NOT use DR or EC tablets. Consider holding tube feeding 1 hour before dose | |
| penicillin VK (Pen-VK) |
Unpredictable absorption with tube feeds. | Suggest holding enteral nutrition 1 hour before and 1 hour after dose. Consider alternative (amoxicillin) | |
| phenytoin (Dilantin, Phenytek) |
Stop EN 2hours before and after (up to70% reduction in serum drug levels) | Suggest IV fosphenytoin or phenytoin. Suggest holding tube feeds 1 hour before and 1 hour after dose. Total daily dose should be divided into twice-daily dosing. Monitor level. | |
| PhosLo - see calcium acetate | |||
| Plendil - see felodipine | |||
| posaconazole (Noxafil) |
Cmax increased 4x and AUC increased 2.5x with high fat meals. Tablet and liquid doses are not interchangeable | Suggest giving each dose with 240 mL of nutritional supplement or 15 mL of canola oil. Not recommended for post-pyloric administration | |
| Pradaxa - see dabigatran | |||
| Prevacid - see lansoprazole | |||
| PriLOSEC - see omeprazole | |||
| Protonix - see pantoprazole | |||
| psyllium (Metamucil) |
Metamucil powders may occlude the enteral tube | Do NOT administer through feeding tube. If patient requires more fiber, suggest an enteral product with higher fiber content. | |
| Q | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| QUEtiapine (SEROquel) |
Successful clinical effects through NGT | Suggest dissolving table in water with no dose adjustments | |
| R | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| raloxifene (Evista) |
Do NOT Crush - unacceptable taste, teratogenic potential | Do NOT administer through feeding tube | |
| Relafen - see nabumetone | |||
| Renvela - see sevelamer | |||
| risedronate (Actonel) |
Do NOT crush tablets as a mucosal irritant. | Use once-weekly tablet dispersed in 60 mL of mineral-free water. Consider holding tube feeding for 2 hours before and after. Patient should remain upright to prevent esophageal damage caused by reflux. | |
| rivaroxaban (Xarelto) |
Exposure to drug reduced with release in distal small intestine. | Suggest no dose adjustment if enteral tube ends in stomach. Suggest using alternative anticoagulant if enteral tube ends distal to stomach. | |
| S | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| SEROquel - see QUEtiapine | |||
| sevelamer (Renvela) |
Therapeutic effect requires drug be taken with food. | Recommend change to suspension and scheduling 4-6 times per day for maximum effect. | |
| Sinemet - see carbidopa-levodopa | |||
| Sporonox - see itraconazole | |||
| Strattera - see atomoxetine | |||
| Stromectol - see ivermectin | |||
| Subutex - see buprenorphine | |||
| sucralfate (Carafate) |
Suspension may cause insoluble mass (bezoar) by binding to proteins. Minimal benefit with post-pyloric tubes. | Do NOT administer through feeding tube. Do NOT use suspension. Recommend NexIUM or H2RA instead. | |
| Synthroid - see levothyroxine | |||
| T | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| tamsulosin (Flomax) |
Do NOT crush or open capsule, contains slow-release product | Do NOT administer through feeding tube | |
| TEGretol - see carBAMazepine | |||
| Tessalon Perles - see benzonatate | |||
| theophylline (Theo-24) |
Absorption decreases 30% with enteral nutrition | Suggest holding enteral nutrition 1 hour before and 1 hour after dose. Use rapid release products/solutions. Divide total daily dose into 3-4 doses. | |
| Tiazac - see diltiaZEM | |||
| Tums - see calcium carbonate | |||
| V | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Valium - see diazePAM | |||
| valproic acid (Depacon, Depakote) |
Administration with food may delay rate of absorption | Suggest administering same total daily dose, but use valproic acid solution dosed every 6-8 hours. Monitor levels. | |
| verapamil (Isoptin, Calan,Verelan) |
May open Verelan capsule but do NOT crush the contents | Verelan capsule may be opened contents may be emptied into feeding tube, but do NOT crush contents. | |
| Vfend - see voriconazole | |||
| Voltaren - see diclofenac | |||
| voriconazole (Vfend) |
AUC decreased by 22% when taken with food. | Suggest holding tube feeding 1 hour before and 1 hour after administration | |
| W | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| warfarin (Jantoven, Coumadin) |
Variable Vit-K content, protein binding | Suggest holding tube feeding 1 hour before and 1 hour after administration. Avoid soy protein feeds. | |
| Wellbutrin - see buPROPion | |||
| X | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Xarelto - see rivaroxaban | |||
| Z | Generic (Brand) |
Comments and Considerations | Recommendations for Administration with Enteral Nutrition |
| Zohydro - see HYDROcodone | |||
| Zovirax - see acyclovir | |||
| Zyvox - see linezolid | |||
| last updated: 10/11/2020 | |||