Handbook of Drug Administration via Enteral Feeding Tubes Handbook of Drug Administration via Enteral Feeding Tubes THIRD EDITION Rebecca White BSc (Hons) MSc MRPharmS (I Presc) FFRPS Medical Advisor, Baxter Healthcare Ltd Compton, UK Vicky Bradnam BPharm (Hons) ClinDip MBAOpen MRPharmS Pharmaceutical Consultant, Kent, UK On behalf of the British Pharmaceutical Nutrition Group Published by Pharmaceutical Press Lambeth High Street, London SE1 7JN, UK © Pharmaceutical Press 2015 is a trade mark of Pharmaceutical Press Pharmaceutical Press is the publishing division of the Royal Pharmaceutical Society First edition 2007 Second edition 2011 Third edition 2015 Typeset by Newgen, India Printed in Great Britain by TJ International, Padstow, Cornwall ISBN 978 85711 162 (print) ISBN 978 85711 221 (ePDF) ISBN 978 85711 222 (ePub) ISBN 978 85711 223 (Mobi) All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior written permission of the copyright holder The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made The right of Rebecca White and Vicky Bradnam to be identified as the authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988 Contents Foreword xi Preface xii About the authors xiii Individual drug monographs: Abacavir 63 Acamprosate calcium 65 Acarbose 66 Acebutolol 67 Aceclofenac 69 Acemetacin 70 Acenocoumarol (Nicoumalone) 71 Acetazolamide 72 Acetylcysteine 74 Aciclovir 75 Acipimox 77 Acitretin 78 Adefovir dipivoxil 79 Alendronic acid 81 Alfacalcidol 84 Alfuzosin hydrochloride 86 Alimemazine (Trimeprazine) tartrate 88 Alitretinoin 89 consequences of Allopurinol 90 administering drugs via Almotriptan 92 Aluminium hydroxide 93 Alverine citrate 94 Amantadine hydrochloride 95 Amiloride hydrochloride 96 Aminophylline 98 Contributors Abbreviations xv xviii Notes on the use of this book xx Introduction Types of enteral feeding tube Flushing enteral feeding tubes Restoring and maintaining patency of enteral feeding tubes Drug therapy review 15 23 Choice of medication formulation 25 The legal and professional enteral feeding tubes 38 Health and safety and clinical risk management 47 Syringes and ports 51 10 Defining interactions 55 11 Medicines optimisation 61 Amiodarone hydrochloride Amisulpride 99 101 vi Contents Amitriptyline hydrochloride 102 Celiprolol hydrochloride 170 Amlodipine 104 Cetirizine hydrochloride 171 Amoxicillin 106 Chloral hydrate 173 Anastrozole 108 Chloroquine 175 Arginine 109 Chlorphenamine Ascorbic acid 111 (Chlorpheniramine) maleate 176 Aspirin 112 Chlorpromazine hydrochloride 178 Atenolol 113 Chlortalidone (Chlorthalidone) 180 Atorvastatin 116 Ciclosporin 181 Azathioprine 117 Cilazapril 183 Baclofen 120 Cimetidine 184 Balsalazide sodium 122 Cinnarizine 186 Beclometasone dipropionate 122 Ciprofloxacin 187 Bendroflumethiazide 123 Citalopram 189 Betahistine dihydrochloride 125 Clarithromycin 191 Betaine 126 Clindamycin 193 Betamethasone 128 Clobazam 195 Bethanechol chloride 129 Clomipramine hydrochloride 196 Bexarotene 130 Clonazepam 198 Bezafibrate 131 Clonidine hydrochloride 200 Bicalutamide 133 Clopidogrel 201 Bisacodyl 134 Clozapine 204 Bisoprolol fumarate 135 Co-amilofruse 205 Bromocriptine 137 Co-amilozide 207 Budesonide 139 Co-amoxiclav 208 Bumetanide 140 Co-codamol 210 Busulfan 141 Co-fluampicil 212 Cabergoline 143 Co-flumactone 213 Caffeine citrate 144 Codeine phosphate 214 Calcium folinate (Calcium leucovorin) 146 Colchicine 216 Calcium salts 147 Colecalciferol 217 Calcium salts with vitamin D 150 Colestyramine 218 Candesartan cilexetil 152 Co-magaldrox 220 Captopril 154 Co-phenotrope 221 Carbamazepine 156 Co-trimoxazole 222 Carbimazole 158 Cyclizine 224 Carbocisteine 159 Cyclophosphamide 226 Carvedilol 161 Dantron (Danthron) 228 Cefalexin (Cephalexin) 162 Dapsone 229 Cefixime 164 Deferasirox 231 Cefradine (Cephradine) 166 Deferiprone 232 Cefuroxime 167 Deflazacort 233 Celecoxib 169 Demeclocycline hydrochloride 234 Contents vii Desloratadine 235 Fexofenadine hydrochloride 305 Desmopressin 236 Finasteride 306 Dexamethasone 239 Flavoxate hydrochloride 307 Dexibuprofen 241 Flecainide acetate 309 Diazepam 241 Flucloxacillin 310 Diazoxide 244 Fluconazole 312 Diclofenac 245 Fludrocortisone acetate 314 Fluoxetine 315 Dicycloverine (Dicyclomine) h ydrochloride 248 Flupentixol (Flupenthixol) 317 Digoxin 249 Flutamide 319 Dihydrocodeine tartrate 251 Fluvastatin 320 Diltiazem hydrochloride 252 Fluvoxamine maleate 322 Dipyridamole 255 Folic acid 323 Disodium etidronate 258 Fosamprenavir 324 Docusate sodium 259 Fosinopril sodium 325 Domperidone 261 Frovatriptan 326 Donepezil hydrochloride 263 Furosemide (Frusemide) 327 Dosulepin (Dothiepin) hydrochloride 264 Gabapentin 330 Doxazosin mesilate 266 Galantamine 332 Doxepin 268 Ganciclovir 334 Doxycycline 270 Glibenclamide 335 Duloxetine hydrochloride 272 Gliclazide 336 Efavirenz 274 Glimepiride 338 Eletriptan 276 Glipizide 339 Enalapril maleate 277 Glyceryl trinitrate 341 Entacapone 279 Glycopyrronium bromide 342 Eprosartan 280 Granisetron 343 Ergocalciferol 282 Griseofulvin 345 Erythromycin 283 Haloperidol 347 Escitalopram 285 Hydralazine hydrochloride 349 Esomeprazole 286 Hydrocortisone 350 Ethambutol hydrochloride 289 Hydromorphone hydrochloride 352 Ethinylestradiol 290 Hydroxycarbamide (Hydroxyurea) 353 Ethosuximide 291 Hydroxyzine hydrochloride 354 Etodolac 293 Hyoscine butylbromide 355 Etoposide 294 Hyoscine hydrobromide 357 Etoricoxib 295 Ibandronic acid 358 Ezetimibe 297 Ibuprofen 359 Famciclovir 299 Imipramine hydrochloride 361 Famotidine 300 Indapamide 363 Felodipine 301 Indometacin (Indomethacin) 364 Fentanyl 302 Indoramin 365 Fesoterodine fumarate 304 Inositol nicotinate 367 viii Contents Irbesartan 368 Medroxyprogesterone acetate 435 Iron preparations 370 Mefenamic acid 436 Isoniazid 373 Megestrol acetate 437 Isosorbide dinitrate 374 Melatonin 438 Isosorbide mononitrate 375 Meloxicam 439 Ispaghula husk 377 Memantine hydrochloride 440 Isradipine 378 Menadiol sodium phosphate Itraconazole 379 (Vitamin K) 441 Ketamine 381 Meptazinol 442 Ketoconazole 382 Mercaptamine 443 Ketoprofen 384 Mercaptopurine 444 Ketorolac trometamol 385 Mesalazine 445 Labetalol hydrochloride 387 Mesna 447 Lacidipine 388 Mesterolone 448 Lacosamide 389 Metformin hydrochloride 449 Lactulose 390 Methadone hydrochloride 451 Lamivudine 392 Methenamine hippurate Lamotrigine 394 (Hexamine hippurate) 452 Lansoprazole 395 Methotrexate 453 Leflunomide 397 Methyldopa 455 Lercanidipine hydrochloride 399 Methylprednisolone 456 Levetiracetam 400 Metoclopramide hydrochloride 457 Levocetirizine hydrochloride 402 Metolazone 459 Levodopa 403 Metoprolol tartrate 460 Levofloxacin 406 Metronidazole 462 Metyrapone 465 Levomepromazine (Methotrimeprazine) 408 Mexiletine hydrochloride 466 Levothyroxine sodium 410 Midazolam 467 Linezolid 412 Minoxidil 469 Lisinopril 413 Mirtazapine 470 Lithium 416 Misoprostol 472 Lofepramine 417 Mizolastine 473 Loperamide hydrochloride 419 Moclobemide 474 Lopinavir with ritonavir 420 Modafinil 475 Loratadine 421 Moexipril hydrochloride 476 Lorazepam 423 Montelukast 477 Losartan potassium 424 Morphine sulfate 479 Macrogols 427 Moxonidine 482 Magnesium preparations 428 Multivitamin preparations 483 Maraviroc 430 Mycophenolate mofetil 486 Mebendazole 431 Nabumetone 488 Mebeverine hydrochloride 432 Nadolol 489 Mecysteine 434 Naftidrofuryl oxalate 490 Contents ix Naproxen 492 Piroxicam 557 Naratriptan 493 Pizotifen 559 Nebivolol 494 Polystyrene sulfonate resins 560 Nefopam hydrochloride 495 Posaconazole 561 Neomycin sulfate 496 Potassium chloride 562 Neostigmine 498 Pravastatin sodium 564 Nevirapine 499 Prazosin 565 Nicardipine hydrochloride 500 Prednisolone 567 Nicorandil 501 Pregabalin 568 Nifedipine 503 Primidone 569 Nimodipine 505 Prochlorperazine 571 Nitrazepam 506 Procyclidine hydrochloride 573 Nitrofurantoin 508 Promethazine hydrochloride 574 Nizatidine 509 Propranolol hydrochloride 576 Norethisterone 510 Pyrazinamide 578 Ofloxacin 512 Pyridostigmine 579 Olanzapine 513 Pyridoxine hydrochloride 581 Olmesartan medoxomil 515 Pyrimethamine 582 Olsalazine sodium 516 Quinapril 583 Omeprazole 518 Rabeprazole sodium 584 Ondansetron 520 Ramipril 585 Orlistat 522 Ranitidine 587 Orphenadrine hydrochloride 523 Ranolazine 589 Oseltamivir 525 Reboxetine 590 Oxazepam 528 Rifabutin 591 Oxcarbazepine 529 Rifampicin 592 Oxprenolol hydrochloride 531 Rifaximin 594 Oxybutynin hydrochloride 532 Riluzole 595 Oxycodone hydrochloride 534 Risedronate sodium 596 Oxytetracycline 536 Risperidone 599 Paliperidone 538 Rivastigmine 601 Pancreatin supplements 539 Rizatriptan 602 Pantoprazole 542 Ropinirole 603 Paracetamol 543 Rosuvastatin 605 Paroxetine 545 Saquinavir 607 Pentoxifylline (Oxpentifylline) 546 Selegiline hydrochloride 608 Perindopril erbumine 547 Senna 609 Phenelzine 548 Sertraline 610 Phenobarbital (Phenobarbitone) 549 Sildenafil 612 Phenoxybenzamine hydrochloride 551 Simvastatin 614 Phenoxymethylpenicillin 552 Sodium clodronate 616 Phenytoin 553 Sodium picosulfate 617 Phosphates 556 Sodium valproate 619 718 Index Erythroped (erythromycin) 283 levothyroxine 410 Erythroped A 283 lisinopril 414 escitalopram 285–286 methyldopa 455 esomeprazole 286–288 metolazone 459 ethambutol 289–290 metoprolol 461 ethics 38–46 metronidazole 463 definition 39 mexiletine 466 ethinylestradiol 290–291 oseltamivir 526–527 ethosuximide 291–292 pentoxifylline 546 etidronate 258–259 pyrazinamide 578 etodolac 293 spironolactone 624 Etopan XL (etodolac) 293 tacrolimus 634 Etopophos (etoposide) 294 terbinafine 645 etoposide 294–295 etoricoxib 295–296 Eucreas (vildagliptin) 688 Eudemine (diazoxide) 244 valaciclovir 675 ezetimibe 297–298 simvastatin with 614 Ezetrol (ezetimibe) 297 Eviphera 643 Evotrox (levothyroxine) 410 famciclovir 299–300 excipients, solutions 26 famotidine 300–301 excretion 59 Famvir (famciclovir) 299 Exelon (rivastigmine) 601 FasTabs (lansoprazole) 31, 395 exit holes 17 fat (dietary) Exjade (deferasirox) 231 on adefovir absorption 80 exposure see occupational exposure gastric emptying 56 extemporaneous preparations lopinavir and 420 allopurinol 91 maraviroc and 430 aminophylline 98 riluzole and 595 amiodarone 100 tenofovir and 644 amlodipine 104 Faverin (fluvoxamine) 322 azathioprine 118 Feldene (piroxicam) 558 Beta-Cardone 622 felodipine 301–302 captopril 154 clonazepam 198 crushing of tablets 42 in Triapin 585 clonidine 200 Felotens XL (felodipine) 301 dapsone 230 female locking ports 53 diltiazem 254 female Luer ports 53 enalapril 277 female Luer syringes 51 etoposide 294 fentanyl 302–304 gabapentin 330 Feofol 371 ganciclovir 334 Feospan (iron) 370 ketamine 381 Ferriprox (deferiprone) 232 labetalol 387 Ferrograd (iron) 370 levofloxacin 407 Ferrograd folic 371 Index 719 ferrous fumarate 370, 372 folinic acid 146–147 ferrous gluconate 370 food, drugs on absorption 58 ferrous sulphate 370, 372 food interactions 50, 55–60 Fersamal (ferrous fumarate) 370 abacavir 64 fesoterodine 304–305 acitretin 78 fexofenadine 305–306 allopurinol 91 fibre (dietary) 57 amisulpride 101 digoxin and 250 calcium supplements 151 Filnarine SR (morphine) 479 carvedilol 161 finasteride 306–307 cefuroxime 167 fine-bore tubes 5, 17 ciprofloxacin 188 for unblocking larger tubes 19 colecalciferol 217–218 Flagyl (metronidazole) 463 demeclocycline 235 flavoxate 307–308 desmopressin 237 flecainide 309–310 digoxin 250 Flomax Relief MR (tamsulosin) 637 dipyridamole 256 Flomaxtra XL (tamsulosin) 637 efavirenz 274 flora, intestinal 59 eprosartan 281 Florinef (fludrocortisone) 314 esomeprazole 287 Floxapen (flucloxacillin) 310 ethambutol 289 Fluanxol (flupentixol) 317 furosemide 328 flucloxacillin 310–312 grapefruit juice 58–59 in Co-fluampicil 212–213 griseofulvin 57, 345 fluconazole 312–314 ibandronic acid 358 fludrocortisone 314–315 isoniazid 373 fluid balance charts 9–10 ketoconazole 383 fluid-restricted patients 13 lansoprazole 396 fluoxetine 315–317 levodopa 405 flupentixol 317–318 linezolid 412 flushing 9–13 metoprolol 57 with air 10–11, 12–13 metronidazole 464 documentation 9–10 paliperidone 538 relation to drug administration 12 perindopril 548 solutions for 17–18 phenelzine 548 syringe size 53 phenoxymethylpenicillin 552 technique 11–12 pravastatin 564 volume 11, 13, 18 propranolol 57 flutamide 319–320 pyridostigmine 580 fluvastatin 320–321 riluzole 595 fluvoxamine 322 saquinavir 607 folic acid 323–324 sodium clodronate 616 iron with 371 tacrolimus 635 methotrexate and 455 Tamiflu 525 in vitamin B compound preparations 690 tenofovir 644 720 Index food interactions (continued ) Glucophage (metformin) 449 theophylline 647 Glucophage SR 449 warfarin 42, 695 glyceryl trinitrate 341–342 see also enteral feeds; fat; protein; Glycophos Sterile Concentrate 556 tyramine glycopyrronium bromide 342–343 Foraven XL (venlafaxine) 683 Gold v Essex County Council (1942) 43 Forceval 483, 484, 485 Gopten (trandolapril) 663 formulations, choosing 25–36 granisetron 343–345 Fortipine LA 40 (nifedipine) 503 granular suspensions 27 Fosamax (alendronic acid) 81 grapefruit juice 58–59 Fosamax Once Weekly 81 griseofulvin 345–346 fosamprenavir 324–325 food and 57 fosinopril 325–326 Grisovin (griseofulvin) 345 French (Fr) unit guidewires 20 Frisium (clobazam) 195 frovatriptan 326–327 Haldol (haloperidol) 347 Frumil 205 Half-Inderal LA (propranolol) 576 Frumil LS 205 Half Securon SR (verapamil) 685 frusemide see furosemide Half Sinemet CR 404 Frusol (furosemide) 327 haloperidol 347–348 Fultium D3 (colecalciferol) 217 hard gelatin capsules 34–35 Furadantin (nitrofurantoin) 508 health and safety 47–50 furosemide 327–329 hepatic mixed-function oxidase system 58 in Co-amilofruse 205–206 Hespera (adefovir) 79 spironolactone with 624 Hexopal (inositol) 367 Fybogel (ispaghula husk) 377 Hiprex (methenamine) 452 Fybogel Hi-Fibre 377 holes (exit holes from tubes) 17 Fybogel Mebeverine 377, 433 home artificial nutrition support hot foods, gastric emptying 56 gabapentin 330–332 hydralazine 349–350 Gabitril (tiagabine) 650–651 Hydrea (hydroxycarbamide) 353 galantamine 332–333 hydrochlorothiazide Galfer (ferrous fumarate) 370 in Co-amilozide 207–208 Galfer FA 371 irbesartan with 368 Galvus (vildagliptin) 688 in Kalten 114 Gamanil (lofepramine) 417 lisinopril with 414 ganciclovir 334–335 losartan with 425 gastric emptying 56 in olmesartan preparations 515 gastrostomy 6–7 telmisartan with 640 glibenclamide 335–336 valsartan with 677 gliclazide 336–338 hydrocortisone 350–351 glimepiride 338–339 hydroflumethiazide, in Co-flumactone glipizide 339–340 Glucobay (acarbose) 66 213–214 hydromorphone 352 Index 721 hydroxycarbamide 353–354 InVita (colecalciferol) 217 hydroxyurea 353–354 Ipocol (mesalazine) 446 hydroxyzine 354–355 irbesartan 368–369 Hygroton (chlortalidone) 180 iron 370–372 hyoscine butylbromide 355–356 chelation with drugs 57 hyoscine hydrobromide 357 disodium etidronate and 258 Hypnovel (midazolam) 468 Hypovase (prazosin) 565 ibandronic acid and 358 Ironorm Drops 370 irrigants, unblocking tubes 18–19 ibandronic acid 358–359 irritants ibuprofen 359–361 doxycycline 270 Ikorel (nicorandil) 501 Praxilene (naftidrofuryl oxalate) 490 Imdur (isosorbide mononitrate) 376 Targretin 130 Imigran (sumatriptan) 631 Ismo (isosorbide mononitrate) 375 Imigran Radis 631 Ismo Retard 376 imipramine 361–362 Isodur (isosorbide mononitrate) 376 Immunoprin (azathioprine) 118 Isogel (ispaghula husk) 377 Imodium (loperamide) 419 Isoket (isosorbide dinitrate) 374 Imuran (azathioprine) 118 Isoket Retard 374 Inconex XL (tolterodine) 656 isoniazid 373–374 indapamide 363–364 isosorbide dinitrate 374–375 Inderal-LA (propranolol) 576 isosorbide mononitrate 375–377 Indo-Paed (indometacin) 364 Isotard (isosorbide mononitrate) 376 indometacin 364–365 Ispagel (ispaghula husk) 377 indoramin 365–366 ispaghula husk 377–378, 433 Inegy (ezetimibe) 297, 614 isradipine 378–379 inhalation risk Istin (amlodipine) 104 bicalutamide 133 itraconazole 379–380 see also occupational exposure injectable formulations 36 jejunostomy inositol 367–368 jejunum, as site of drug delivery Instanyl (fentanyl) 303 instructions to patients 24 Kalcipos-D 151 interactions 50, 55–60 Kaletra 420 see also chelation; food interactions intranasal route Kalten 114 Kay-Cee-L (potassium chloride) 562, 563 desmopressin 237 Keflex (cephalexin) 163 fentanyl 303, 304 Kemadrin (procyclidine) 573 sumatriptan 631 Kentera (oxybutynin) 533 zolmatriptan 703 Keppra (levetiracetam) 400 intravenous route, inadvertent administration 47–48 Ketalar (ketamine) 381 ketamine 381–382 Invegra (paliperidone) 538 Ketek (telithromycin) 639 Invirase (saquinavir) 607 Ketocid (ketoprofen) 384 722 Index ketoconazole 382–383 Levitra (vardenafil) 680 ketoprofen 384–385 levocetirizine 402–403 ketorolac 385–386 levodopa 403–406 Ketovail (ketoprofen) 384 levofloxacin 406–408 Ketovite 483, 484 feed on absorption 57 Kidmel (melatonin) 438 levomepromazine 408–409 Kidnaps (melatonin) 438 levothyroxine 410–411 Kivexa 63 Lexpec (folic acid) 323 Klaricid (clarithromycin) 191 Lexpec with Iron-M 371 Klaricid XL 192 Li-Liquid (lithium) 416 Kloref (potassium supplement) 563 liability, civil 41–43 Kytril (granisetron) 343 licences L-arginine 109 linezolid 412–413 labetalol 387–388 Lioresal (baclofen) 120 lacidipine 388–389 lipase, in pancreatin supplements 539 lacosamide 389–390 Lipitor (atorvastatin) 116 lactose, donepezil formulations 263 Lipostat (pravastatin) 564 Lactugal (lactulose) 391 liquid formulations 25 lactulose 390–392 lisinopril 413–415 Lamictal (lamotrigine) 394 Liskonium (lithium) 416 Lamisil (terbinafine) 645 lithium 416–417 see also Marketing Authorisations lamivudine 392–393 carbonate vs citrate 416 in Kivexa 63 locking ports, female 53 in Trizivir 63 lofepramine 417–418 zidovudine with 700 Lomont (lofepramine) 417 lamotrigine 394–395 Lomotil 221 Lanoxin (digoxin) 249 Longtec (oxycodone) 535 Lanoxin-PG 249 Loniten (minoxidil) 469 lansoprazole 395–397 loperamide 419–420 Largactil (chlorpromazine) 178 lopinavir, ritonavir with 420–421 Lasilactone 624 Lopresor (metoprolol) 460 Lasix (furosemide) 328 Lopresor SR 460 latex, enteral feeding tubes loratadine 421–423 Laxido Orange (macrogols) 429 lorazepam 423–424 Lecado 405 Loron 520 (clodronate) 616 leflunomide 397–398 losartan 424–426 legal aspects 38–46 Losec (omeprazole) 518 lercanidipine 399 Luer lock syringes 52 Lescol (fluvastatin) 320 Lustral (sertraline) 610 Lescol XL 320 Lyflex (baclofen) 120 leucovorin (calcium folinate) lyophilisates, selegiline 608 146–147 levetiracetam 400–401 Lyrica (pregabalin) 568 Lyrinel XL (oxybutynin) 533 Index 723 Maalox 220 melatonin 438–439 Maalox Plus 220 meloxicam 439–440 Macrobid (nitrofurantoin) 508 memantine 440–441 Macrodantin (nitrofurantoin) 508 menadiol 441–442 macrogols 427–428 meptazinol 442–443 Madopar 403, 405 Meptid (meptazinol) 442 Magnaspartate 429 mercaptamine 443–444 magnesium 428–430 mercaptopurine 444–445 chelation with drugs 57 ibandronic acid and 358 in vitamin B compound preparations 690 Merck Gastroenterology, on syringe size 54 mesalazine 445–447 see also olsalazine magnesium glycerophosphate 428 mesna 447–448 magnesium hydroxide 429 mesterolone 448–449 in Co-magaldrox 220–221 Mestinon (pyridostigmine) 579 interactions 58 metabolism 58–59 magnesium oxide 429 magnesium sulphate 429 metformin 449–450 on vitamin B12 absorption 57 Malarivon (chloroquine) 175 methadone 451–452 male Luer ports 53 Methadose (methadone) 451 male Luer syringes 52 methenamine 452–453 malnutrition, distribution of drugs 58 methotrexate 453–454 Manerix (moclobemide) 474 Manevac (senna) 609 dihydrofolate reductase inhibition 323 maraviroc 430–431 methotrimeprazine 408–409 Marketing Authorisations 40 methyldopa 455–456 see also licences methylprednisolone 456–457 Maxalt (rizatriptan) 602 metoclopramide 457–459 Maxalt Melt 602 metolazone 459–460 Maxolon (metoclopramide) 458 Metopirone (metyrapone) 465 Maxolon High Dose 458 metoprolol 460–462 mebendazole 431–432 mebeverine 432–434 in Fybogel Mebeverine 377 food and 57 Metrolyl (metronidazole) 463 metronidazole 462–465 mechanical devices, occlusion clearance 20 metyrapone 465–466 mecysteine 434 mexiletine 466–467 medication reviews 23–24 Mezavant XL (mesalazine) 446 Medicines Act 1968 40 Mezzopram (omeprazole) 518 medicines optimisation 61–62 Micardis (telmisartan) 640 Medrone (methylprednisolone) 456 Micardis Plus 640 medroxyprogesterone 435–436 Micronor (norethisterone) 510 mefenamic acid 436–437 Micropirin (aspirin) 112 Megace (megestrol) 437 midazolam 467–469 megestrol 437–438 Migard (frovatriptan) 326 724 Index milk demeclocycline and 235 vitamin B compound preparations 689–691 disodium etidronate and 258 Myambutol (ethambutol) 289 Exjade and 231 Mycobutin (rifabutin) 591 nabumetone and 488 mycophenolate mofetil 486–487 see also dairy products Myfortic (mycophenolate) 486 minerals, disodium etidronate and 258 Myleran (busulfan) 141 Minodiab (glipizide) 339 Myotonine (bethanechol) 129 minoxidil 469–470 mirtazapine 470–471 nabumetone 488–489 misoprostol 472–473 nadolol 489–490 diclofenac with 246 naftidrofuryl oxalate 490–491 mixed-function oxidase system 58 naloxone, in Targinact 535 mizolastine 473 Naprosyn (naproxen) 492 Mizollen (mizolastine) 473 naproxen 492–493 moclobemide 474–475 Naramig (naratriptan) 493 modafinil 475–476 naratriptan 493–494 modified-release tablets 34 Nardil (phenelzine) 548 crushing 49 nasal sprays see intranasal route Modigraf (tacrolimus) 634 nasoduodenal tubes 5–6 Moduret 25 207 nasogastric tubes Moduretic 207 moexipril 476–477 air flushing 10–11 unblocking 21 Molaxole (macrogols) 429 nasojejunal tubes Molipaxin (trazodone) 665 Nastrosa (anastrozole) 108 monoamine oxidase inhibitors 59 Natecal D3 151 Monomax SR (isosorbide mononitrate) 376 National Patient Safety Agency 48 Monotrim (trimethoprim) 670 Natrilix (indapamide) 363 montelukast 477–478 Nebilet (nebivolol) 494 Morphgesic MR 479 nebivolol 494–495 morphine 479–481 Neditol (tolterodine) 656 fentanyl equivalence 304 mortars and pestles 33–34 effect on dose 48–49 nefopam 495–496 negligence 42 Neo-Mercazole (carbimazole) 158 Motens (lacidipine) 388 Neoclarityn (desloratadine) 235 Motilium (domperidone) 261 neomycin 496–497 Movicol preparations 428 Neoral (ciclosporin) 181 moxonidine 482–483 neostigmine 498–489 MST Continus (morphine) 479 Neotigason (acitretin) 78 Mucodyne (carbocisteine) 159 Neurontin (gabapentin) 330 Mucodyne Paediatric 159 nevirapine 499–500 Mucogel 220 Nexium (esomeprazole) 286, 287 multilumen tubes nicardipine 500–501 multivitamin preparations 483–485 nicorandil 501–502 Index 725 nicotinamide in multivitamin preparations 484 in Pabrinex 648 in vitamin B compound preparations 690 nicoumalone 71–72 nifedipine 56, 503–505 alendronic acid 82 reflux 13 risedronate 597 ofloxacin 512–513 feed on absorption 57 olanzapine 513–515 in Beta-Adalat 114 Olbetan (acipimox) 77 malnutrition 58 Olena (fluoxetine) 315 in Tenif 114 olmesartan 515–516 Nifedipress MR (nifedipine) 503 Olmetec (olmesartan) 515 Niferex (iron) 371 Olmetec Plus 515 nimodipine 505–506 olsalazine 516–517 Nimotop (nimodipine) 505 omeprazole 518–520 Nimvastid (rivastigmine) 601 in Axorid 384 Nipatra (sildenafil) 612 Ondamet (ondansetron) 521 nitrazepam 506–507 ondansetron 520–522 nitrofurantoin 508–509 One-Alpha (alfacalcidol) 84 Nivaquine (chloroquine) 175 optimisation see medicines optimisation nizatidine 509–510 oral ports 53 Nizoral (ketoconazole) 382 oral syringes 51 Nocutil (desmopressin) 237 orlistat 522–523 norethisterone 510–511 orodispersible tablets 31 Noriday (norethisterone) 510 Oromorph (morphine) 479 Norzol (metronidazole) 463 Oromorph Concentrated Oral Solution 479 Novartis Consumer Health orphenadrine 523–524 on syringe size 54 Orudis (ketoprofen) 384 Noxafil (posaconazole) 561 Oruvail (ketoprofen) 384 Nozinan (levomepromazine) 408 oseltamivir 525–528 Nuelin SA (theophylline) 646 osmolality 13 nurses osteomalacia, antacid abuse 58 drug authorisations and 41 Oxactin (fluoxetine) 316 liability 43 oxazepam 528–529 professional standards 46 oxcarbazepine 529–530 see also occupational exposure oxpentifylline 546–547 Nursing and Midwifery Council (NMC), professional standards 45 Nutrizym 22 539 oxprenolol 531–532 oxybutynin 532–534 oxycodone 534–536 OxyNorm (oxycodone) 534 occlusion see blockage risk oxytetracycline 536–537 occupational exposure 49 see also inhalation risk Pabrinex, pyridoxine in 582, 648 Octasa (mesalazine) 446 Pabrinex i v high potency 689 Octim (desmopressin) 237 Pabrinex IM (thiamine) 648 oesophagus Pabrinex IV (thiamine) 648 726 Index paliperidone 538 cyclical feeding 16–17 Palladone (hydromorphone) 352 on drug absorption 56 Pamid XL (felodipine) 301 flushing after checking 12–13 Pancrease HL 539 imipramine absorption 361 pancreatic enzymes, for blockage risk precipitation and 16 17–18, 19–20 pancreatin supplements 539–541 testing 10 pharmacists Pancrex (formulations) 539 duty to advise 44 Pantaloc (pantoprazole) 542 liability 43 panthenol, in vitamin B compound preparations 690 professional standards 46 pharmacokinetics 56–58 pantoprazole 542–543 phenelzine 548–549 paracetamol 543–544 Phenergan (promethazine) 574 in Co-codamol 210–212 phenobarbital 549–551 pectin and 57 phenoxybenzamine 551–552 tramadol with 661 phenoxymethylpenicillin 552–553 parenteral administration, inadvertent 47–48 phenytoin 553–556 interactions 57 Pariet (rabeprazole) 584 phosphates 556–557 Parlodel (bromocriptine) 137 Phyllocontin Continus (aminophylline) 98 paroxetine 545–546 Phyllocontin Continus Forte 98 Parvolex (acetylcysteine) 74 physical interactions 57 passive diffusion 56 Physiotens (moxonidine) 482 patency, enteral feeding tubes 15–21 Picolax 617 PecFent (fentanyl) 303 picosulfate 617–618 pectin 57 Piriteze (cetirizine) 171 Pentasa (mesalazine) 30, 446 Piriton (chlorphenamine) 176 pentoxifylline 546–547 piroxicam 557–559 peptide feeds, pancreatin supplements pizotifen 559–560 with 540 percutaneous gastrojejunostomy percutaneous gastrostomy 6–7 plastics alfacalcidol 84 see also polyvinyl chloride percutaneous jejunostomy Plavix (clopidogrel) 202 Perdix (moexipril) 476 Plenachol (colecalciferol) 217 Perfalgan (paracetamol) 543 Plenadren (hydrocortisone) 350 perindopril 547–548 Plendil XL (felodipine) 301 Periostat (doxycycline) 270 poloxamer 228 Perixis (tacrolimus) 634 polyethylene glycol 274 Persantin (dipyridamole) 256 polystyrene sulfonate resins 560–561 Persantin Retard 256 polyurethane pestles see mortars and pestles Peyona 145 pH activation of pancreatic enzymes 19 blockage risk 17 enteral feeding tubes polyvinyl chloride (PVC) drug interactions with 59 Index 727 tacrolimus and 635 Ponstan (mefenamic acid) 436 ports 53 safety requirements 48 protease, in pancreatin supplements 539 protein (dietary) 56, 57 levodopa and 405 Prothiaden (dosulepin) 265 posaconazole 561–562 Protium (pantoprazole) 542 position of patient 13 protocols 42, 44 tube flushing 12 Provera (medroxyprogesterone) 435 position of tube, confirmation of 8, 12–13 Provigil (modafinil) 475 postpyloric tubes 5–6 Prozac (fluoxetine) 316 potassium, phosphate preparations 556 Prozit (fluoxetine) 316 potassium chloride 562–563 Pulmocare, ciprofloxacin and 188 Powergel (ketoprofen) 384 pulsatile flushing 9, 11 pravastatin 564–565 pump alarms 18–20 Praxilene (naftidrofuryl oxalate) 490 Puri-Nethol (mercaptopurine) 444 prazosin 565–566 push-pull technique 20 Preblacont XL (tolterodine) 656 lansoprazole 396 precipitation 16 pyrazinamide 578–579 prednisolone 567–568 pyridostigmine 579–580 pregabalin 568–569 pyridoxine 581–582 Pregaday 371 in multivitamin preparations 484 pregnancy in Pabrinex 582, 648 bicalutamide and 133 finasteride 307 Prescal (isradipine) 378 in vitamin B compound preparations 690 pyrimethamine 582 prescribing errors, administration errors vs Questran (colestyramine) 218 Preservex (aceclofenac) 69 Questran Light 218 pressures, syringe size 54 quinapril 583 Prestim 651 Priadel (lithium) 416 rabeprazole 584 primidone 569–570 ramipril 585–586 Primulut (norethisterone) 510 Ranbaxy capsules (tramadol) 660 Pro-Viron (mesterolone) 448 Ranexa (ranolazine) 589 prochlorperazine 571–572 ranitidine 587–589 procyclidine 573–574 famotidine vs 301 professional standards 45 ranolazine 589 Proglycem (diazoxide) 244 Rasburicase injection 91 Prograf (tacrolimus) 634 reboxetine 590–591 promethazine 574–575 Recogesic (glyceryl trinitrate) 341 Propecia (finasteride) 306 reflux 13 propranolol 576–577 Refolinon (calcium folinate) 146 food and 57 Regulan (ispaghula husk) 377 propylene glycol, Rosemont solution 330 Relifex (nabumetone) 488 Proscar (finasteride) 306 Reminyl (galantamine) 332 728 Index Replax (eletriptan) 276 Sabril (vigabatrin) 687 Requip (ropinirole) 604 saccharin sodium, Rosemont solution 330 Requip XL 604 safety (health and safety) 47–50 residual gastric volume, checking 12, 16 Salazopyrin (sulfasalazine) 628 residues, gliclazide 336 Salofalk (mesalazine) 446 Resonium A 560 Samsca (tolvaptan) 658 retinoids 78 Sancuso (granisetron) 344 Retrovir (zidovudine) 700 Sandimmun (ciclosporin) 181 Revatio (sildenafil) 612 Sando K (potassium chloride) 562 reverse Luer syringes 51 Sandocal-1000 (calcium) 148 reviews, medication 23–24 Sanomigran (pizotifen) 559 riboflavine Santizor (tolterodine) 656 in multivitamin preparations 484 saquinavir 607 in Pabrinex 648 Scopaderm (hyoscine hydrobromide) 357 in vitamin B compound preparations Sectral (acebutolol) 68 690 Securon (verapamil) 685 rifabutin 591–592 Securon SR 685 Rifadin (rifampicin) 592 selegiline 608–609 rifampicin 592–594 semi-recumbent position 13 rifaximin 594–595 rilpivirine, tenofovir and emtricitabine with 643 tube flushing 12 senna 609–610 Senokot (senna) 609 Rilutek (riluzole) 595 Septrin 222 riluzole 595–596 Seractil (dexibuprofen) 241 Rimactane (rifampicin) 593 Serc (betahistine) 125 Rimapurinol (allopurinol) 90 Serenace (haloperidol) 347 rinsing 26 Seroxat (paroxetine) 545 risedronate 596–598 sertraline 610–612 risk management, clinical 47–50 Setofilm (ondansetron) 521 Risperdal (risperidone) 599 Sevikar (olmesartan) 515 Risperdal Consta 599 Sevikar HCT 516 risperidone 599–600 Sevredol (morphine) 479 ritonavir, with lopinavir 420–421 Siklos (hydroxycarbamide) 353 rivastigmine 601–602 sildenafil 612–613 Rivotril (clonazepam) 198 silicone tubes rizatriptan 602–603 blockage risk 17 Robinul (glycopyrronium bromide) 342 Simvador (simvastatin) 614 Robinul Forte 342 simvastatin 614–615 ropinirole 603–605 Simzal (simvastatin) 614 Rosemont solution, gabapentin 330 Sinemet preparations 404, 405 Rosemont suspension, paracetamol 543 Sinepin (doxepin) 268 rosuvastatin 605–606 Singulair (montelukast) 477 Royal Pharmaceutical Society, guidelines 44 Sinthrome (acenocoumarol) 71 rupture of tubes, risk 20 site of drug delivery Index 729 Slo-Phyllin (theophylline) 646 Slow-K (potassium chloride) 562 Slow-Trasicor (oxprenolol) 531 Slozem (diltiazem) 253 Sodiofolin (folinate) 146 sodium Comtess (entacapone) 279 Dipentum (olsalazine) 516 standards administrative 43–44 professional 45 stavudine 625–626 paracetamol brands 543 Stelazine (trifluoperazine) 667 phosphate preparations 556 Stemetil (prochlorperazine) 571 sodium bicarbonate sterile water 11 activation of pancreatic enzymes 19 Stilnoct (zolpidem) 704 lansoprazole flushing 396 storage, oseltamivir 527 pantoprazole solution 542 Stribild 643 unblocking tubes 19 Stugeron (cinnarizine) 186 sodium clodronate 616–617 sublingual tablets see buccal absorption sodium feredetate 371, 372 sucralfate 627–628 sodium picosulfate 617–618 sodium valproate 619–621 soft gelatin capsules 35–36 interactions 57 sulfamethoxazole, in Co-trimoxazole 222–224 Solian (amisulpride) 101 sulfasalazine 628–629 soliphenacin, tamsulosin with 638 sulpiride 630–631 Solpadol 211 Sulpor (sulpiride) 630 Solu-Cortef (hydrocortisone) 350 sumatriptan 631–633 Solu-Medrone (methylprednisolone) 456 Suprax (cefixime) 164 soluble tablets 28–29 Surmontil (trimipramine) 671 solutions (liquid) 25–26 suspensions 27–28 Solvay (betahistine) 125 Sustiva (efavirenz) 274 Solvazinc (zinc sulphate) 702 Symmetrel (amantadine) 95 Sominex (promethazine) 574 Syprol (propranolol) 576 Sonata (zaleplon) 699 syringes 51–54 Sorbisterit 560 blockage clearance with 20 sorbitol 26 choosing 48 Sotacor (sotalol) 622 for crushing 34 sotalol 622–623 size 9, 53–54 Spasmonal (alverine) 94 Telzir (fosamprenavir) 324 Spasmonal Forte 94 Syrpalta, suspending valaciclovir 675 spheres, Epilim Chronosphere 619 syrups 25 spironolactone 623–625 Sytron (sodium feredetate) 371 in Co-flumactone 213–214 splanchnic blood flow 56 tablets Sporanox (itraconazole) 379 for buccal absorption 31 stability, gabapentin 330 compressed 31–34 stagnant feed, blockage risk 16 dispersible 30–31 staining effervescent 29–30 Colazide (balsalazide) 122 with enteric coating 36 730 Index tablets (continued ) tipranavir 652–653 modified-release 34, 49 tizanidine 654–655 orodispersible 31 Toctino (alitretinoin) 89 soluble 28–29 tolbutamide 655–656 Tacni (tacrolimus) 634 tolterodine 656–657 tacrolimus 634–636 tolvaptan 658 Tagamet (cimetidine) 184 Topamax (topiramate) 659 Tambocor (flecainide) 309 topiramate 659–660 Tamiflu (oseltamivir) 525 Toradol (ketorolac) 385 tamoxifen 636–637 Tovaiz (fesoterodine) 304 tamsulosin 637–638 Tramacet 661 tap water 11 tramadol 660–662 Targaxan (rifaximin) 594 unsuitable brands 661 Targinact (oxycodone) 535 Trandate (labetalol) 387 Targretin (bexarotene) 130 trandolapril 663 Tarivid (ofloxacin) 512 verapamil with 663, 685 Tarka 663, 685 tranexamic acid 664–665 Tavanic (levofloxacin) 406, 407 transdermal patches Tegretol (carbamazepine) 156 fentanyl 303, 304 Tegretol Prolonged Release 156 glyceryl trinitrate 341 Telfast (fexofenadine) 305 granisetron 344 telithromycin 639–640 hyoscine hydrobromide 357 telmisartan 640–641 oxybutynin 533 Telzir (fosamprenavir) 324 rivastigmine 601 temazepam 641–642 trazodone 665–667 Tenif 114 Trental (pentoxifylline) 546 tenofovir 642–644 Triapin (ramipril and felodipine) 585 Tenormin (atenolol) 113 trifluoperazine 667–668 Tensipine MR (nifedipine) 504 trihexyphenidyl 668–669 terbinafine 645–646 Trileptal (oxcarbazepine) 529 tetracyclines, chemical interactions 57 trimeprazine 88–89 Teveten (eprosartan) 280 trimethoprim 670–671 Thaden (dosulepin) 265 in Co-trimoxazole 222–224 theophylline 646–648 trimipramine 671–672 thiamine 648–649 Trimopan (trimethoprim) 670 in multivitamin preparations 484 Tritace (ramipril) 585 in vitamin B compound preparations Tritace Titration Pack 585 690 Trizivir 63 three-way taps 48 Truvada 643 tiagabine 650–651 tryptophan, phenelzine and 548 Tildiem (diltiazem) 252, 253 Tylex 211 Tildiem Retard 254 tyramine 59 timing, simvastatin 615 linezolid and 412 timolol 651–652 moclobemide and 474 Index 731 Tyvera (thiamine) 648 Vimoro (naproxen) 492 Vimovo (esomeprazole) 287 Ucerax (hydroxyzine) 354 Vimpat (lacosamide) 389 ‘unauthorised drugs’ 41–43 Viokase 19 unblocking tubes 18–20, 54 Viramune (nevirapine) 499 Uniphylliin Continuous (theophylline) 647 Viread (tenofovir) 642 Univer (verapamil) 685 Visclair (mecysteine) 434 unlicenced use of medicines viscosity Urdox (ursodeoxycholic acid) 673 clarithromycin 191–193 Urispas (flavoxate) 307 codeine syrup 214–215 ursodeoxycholic acid 673–674 Epanutin (phenytoin) 554 Ursofalk (ursodeoxycholic acid) 673 lactulose 390–392 Ursogal (ursodeoxycholic acid) 673 Septrin 222 Utovlan (norethisterone) 510 Zovirax 75 vitamin A, in multivitamin valaciclovir 675–676 Valni XL (nifedipine) 504 preparations 484 vitamin B compound preparations 689–691 Valoid (cyclizine) 224 vitamin B12, metformin on absorption 57 valproate 619–621 vitamin C see ascorbic acid valsartan 677–678 vitamin D Valtrex (valaciclovir) 675 Vancocin (vancomycin) 678 vancomycin 678–680 vardenafil 680–681 calcium with 150–152 in multivitamin preparations 484 vitamin E 691–692 in multivitamin preparations 484 varenicline 681–682 vitamin K (menadiol) 441–442 Vascace (cilazapril) 183 Vivadex (tacrolimus) 634 Vascalpha (felodipine) 301 Voltarol (diclofenac) 245 Vasran XL (alfuzosin) 86 volume, flushing 11, 13, 18 venlafaxine 682–684 voriconazole 693–694 Venlafaxine XL 683 Vygon UK, recommendations 54 Vepesid (etoposide) 294 verapamil 685–686 trandolapril with 663, 685 warfarin 695–696 food and 42, 57 Verapress MR (verapamil) 685 warm water, unblocking tubes 19 Vermox (mebendazole) 431 water Vertab SR (verapamil) 685 Vesomni 638 Vfend (voriconazole) 693 Viagra (sildenafil) 612 Viazem XL (diltiazem) 254 drug interactions 57 as solvent 26 water flushing 11–13 after checking pH 12–13 relation to drug administration 12 Vibramycin-D (doxycycline) 270 Welldorm (chloral betaine) 173 vigabatrin 687–688 wet granulation, tablets 32 Vigranon 689 whole-protein feeds, pancreatin vildagliptin 688–689 supplements with 540 732 Index withdraw/flush method see push-pull technique wrong-route errors 47–48 zidovudine 700–701 in Trizivir 63 Zimovane (zopiclone) 707 Zinacef (cefuroxime) 167 Xaluprine (mercaptopurine) 444 Zinamide (pyrazinamide) 578 Xanthomax (allopurinol) 90 zinc 702–703 Xatral (alfuzosin) 86 Xatral XL 86 in vitamin B compound preparations 690 Xenical (orlistat) 522 Zinnat (cefuroxime) 167 Xeplion (paliperidone) 538 Zirtek (cetirizine) 172 Xifaxanta (rifaximin) 594 Zispin SolTab (mirtazapine) 470 xipamide 697 Zocor (simvastatin) 614 Xyzal (levocetirizine) 402 Zofran (ondansetron) 521 Zofran Melt 521 yeasts, blockage risk 17 zolmitriptan 703–704 Yentreve (duloxetine) 272 zolpidem 704–705 Zolvera (verapamil) 685 zafirlukast 698 Zomig (zolmitriptan) 703 zaleplon 699 Zomig Rapimelt 703 Zamadol (tramadol) 660 Zonegran (zonisamide) 705 Zamadol Melt 660 Zonestine (oxycodone) 535 Zanaflex (tizanidine) 654 zonisamide 705–706 Zanidip (lercanidipine) 399 zopiclone 707 Zantac (ranitidine) 587 tube blockage 42 Zaponex (clozapine) 204 Zoton FasTab (lansoprazole) 31, 395 Zarontin (ethosuximide) 291 Zovirax (aciclovir) 75 Zeffix (lamivudine) 392 zuclopenthixol 708–709 Zelapar (selegiline) 31, 608 Zydol (tramadol) 661 Zemzard (diltiazem) 254 Zyloric (allopurinol) 90 Zerit (stavudine) 625 Zypadhera (olanzapine) 514 Zestoretic 414 Zyprexa (olanzapine) 513 Zestril (lisinopril) 413 ZyprexaVelotab 513 Ziagen (abacavir) 63 Zyvox (linezolid) 412 .. .Handbook of Drug Administration via Enteral Feeding Tubes Handbook of Drug Administration via Enteral Feeding Tubes THIRD EDITION Rebecca White BSc (Hons)... Use of enteral feeding tubes for drug administration is increasing • Sizes of feeding tubes are decreasing • The range of healthcare professionals involved in drug administration via enteral feeding. .. jejunum via an existing PEG tube 8 Handbook of Drug Administration via Enteral Feeding Tubes Implications of tube type and placement for drug administration Site of drug delivery This is of particular