handbook of drug administration via enteral feeding tubes

Rebecca White and Vicky Bradnam An enteral feeding tube provides a means of maintaining nutritional intake when there is limited access to the gastrointestinal tract The use of enteral feeding tubes has increased for both short and long term feeding in both primary and secondary care due to the increase in awareness of the importance of adequate nutritional intake Handbook of Drug Administration via Enteral Feeding Tubes is a practical guide to the safe administration of medicines via enteral feeding tubes Ten chapters provide the background knowledge to inform clinical decisions, and the accompanying 344 monographs contain guidance on the safe administration of specific drugs and formulations Contents include: types of enteral feeding tubes, tube flushing, restoring and maintaining patency, drug therapy review, medication formulation choice, unlicensed medication use, health and safety and interactions Handbook of Drug Administration via Enteral Feeding Tubes is an essential guide for pharmacists, doctors, nurses, dieticians, and also for nursing homes and hospices Rebecca White is Lead Pharmacist, Nutrition and Surgery, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK www.pharmpress.com on behalf of the British Pharmaceutical Nutrition Group AdminEntFINALFINAL.indd Handbook of Drug Administration via Enteral Feeding Tubes Rebecca White and Vicky Bradnam White and Bradnam Vicky Bradnam is Chief Pharmacist, Bromley Hospitals NHS Trust, Kent, UK Handbook of Drug Administration via Enteral Feeding Tubes Handbook of Drug Administration via Enteral Feeding Tubes on behalf of the British Pharmaceutical Nutrition Group 2/11/06 09:20:13 01_1603PP_FM.qxd 26/10/06 7:56 pm Page i Handbook of Drug Administration via Enteral Feeding Tubes 01_1603PP_FM.qxd 26/10/06 7:56 pm Page ii 01_1603PP_FM.qxd 26/10/06 7:56 pm Page iii Handbook of Drug Administration via Enteral Feeding Tubes Rebecca White BSc (Hons) MSc MRPharmS Lead Pharmacist; Nutrition and Surgery, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK Vicky Bradnam BPharm (Hons) ClinDip MBA Open MRPharmS Chief Pharmacist, Bromley Hospitals NHS Trust, Kent, UK On behalf of the British Pharmaceutical Nutrition Group London ● Chicago 01_1603PP_FM.qxd 26/10/06 7:56 pm Page iv Published by the Pharmaceutical Press An imprint of RPS Publishing Lambeth High Street, London SE1 7JN, UK 100 South Atkinson Road, Suite 200, Grayslake, IL 60030-7820, USA © Rebecca White and Vicky Bradnam 2007 is a trade mark of RPS Publishing RPS Publishing is the publishing organisation of the Royal Pharmaceutical Society of Great Britain First published 2007 Typeset by MCS Publishing Services Ltd, Salisbury, Wiltshire Printed in Great Britain by Cambridge University Press, Cambridge ISBN-10 85369 648 ISBN-13 978 85369 648 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 A catalogue record for this book is available from the British Library 02_1603PP_CON.qxd 23/10/06 9:48 pm Page v Contents Foreword x Individual drug monographs: Preface xi Abacavir 58 About the authors xii Acamprosate 59 List of contributors xiv Acarbose 60 Abbreviations xvii Acebutolol 62 Notes on the use of this book xix Aceclofenac 63 Acenocoumarol (Nicoumalone) 64 Acetazolamide 65 Acetylcysteine 67 Aciclovir 68 Acitretin 70 Alendronic acid 72 Alfacalcidol 74 Allopurinol 75 Alverine citrate 77 Amantadine hydrochloride 78 Amiloride hydrochloride 79 Introduction Types of enteral feeding tubes Flushing enteral feeding tubes Restoring and maintaining patency of enteral feeding tubes 14 Drug therapy review 21 Choice of medication formulation 23 The legal and professional Amiodarone hydrochloride 80 Amitriptyline hydrochloride 82 Amlodipine 84 Amoxicillin 86 44 Amphotericin 87 Syringes and ports 48 Amprenavir 89 Anastrazole 90 10 Defining interactions 52 Ascorbic acid 91 Aspirin 93 consequences of administering drugs via enteral feed tubes 35 Health and safety and clinical risk management Atenolol 94 Atorvastatin 96 Auranofin 98 02_1603PP_CON.qxd vi 23/10/06 9:48 pm Page vi Handbook of Drug Administration via Enteral Feeding Tubes Azathioprine 99 Citalopram 158 Baclofen 101 Clarithromycin 159 Balsalazide 103 Clindamycin 161 Bendroflumethiazide 104 Clobazam 163 Betahistine 105 Clomipramine hydrochloride 164 Betaine 107 Clonazepam 166 Betamethasone 108 Clonidine hydrochloride 167 Bethanechol 109 Clopidogrel 169 Bexarotene 111 Co-amilofruse 170 Bezafibrate 112 Co-amilozide 172 Bicalutamide 113 Co-amoxiclav 173 Bisacodyl 115 Co-codamol 174 Bisoprolol fumarate 116 Codeine phosphate 176 Bromocriptine mesilate 117 Colchicine 178 Budenoside 119 Co-phenotrope 179 Bumetanide 120 Co-trimoxazole 180 Busulfan 121 Cyclizine 182 Cabergoline 123 Cyclophosphamide 184 Calcium folinate (Leucovorin) 124 Dantron (Danthron) 185 Deflazacort 187 Calcium resonium (Polystyrene sulphonate resins) 125 Desmopressin acetate 188 126 Dexamethasone 190 Calcium salts with vitamin D 128 Diazepam 192 Candesartan cilexetil 130 Diclofenac sodium 194 Captopril 131 Dicycloverine (Dicyclomine) Calcium salts Carbamazepine 133 Carbimazole 135 Digitoxin 197 Carvedilol 136 Digoxin 198 Cefalexin (Cephalexin) 137 Dihydrocodeine tartrate 200 Cefixime 139 Diltiazem 202 Cefradine (Cephradine) 140 Dipyridamole 205 Cefuroxime 142 Docusate sodium 206 Celecoxib 144 Domperidone 208 Celiprolol hydrochloride 145 Donepezil 209 Cetirizine hydrochloride 146 Dosulepin (Dothiepin) hydrochloride 211 Chloroquine 147 Doxazosin 213 Chlorphenamine (Chlorpheniramine) hydrochloride 196 Doxepin hydrochloride 214 148 Doxycycline 215 Chlorpromazine hydrochloride 150 Efavirenz 217 Chlortalidone (Chlorthalidone) 151 Enalapril maleate 218 Cilazapril 152 Entacapone 220 Cimetidine 153 Eprosartan mesilate 221 Cinnarizine 155 Ergometrine maleate 222 Ciprofloxacin 156 Erythromycin 224 maleate 02_1603PP_CON.qxd 23/10/06 9:48 pm Page vii Contents vii Escitalopram 225 Hydroxycarbamide (Hydroxyurea) 283 Esomeprazole 226 Hydroxyzine hydrochloride 284 Ethambutol 228 Hyoscine butylbromide 285 Ethinylestradiol 229 Hyoscine hydrobromide 286 Ethosuximide 230 Ibuprofen 287 Etidronate 232 Imipramine hydrochloride 289 Etodolac 233 Indapamide 290 Etoposide 234 Indometacin (Indomethacin) 291 Etoricoxib 236 Indoramin 292 Ezetimibe 237 Inositol nicotinate 294 Famciclovir 238 Irbesartan 295 Famotidine 239 Iron preparations 296 Felodipine 240 Isoniazid 298 Fexofenadine hydrochloride 241 Isosorbide dinitrate 300 Finasteride 242 Isosorbide mononitrate 301 Flavoxate hydrochloride 243 Ispaghula husk 303 Flecanide 244 Isradipine 304 Flucloxacillin 245 Itraconazole 305 Fluconazole 247 Ketoconazole 306 Fludrocortisone acetate 249 Ketoprofen 308 Fluoxetine hydrochloride 250 Ketorolac trometamol 309 Flupentixol (Flupenthixol) 252 Labetalol hydrochloride 310 Fluphenazine 253 Lacidipine 312 Flutamide 255 Lactulose 313 Fluvastatin 256 Lamivudine 314 Fluvoxamine maleate 257 Lamotrigine 316 Folic acid 258 Lansoprazole 317 Fosinopril 260 Leflunomide 319 Furosemide (Frusemide) 261 Lercanidipine hydrochloride 320 Gabapentin 263 Levetiracetam 321 Galantamine hydrobromide 264 Levodopa 323 Ganciclovir 265 Levofloxacin 325 Glibenclamide 267 Levomepromazine Gliclazide 268 Glimepiride 270 Levothyroxine sodium 328 Glipizide 271 Linezolid 330 Glyceryl trinitrate 273 Lisinopril 331 Glycopyrronium 274 Lofepramine hydrochloride 334 Granisetron hydrochloride 275 Loperamide 335 Griseofulvin 277 Loratadine 337 Haloperidol 278 Lorazepam 338 Hydralazine hydrochloride 279 Losartan potassium 339 Hydrocortisone 281 Macrogols 341 Hydromorphone hydrochloride 282 Magnesium preparations 342 (Methotrimeprazine) 327 02_1603PP_CON.qxd viii 23/10/06 9:48 pm Page viii Handbook of Drug Administration via Enteral Feeding Tubes Mebendazole 344 Norethisterone Mebeverine hydrochloride 345 Ofloxacin 408 Medroxyprogesterone 346 Olanzapine 410 Mefenamic acid 348 Olmesartan medoxomil 411 Megestrol acetate 349 Olsalazine sodium 412 Meloxicam 350 Omeprazole 413 Memantine hydrochloride 351 Ondansetron 416 Mercaptopurine 352 Orciprenaline sulphate 417 Mesalazine 354 Orlistat 418 Metformin hydrochloride 356 Orphenadrine 419 Methotrexate 358 Oxazepam 420 Methyldopa 359 Oxprenolol hydrochloride 421 Methylprednisolone 361 Oxybutynin hydrochloride 423 Metoclopramide hydrochloride 362 Oxycodone hydrochloride 424 Metolazone 364 Oxytetracycline 426 Metoprolol tartrate 365 Pancreatic enzyme supplements 427 Metronidazole 368 Pantoprazole 430 Mexiletine hydrochloride 371 Paracetamol 431 Minoxidil 372 Paroxetine hydrochloride 432 Mirtazapine 373 Perindopril erbumine 434 Misoprostol 375 Phenelzine 435 Moclobemide 376 Phenobarbital (Phenobarbitone) 436 Modafinil 377 Phenoxymethylpenicillin 438 Moexipril hydrochloride 378 Phenytoin 439 Morphine sulfate 379 Piroxicam 442 Moxonidine 382 Pizotifen 443 Mycophenolate mofetil 383 Potassium 444 Nabumetone 384 Pravastatin sodium 446 Nadolol 386 Prednisolone 447 Naftidrofuryl oxalate 387 Primidone 449 Naproxen 388 Prochlorperazine 450 Nebivolol 390 Procyclidine hydrochloride 452 Nefopam hydrochloride 391 Promethazine hydrochloride 453 Nelfinavir 392 Propranolol hydrochloride 455 Neomycin sulphate 393 Pyrazinamide 457 Nevirapine 394 Pyridoxine hydrochloride 459 Nicardipine hydrochloride 396 Pyrimethamine 460 Nicorandil 397 Quinapril 461 Nifedipine 398 Rabeprazole sodium 462 Nimodipine 400 Ramipril 462 Nisoldipine 402 Ranitidine hydrochloride 464 Nitrazepam 402 Reboxetine 466 Nitrofurantoin 404 Rifabutin 467 Nizatidine 406 Rifampicin 469 407 02_1603PP_CON.qxd 23/10/06 9:48 pm Page ix Contents ix Riluzole 470 Tolbutamide 512 Risedronate sodium 472 Tolterodine tartrate 513 Risperidone 474 Topiramate 514 Ropinirole 475 Tramadol hydrochloride 516 Rosiglitazone 476 Trandolapril 518 Rosuvastatin 478 Tranexamic acid 519 Saquinavir 479 Trazodone hydrochloride 520 Selegiline hydrochloride 480 Trifluoperazine hydrochloride 522 Senna 482 Trihexyphenidyl (Benzhexol) Sertraline 483 Sildenafil 484 Trimethoprim Simvastatin 485 Trimipramine 527 Sodium clodronate 487 Ursodeoxycholic acid 528 Sodium picosulfate 489 Valaciclovir 530 Sotalol hydrochloride 490 Valproate (Sodium valproate) 531 Spironolactone 492 Valsartan 534 Stavudine 494 Vancomycin hydrochloride 535 Sucralfate 495 Venlafaxine hydrochloride 536 Sulfasalazine 496 Verapamil hydrochloride 537 Sulpiride 498 Vigabatrin 539 Tamoxifen citrate 499 Vitamin E 540 Tamsulosin hydrochloride 501 Voriconazole 542 Telmisartan 501 Warfarin sodium 543 Temazepam 503 Zalcitabine 545 Tenofovir disoproxil 504 Zidovudine 545 Terbinafine 505 Zinc sulphate 547 Theophylline 506 Zopiclone 548 Tiagabine 509 Timolol maleate 510 Index 551 Tizanidine hydrochloride 511 hydrochloride 524 525 39_INDEX.qxd 23/10/06 11:05 pm Page 555 Index cytotoxic drugs azathioprine, 100 busulfan, 121–2 cyclophosphamide, 184 colchicine, 54 Kay-Cee-L, 444 misoprostol, 375 diazepam, 192–3 etoposide, 235 instead of baclofen, 101 hydroxycarbamide, 283 instead of temazepam, 503 mercaptopurine, 353 methotrexate, 358 tablet crushing, 32 555 instead of tizanidine, 511 diclofenac, 64, 194–6 instead of naproxen, 389 dicycloverine (dicyclomine) Dalacin, 161 hydrochloride, 196–7 Dalacin C (capsules, injection), 161 Didronel, 232 dantron (danthron), 185–6 diffusion, passive, 53 Daonil, 267 Diflucon (formulations), 247 Daraprim, 460 digitoxin, 197–8 DDAVP (tablets, nasal solution), 188 digoxin, 198–200 DDAVP Melt, 188 fibre on absorption, 54–5, 199, 200 dead-space volume, syringe types, 48–9 dihydrocodeine, 200–1 Decadron, 190 dihydrofolate reductase, inhibition, 259 deflazacort, 187–8 Dilcardia SR, 202 Depixol (tablets, injection), 252 diltiazem, 202–4 Depixol Conc, 252 Dilzem SR, 203 Depixol Low, 252 Dilzem XL, 203 Depo-Medrone, 361 Dioctyl, 206 desmopressin, 188–9 Diovan (capsules, tablets), 534 Desmospray, 188 Dipentum, 412 Desmotabs, 188 diphenoxylate, in co-phenotrope, Destolit, 528, 529 179–80 Detrusitol, 513 dipyridamole, 205–6 Detrusitol XL, 513 discharge planning, 22 dexamethasone, 190–1 Disipal, 419 Dexcel tablets, omeprazole, 414, 415 dispensers, 45 DF 118 Forte, 201 dispersible tablets, 28–9 DHC Continuous, 201 dissolving of tablets, 26 diabetes mellitus distribution of drugs, malnutrition, 55 acarbose and, 61 disulfiram, 60 gliclazide, 269 Ditropan (tablets, elixir), 423 glipizide, 272 Dixarit, 167 diameter, enteral feeding tubes, doctors, legal position, 37–8, 40, 43 Diamicron, 268 documentation, enteral tube flushing, Diamicron MR, 268 Diamox (tablets, injection), 65 Diamox SR, 66 diarrhoea 9–10 docusate, 206–7 in Co-danthrusate, 186 Docusol, 207 39_INDEX.qxd 556 23/10/06 11:05 pm Page 556 Index Dolmatil, 498 Hazardous to Health Regulations, 46 domperidone, 208–9 enalapril, 218–20 donepezil, 209–10 Endoxana (tablets, injection), 184 Doralese, 292 Ensure, interactions dosulepin (dothiepin), 211–12 doxazosin, 213–14 levofloxacin, 325–7 ofloxacin, 409 doxepin, 214–15 entacapone, 220–1 doxycycline, 215–16 Enteral Feeding Tube Declogger, 19 Dozic, 278 enteral feeding tubes Drogenil, 255 drug interactions with, 5, 37, 56 drug nutrient interactions, 53–5 patency, 14–20 ciprofloxacin, 54, 157 see also occlusion of tubes levofloxacin, 54, 157, 325–7 ports, 45, 50 moxifloxacin, 54 types, 4–8 ofloxacin, 54, 157, 409 see also flushing of enteral feeding perindopril, 434 tubes phenytoin, 54, 440 enteral syringes, 45 potassium, 445 enteric-coated granules, 25 tenofovir, 504 enteric-coated tablets, 33–4 tetracyclines, 426 Entocort (CR capsules, enema), 119 trandolapril, 518 Epanutin (formulations), 439–40 trimethoprim, 526 Epilim (formulations), 531–2 warfarin, 54, 544 Epilim Chrono, 532 see also fat on drug absorption Epilim Intravenous, 532 Dulco-lax (formulations), 115, 489 Epivir (tablets, oral solution), 314 duplication, therapeutic, 21 eprosartan, 221–2 duty of care, 39, 40 ergocalciferol, calcium and, 129 Dyspomet, 153 ergometrine, 222–3 errors, Ebixa (tablets, oral drops), 351 Ecopace, 131 wrong-route, 44–5 see also MST Continuous Edronax, 466 Erymax, 224 efavirenz, 217–18 Erythrocin, 224 Efexor, 536 erythromycin, 224–5 Efexor XL, 536 Erythroped, 224 effervescent tablets, 26–7 Erythroped A, 224 Elantan, 301 escitalopram, 225–6 Elantan LA, 301 esomeprazole, 226–7 Eldepryl (tablets, oral liquid), 480 ethambutol, 228–9 elemental feeds, pancreatic enzyme ethics, 36 supplements for, 429 see also professional standards Emcor, 116 ethinylestradiol, 229–30 Emeside (capsules, syrup), 230 ethosuximide, 230–2 employers, Control of Substances etidronate, 232–3 39_INDEX.qxd 23/10/06 11:05 pm Page 557 Index etodolac, 233–4 lercanidipine, 321 Etopophos, 234 metoprolol, 54 etoposide, 234–5 nicardipine, 396 etoricoxib, 236–7 propranolol, 54 Eucardic, 136 riluzole, 471 Euglucon, 267 tenofovir, 504 excipients, solutions, 24 voriconazole, 542 excretion, factors, 56 Faverin, 257 exit holes, tube occlusion and, 16 Feldene (formulations), 442 exposure, occupational, 45–6 Feldene Melt, 442 extemporaneous preparations felodipine, 240–1 captopril, 131 female locking ports, 50 clonazepam, 166 female Luer ports, 50 clonidine, 168 female Luer syringes, 49 diltiazem, 203 ferrous gluconate, 296 enalapril, 219 ferrous sulphate, 296 etoposide, 234 Fersamal, 296 ganciclovir, 266 fexofenadine, 241 labetalol, 311 fibre levothyroxine, 328 lisinopril syrup, 332 methyldopa, 360 on drug absorption, 54–5 see also digoxin interaction with ciprofloxacin, 157 metoprolol, 366 Fibrerelief, 303 metronidazole, 369 finasteride, 242 mexiletine, 371 fine-bore tubes omeprazole, 413, 414, 415 pyrazinamide, 457 nasogastric tubes, occlusion, 16 rifabutin, 467, 468 Flagyl, 368 sildenafil, 484 Flagyl S, 368 terbinafine, 505 flavoxate, 243–4 valaciclovir, 530 Flecainide, 244 ezetimibe, 237–8 flecanide, 244–5 Ezetrol, 237 Flomax MR, 501 Florinef, 249 famciclovir, 238–9 Floxapen (formulations), 245–6 famotidine, 239–40 Fluanxol, 252 Famvir, 238 flucloxacillin, 245–7 Farlutal, 346 fluconazole, 88, 247–9 Fasturtec, 76 fludrocortisone, 249–50 fat absorption, orlistat on, 418 fluid balance, enteral tube flushing, fat on drug absorption, 54 557 9–10, 12 desmopressin, 189 fluoxetine, 250–1 efavirenz, 217 flupentixol, 252–3 griseofulvin, 54, 277 fluphenazine, 253–4 39_INDEX.qxd 558 23/10/06 11:05 pm Page 558 Index flushing of enteral feeding tubes, 9–12, 17 solutions, 16 Vygon UK on, 51 legal aspects, 37–41 tube size, 16 gelatin capsules, 37 Celebrex, 144 flutamide, 255–6 hard, 32–3 fluvastatin, 256–7 occupational exposure to contents, 45 fluvoxamine, 257–8 folic acid, 258–60 iron with, 258, 259, 297 soft, 33 glibenclamide, 267–8 Glibenese, 271 folinic acid, 124 gliclazide, 268–70 formulations, 23–34 glimepiride, 270–1 Fortipine LA, 399 glipizide, 271–2 Fortovase, 479 Glucobay, 60 Fosamax (formulations), 72 Glucophage, 356 Fosavance, 72 glyceryl trinitrate, 273–4 fosinopril, 260–1 French unit, instead of isosorbide dinitrate, 300 instead of isosorbide mononitrate, 302 frequency, water flushing, 12 glycopyrronium, 274–5 Frisium, 163 gold, 98 frusemide, see furosemide Gold v Essex County Council (1942), 40 Frusol, 261 Gopten, 518 Fungilin (formulations), 87 granisetron, 275–6 Furadantin, 404 granular suspensions, 25 furosemide (frusemide), 261–2 granulation, wet, 29 in co-amilofruse, 170–1 Fybogel, 303 griseofulvin, 277 fat ingestion on absorption, 54, 277 guidewires, occlusion clearance, 19 gabapentin, 263–4 gut flora, 56 Gabitril, 509 galantamine, 264–5 Haldol (formulations), 278 Galfer, 297 Half Sinemet CR, 324 Gamanil, 334 Half-Inderal LA, 456 ganciclovir, 265–6 Half-Securon SR, 538 gastric aspiration haloperidol, 278–9 flushing after, 10 hard gelatin capsules, 32–3 tube occlusion after, 15 health and safety, 44–7 tubes for, 5, gastric emptying antiandrogens, 114 cefuroxime, 142 on drug absorption, 53 chlorpromazine, 150 osmolality on, 13 ganciclovir, 266 gastric residual volume, checking, 12 metronidazole, 369 Gastrobid Continuous, 363 misoprostol, 375 gastrojejunostomy, percutaneous, MST Continuous and, 381 gastrostomy, 6–7 mycophenolate, 383 39_INDEX.qxd 23/10/06 11:05 pm Page 559 Index 559 pancreatic enzymes, 429 Indo-Paed, 292 tamoxifen, 500 indoramin, 292–3 see also cytotoxic drugs inhalation, occupational exposure to healthcare teams, communication, 22 drugs, 45, 46 heparin, instead of warfarin, 543 injectable formulations, 34 hepatic mixed-function oxidase enzyme Innovace, 218 system, 55 inositol nicotinate, 294–5 see also cytochrome P450 enzymes intact protein feeds, see whole-protein Hexopal, 294 feeds Hexopal Forte, 294 interactions, 46, 52–7 high osmolality, 13 ciprofloxacin, 157 Hivid, 545 copper with zinc, 547 home enteral tube feeding (HETF), Ensure with levofloxacin, 325–7 hormones, tablet crushing, 32 enteral feeding tubes, 5, 37, 56 hydralazine, 279–81 iron with methyldopa, 360 Hydrea, 283 isoniazid, 298 hydrochlorthiazide ketoconazole, 307 with amiloride, 172–3 nabumetone, 384 with irbesartan, 295 protein with levodopa, 324 with lisinopril, 332 theophylline, 507 with losartan, 339 with telmisartan, 502 hydrocortisone, 281–2 see also drug nutrient interactions intrinsic factor, metformin on production, 54, 356 hydromorphone, 282–3 Invirase, 479 hydroxycarbamide, 283–4 Ipocol, 354 hydroxyzine, 284–5 irbesartan, 295–6 Hygroton, 151 hyoscine butylbromide, 285–6 instead of mebeverine, 346 hyoscine hydrobromide, 286–7 Hypolar Retard 20, 399 instead of candesartan, 130 iron, 296–8 ascorbic acid and, 92 folic acid with, 258, 259, 297 interaction with methyldopa, 360 Ironorm Drops, 296 ibuprofen, 287–9 irrigants, 17–18 Idrolax, 341 Ismo, 301 Ikorel, 397 Ismo Retard, 301 Imdur, 301 Isodur, 301 imipramine, 289–90 Isogel, 303 Immunoprin, 99 Isoket Retard, 300 Imodium (capsules, syrup), 335 isoniazid, 298–9 Imuran (tablets, injection), 99 elixir BPC, 298 indapamide, 290 isosorbide dinitrate, 300 Inderal (tablets, injection), 455 isosorbide mononitrate, 301–2 Inderal-LA, 456 Isotard, 301 indometacin, 291–2 Ispagel, 303 39_INDEX.qxd 560 23/10/06 11:05 pm Page 560 Index ispaghula husk, 303 latex tubes, isradipine, 304 leflunomide, 319–20 Istin, 84 legal aspects, 35–43 itraconazole, 305–6 lercanidipine, 320–1 Lescol, 256 jejunostomy Lescol XL, 256 flushing, 13 leucovorin, 124–5 percutaneous, levetiracetam, 321–2 tube size, 16 levodopa, 323–5 jejunum drug delivery to, ketoconazole, 8, 306 see also jejunostomy; nasojejunal tubes nutrients on absorption, 53 levofloxacin, 325–7 interactions with enteral feeds, 54, 157 levomepromazine, 327–8 levothyroxine, 328–9 Kaplon, 131 Lexpec with Iron, 259, 297 Kay-Cee-L, 444, 445 Lexpec with Iron-M, 258, 297 Keflex (formulations), 138 liability (civil), 38–40 Kemadrin (tablets, injection), 452 licencing, administration outside Kentera, 423 terms, Keppra (tablets, oral solution), 321 linezolid, 330–1 ketoconazole, 306–7 Lioresal (formulations), 101 jejunum, 8, 306 ketoprofen, 308–9 ketorolac, 309–10 Klaricid (formulations), 159–60 liothyronine, instead of levothyroxine, 329 lipase, in pancreatic enzyme preparations, 427–8 Klaricid XL, 160 Lipitor, 96 Kloref, 444 Lipostat, 446 Kytril (formulations), 275–6 liquid formulations, 23–5 lisinopril, 331–3 labetalol, 310–12 locking ports, female, 50 lacidipine, 312 Lodine SR, 233 lactulose, 313–14 lofepramine, 334–5 Lamictal (formulations), 316 Lomont, 334 Lamisil, 505 Lomotil, 179 lamivudine, 314–15 Loniten, 372 with abacavir, 58 loperamide, 335–6 with zidovudine, 546 Lopresor, 366 lamotrigine, 316–17 loratadine, 337–8 Lanoxin (tablets, injection), 199 lorazepam, 338–9 Lanoxin-PG (tablets, elixir), 199 Loron 520, 488 lansoprazole, 317–19 losartan, 339–40 Largactil (formulations), 150 Losec (formulations), 413–14 Lasix (tablets, injection), 261 Luer lock syringes, 49 39_INDEX.qxd 23/10/06 11:05 pm Page 561 Index Luer ports, 50 Merbentyl (tablets, syrup), 196 Luer syringes, 49 mercaptopurine, 352–4 Lustrol, 483 Merck Gastroenterology, on syringe Lyflex, 101 Lyrinel XL, 423 561 sizes, 51 mesalazine, 354–5 from balsalazide, 103 Macrobid, 404 from olsalazine, 412 Macrodantin, 404 Mesren MR, 354 macrogols, 341–2 metabolism, factors, 55–6 Madopar (formulations), 323 Metenix 5, 364 Madopar CR, 323 metformin, 356–7 magnesium salts, 342–3 Malarivon, 147 male Luer ports, 50 male Luer syringes, 49 malnutrition, on drug distribution, 55 on intrinsic factor production, 54, 356 with rosiglitazone, 476 methotrexate, 358–9 folic acid therapy, 259 gut flora and, 56 Manerix, 376 methotrimeprazine, 327–8 Manevac, 482 methyldopa, 359–61 manufacturer recommendations, syringe sizes, 51 nutrients on absorption, 53 methylprednisolone, 361–2 marketing authorisation, 37–8 metoclopramide, 362–4 Maxolon (formulations), 362–3 metolazone, 364–5 Maxolon High Dose, 363 metoprolol, 365–6 Maxolon SR, 363 fat ingestion on absorption, 54 MCR-50 (isosorbide mononitrate), 302 Metrolyl, 368 mebendazole, 344–5 metronidazole, 368–70 mebeverine, 345–6 mexiletine, 371–2 mechanical occlusion clearance, 19 Mexitil (capsules, injection), 371 medicine pots, 45 Micardis, 501 dissolving tablets, 26 Micardis Plus, 502 drugs from capsules, 32–3 Micronor HRT, 407 medicine spoons, 45 Minodiab, 271 Medicines Act (1968), 37–8 minoxidil, 372–3 medicines information departments, mirtazapine, 373–4 39, 41 Medrone, 361 medroxyprogesterone, 346–8 mefenamic acid, 348–9 Megace, 349 misoprostol, 375–6 with diclofenac, 195 mixed-function oxidase enzyme system, 55 see also cytochrome P450 enzymes megestrol, 349–50 Mobic (tablets, suppositories), 350 meloxicam, 350–1 moclobemide, 376–7 instead of etodolac, 233 modafinil, 377–8 instead of etoricoxib, 236 Modecate, 253 memantine, 351–2 Modecate Conc, 253 39_INDEX.qxd 562 23/10/06 11:05 pm Page 562 Index modified-release granules, 25 Naprosyn, 388 modified-release tablets, 32 Naprosyn EC, 388 crushing, 46 Modisal XL, 302 Moditen, 253 naproxen, 388–90 nasoduodenal tubes, 5–6 flushing, 13 moexipril, 378–9 nasoenteric tubes, Molipaxin (formulations), 520–1 nasogastric tubes, Monit XL, 302 monitoring, drug changing, 22 monoamine oxidase inhibitors (MAOIs), 56 Monocor, 116 Monomax SR, 302 Monosorb XL 60, 302 unblocking, 19 nasojejunal tubes, flushing, 13 National Care Standards Commission, standards, 40–1 National Patient Safety Agency, on wrong-route errors, 45 Monotrim (injection), 526 Natrilix, 290 Monotrim (suspension), 525 Natrilix SR, 290 Morcap SR, 380 Nebilet, 390 Morphgesic MR, 380 nebivolol, 390 morphine, 379–81 nefopam, 391 mortars, 31 negligence, 39 Motens, 312 nelfinavir, 392–3 Motilium (formulations), 208 Neo-Mercazole, 135 Movicol Paediatric Plain, 341 neomycin, 393–4 Movicol-Half, 341 Neo-NaClex, 104 moxifloxacin, interactions with enteral Neoral, ciclosporin in, 33 feeds, 54 Neotigason, 70 moxonidine, 382 Neurontin (capsules, tablets), 263 MST Continuous (tablets, suspension), nevirapine, 394–5 380, 381 Nexium (tablets, injection), 226 multilumen tubes, nicardipine, 396 multivitamin preparations, 541 nicorandil, 397–8 MXL (morphine), 380 nicoumalone, 64–5 Myambutol, 228 nifedipine, 398–400 Mycobutin (capsules, suspension), 467 capsules, 33 mycophenolate, 383–4 food on absorption, 53 Myfortic, 383 malnutrition and, 55 Myleran, 121 Nifedipress MR, 399 Myocristin, 98 Niferex, 297 Myotonine, 109 Nifopress Retard, 399 Mysoline, 449 nimodipine, 400–1 Nimotop (tablets, infusion), 400 nabumetone, 384–5 nisoldipine, 402 nadolol, 386–7 nitrazepam, 402–4 naftidrofuryl, 387–8 nitrofurantoin, 404–5 39_INDEX.qxd 23/10/06 11:05 pm Page 563 Index Nivoquine (tablets, syrup), 147 Oprisine, 99 nizatidine, 406 oral ports, 50 NMC (Nursing and Midwifery Council), oral syringes, 45, 48 42 orciprenaline, 417–18 Nocutil, 188 Orlept, 532 Nolvadex, 500 orlistat, 418–19 non-steroidal anti-inflammatory drugs, orodispersible tablets, 28–9 COX II-selective, 144 Oromorph (formulations), 379 norethisterone, 407–8 orphenadrine, 419–20 Novartis Consumer Health, on syringe Orudis (capsules, suppositories), 308 sizes, 51 Oruvail (formulations), 308 Nozinan (tablets, injection), 327 osmolality, 13 Nuelin, 506 osteoporosis, 72 Nuelin SA, 507 ostomy tubes, nurses oxazepam, 420–1 legal position, 38, 39–40 professional standards, 42 Nursing and Midwifery Council (NMC), 42 Nutrizyme (formulations), 427 oxidase enzyme system, 55 see also cytochrome P450 enzymes oxprenolol, 421–3 oxybutynin, 423–4 oxycodone, 424–6 OxyContin, 425 occlusion of tubes OxyNorm (formulations), 424–5 aetiology, 14–16, 54 oxypurinol, 76 clearance, 17–19, 51 oxytetracycline, 426–7 dipyridamole, 205 sucralfate, 495 Pabrinex (injection), 459 Topamax sprinkle capsules, 514 Palladone, 282 zopiclone, 39 Palladone SR, 282 occupational exposure, 45–6 Pancrease, 428 Odrik, 518 Pancrease HL, 428 oesophageal reflux, 12 pancreatic enzymes, 427–9 alendronate and, 73 tube clearance, 17–18, 19 risedronate and, 473 ofloxacin, 408–10 tube occlusion and, 16 Pancrex, 428 interactions with enteral feeds, 54, Pancrex V (formulations), 428 157, 409 pantoprazole, 430 olanzapine, 410–11 olmesartan, 411–12 Olmetec, 411 olsalazine, 412–13 paracetamol, 175, 431–2 pectin on absorption, 54 parenteral route, connections for, 45 omeprazole, 413–15 Pariet, 462 ondansetron, 416–17 Parlodel (tablets, capsules), 117 One-Alpha (formulations), 74 paroxetine, 432–3 opioids, 283, 425 Parvolex, 67 563 39_INDEX.qxd 564 23/10/06 11:05 pm Page 564 Index passive diffusion, 53 patency, enteral feeding tubes, 14–20 see also occlusion of tubes patient positioning, 13 tube flushing, 11 interactions with enteral feeds, 54, 440 phosphate antacids on absorption, 55 calcium salts and, 127 pectin, on drug absorption, 54 physical interactions, 54, 56 PEG tubes, see gastrostomy Physiotens, 382 penicillin (phenoxymethylpenicillin), Picolax, 489 438–9 Piriton (tablets, syrup), 149 Pentasa (formulations), 354 piroxicam, 442–3 Pepcid, 239 pizotifen, 443–4 peptide feeds, pancreatic enzyme Plavix, 169 supplements for, 429 Plendil, 240 percutaneous gastrojejunostomy, Plesmet, 297 percutaneous gastrostomy, see pneumonia, prevention by cyclical gastrostomy feeding, 15 percutaneous jejunostomy, poloxamer, in Co-danthramer, 185, 186 Percutol, 273 polyethylene glycol, efavirenz and, 217 Perdix, 378 polystyrene sulphonate resins, calcium Perfalgan, 431 perindopril, 434–5 interactions with enteral feeds, 434 Persantin, 205 resonium, 125–6 polyurethane tubes (PUR tubes), 4, 16 polyvinylchloride tubes, carbamazepine adsorption, 5, 56 Persantin Retard, 205 ports, enteral feeding tubes, 45, 50 pestles, 31 position checking pH enteral feeding tubes, 8, 10 on drug absorption, 53 imipramine, 289, 290 itraconazole, 305 ketoconazole, 306 furosemide preparations, 262 testing, 8, 10 water flushing after, 12 see also acidic fluids pharmacists water flushing after, 12 positioning of patient, 13 tube flushing, 11 postpyloric tubes, see nasoduodenal tubes potassium, 444–6 interactions with enteral feeds, 445 pravastatin, 446–7 instead of fluvastatin, 257 liability, 40 Praxilene, 387 responsibilities, 2–3, 43 precipitates, tube occlusion, 15, 16 RPSGB guidelines, 41 prednisolone, 447–8 pharmacokinetic interactions, 53–5 instead of budesonide, 119 phenelzine, 435–6 Prescal, 304 Phenergan (formulations), 453–5 prescribing errors, phenobarbital, 436–7 see also MST Continuous phenoxymethylpenicillin, 438–9 Preservex, 63 phenytoin, 439–41 primidone, 449–50 39_INDEX.qxd 23/10/06 11:05 pm Page 565 Index Primulut N, 407 reboxetine, 466–7 prochlorperazine, 450–2 reflux, see oesophageal reflux procyclidine, 452–3 Regulan, 303 instead of trihexyphenidyl, 524 Relifex (tablets, suspension), 384 professional bodies, 36 Reminyl (formulations), 264 professional standards, 42, 43 Requip, 475 prolonged effect, drug choice for, 22 residual gastric volume, 12 promethazine, 453–5 Resonium A, 125 propranolol, 455–7 fat ingestion on absorption, 54 Retrovir (formulations), 545–6 review of drug therapy, 21–2 Proscar, 242 Ridaura, 98 protease, in pancreatic enzyme rifabutin, 467–8 preparations, 427–8 Rifadin (formulations), 469 protease inhibitors, 479 rifampicin, 469–70 protein, interaction with levodopa, 324 Rilutek, 470 protein feeds, see whole-protein feeds riluzole, 470–1 Prothiaden (capsules, tablets), 211 Rimactane, 469 Protium (tablets, injection), 430 Rimapurinol, 75 protocols, legal status, 39, 41 risedronate, 472–3 proton pump inhibitors, 227, 462 risk management, 44–7 Provera, 347 Risperdal (tablets, liquid), 474 Provigil, 377 Risperdal Consta, 474 Prozac (capsules, liquid), 250 Risperdal Quicklet, 474 psoriasis, 71 risperidone, 474–5 Pulmocare, interaction with Rivotril (tablets, injection), 166 ciprofloxacin, 157 pulmonary reflux, 12 see also pneumonia Robinul (injection, powder), 274 Robinul Forte, 274 ropinirole, 475–6 pulsatile flushing, 11 rosiglitazone, 476–7 purchasing decisions, health and safety, rosuvastatin, 478 45 Puri-Nethol, 352 PVC tubes, see polyvinylchloride tubes route of administration, errors, 44–5 Royal Pharmaceutical Society (RSPGB), on tablet crushing, 41 pyrazinamide, 457–8 rupture risk, tube clearance, 19 pyridoxine, 459–60 Ryles tubes pyrimethamine, 460 565 nasogastric tubes, see also wide-bore tubes quinapril, 461 Sabril (tablets, powder), 539 rabeprazole, 462 ramipril, 462–4 ranitidine, 464–6 instead of pantoprazole, 430 rasburicase, 76 safety, see cytotoxic drugs; health and safety Salazopyrin (formulations), 496 Salofalk (formulations), 354–5 Sando K, 445 39_INDEX.qxd 566 23/10/06 11:05 pm Page 566 Index Sandocal-400, 127 sodium bicarbonate Sandocal-1000, 127 omeprazole preparation, 413, 414 Sanomigran (tablets, elixir), 443 pancreatic enzyme activation, 18 saquinavir, 479–80 pantoprazole, 430 Scopoderm TTS, 287 in Zoton, 317 Secadrex, 62 sodium clodronate, 487–9 Sectral (capsules, tablets), 62 sodium picosulfate, 489–90 Securon (tablets, injection), 537 sodium valproate, 531–3 Securon SR, 538 soft gelatin capsules, 33 selegiline, 480–1 solid dosage formulations, 26–34 instead of cabergoline, 123 Solpadol, 175 Zelapar, 29, 480 soluble tablets, 26 Semi-Daonil, 267 Solu-Cortef, 281 senna, 482–3 Solu-Medrone, 361 Senokot (syrup, granules), 482 solutions (drugs), 23–4 Septrin (formulations), 181 solutions (flushing), 16 Serc, 105 Solvazinc, 547 Serenace (formulations), 278 solvents, 23–4 Seroxat (tablets, liquid), 432–3 sorbitol, 24, 134 sertraline, 483 cimetidine formulations, 153 Sevredol, 379 Kay-Cee-L, 444 sildenafil, 484–5 silicone tubes, occlusion, 16 ondansetron, 416 Sotacor (tablets, injection), 491 sotalol, 490–2 Simvador, 486 Spasmonal, 77 simvastatin, 485–7 Spasmonal Forte, 77 grapefruit juice and, 56 Simzol, 486 Sinemet (formulations), 323–4 spironolactone, 492–3 splanchnic blood flow, on drug absorption, 54 Sinequan, 214 Sporanox (formulations), 305 Sinthrome, 64 sprinkle capsules, Topamax, 514 Slofedipine, 399 stagnant feed, tube occlusion, 15 Slofedipine XL, 399 staining, olsalazine, 412 Slo-Phyllin, 507 Staril, 260 Slow-K, 445 stavudine, 494–5 Slow-Trasicor, 422 Stelazine (formulations), 522–3 Slozem, 203 Stelazine Spansules, 522 sodium Stemetil (formulations), 450 Brufen granules, 288 sterile water, 11 cimetidine formulations, 153 Stugeron, 155 co-codamol, 174–5 Stugeron Forte, 155 effervescent tablets, 27 sublingual tablets, 29 paracetamol preparations, 431 sodium aurothiomalate, 98 glyceryl trinitrate, 274 sucralfate, 54, 495–6 39_INDEX.qxd 23/10/06 11:05 pm Page 567 Index sucrose, syrup, 23 Tarka, 518 sulfamethoxazole, in co-trimoxazole, Tavanic (tablets, infusion), 325–7 180–2 sulfasalazine, 496–7 instead of balsalzide, 103 Tegretol (formulations), 133 Telfast, 241 telmisartan, 501–2 sulpiride, 498–9 temazepam, 503–4 Sulpitil, 498 tenofovir, 504–5 Sulpor, 498 Tenormin (formulations), 94 Suprax, 139 Tensipine MR, 399 Surmontil (capsules, tablets), 527 Tensopril, 131 Suscard, 273 teratogenicity suspensions, 25 acitretin, 71 Sustac, 273 finasteride, 242 Sustiva (formulations), 217 gold, 98 Symmetrel (capsules, syrup), 78 terbinafine, 505–6 Synflex, 388 terfenadine, grapefruit juice and, 56 Syprol, 455 Teril Retard, 133 syringes, 24, 25, 26, 30–1 tetracyclines for crushing, 31–2 oral, 45, 48 size, 50–1 enteral tube flushing, 9, 50 567 chemical interactions, 54 interactions with enteral feeds, 426 Teveten, 221 theophylline, 506–8 tube clearance, 19 tiagabine, 509 types, 48–9 Tildiem, 202 wrong-route errors, 44 Tildiem LA, 203 syrup, 23 Tildiem Retard, 203 Syscor MR, 402 Tillomed, 146 Sytron, 297 timolol, 510 Timonil Retard, 133 tablets, 26–32 crushing, 31, 37 tizanidine, 511–12 Tofranil, 289 clopidogrel, 169 tolbutamide, 512–13 dosulepin, 211 tolterodine, 513–14 exposure to contents, 45–6 Topamax (tablets, sprinkle capsules), Royal Pharmaceutical Society on, 41 tube occlusion and, 16 wrong formulations, 46 enteric-coated, 33–4 514 topical preparations, glyceryl trinitrate, 273, 274 topiramate, 514–15 Tagamet (formulations), 153 Toradol (tablets, injection), 309 Tambacor (tablets, injection), 244 Torivid (tablets, injection), 408 tamoxifen, 499–500 tramadol, 516 tamsulosin, 501 Tramake Insts, 516 tap water, 11 Trandate (tablets, injection), 310 Targretin, 111 trandolapril, 518–19 39_INDEX.qxd 568 23/10/06 11:05 pm Page 568 Index tranexamic acid, 519–20 Vermox (tablets, suspension), 344 transdermal formulations, glyceryl Veropress MR, 538 trinitrate, 273 Vertab SR 240, 538 Trasicor, 421 Vespesid (capsules, injection), 234 trazodone, 520 Vfend (formulations), 542 Triapin, 463 Viagra, 484 trifluoperazine, 522–4 Vibramycin, 215 trihexyphenidyl, 524–5 Vibramycin-D, 215 trimethoprim, 525–7 vigabatrin, 539–40 in co-trimoxazole, 180–2 trimipramine, 527 Viokase, activated, tube clearance, 17–18 Trimopan, 526 Viracept (tablets, powder), 392 Tritace, 462 Viramune (tablets, suspension), 394 Tritace Titration pack, 463 Viread, 504 Trizivir, 58 vitamin(s), orlistat on absorption, 418 tryptophan, phenelzine and, 435 vitamin B 12, metformin on absorption, Tylex, 175 tyramine, monoamine oxidase inhibitors and, 56 54, 356 vitamin D, calcium salts with, 128–30 vitamin E, 540–1 vitamin K, warfarin and, 544 Ucerax, 284 Voltarol (formulations), 194 unblocking, tube occlusion, 17–19, 51 Voltarol Rapid, 194 Uniphyllin Continuous, 507 volumes Univer, 538 dead space, syringe types, 48–9 Urdox, 528 gastric residual, checking, 12 Urispas, 243 water flushes, 11 ursodeoxycholic acid, 528–9 tube occlusion prevention, 17 Ursofalk (capsules, suspension), 528 voriconazole, 542–3 Ursogol, 528 Vygon UK, on syringe sizes, 51 Utovlan, 407 warfarin, 39, 543–4 Vaginyl, 368 interactions with enteral feeds, 54 valaciclovir, 530 water, interactions with ions, 54 Valoid (tablets, injection), 182 water flushing, 10–12, 17 valproate, 531–3 wet granulation, 29 valsartan, 534–5 whole-protein feeds Valtrex, 530 pancreatic enzyme supplements for, Vancocin, 535 429 vancomycin, 535–6 Vascase, 152 Velosef (formulations), 140–1 venlafaxine, 536–7 verapamil, 537–9 with trandolapril, 518 tube occlusion after, 15 wide-bore tubes occlusion, 16 see also Ryles tubes wrong-route errors, 44–5 39_INDEX.qxd 23/10/06 11:05 pm Page 569 Index Xanthomax, 75 Zimovane, 548 Xenical, 418 zinc sulphate, 547–8 Zinnat (formulations), 142 yeasts, tube occlusion, 16 Ziogen, 58 Zispin SolTab, 373 zalcitabine, 545 Zocor, 485 Zamadol, 516 Zofran (formulations), 416 Zamadol Melt, 516 Zofran Melt, 416 Zanaflex, 511 Zolvera, 538 Zanidip, 320 Zomorph, 380 Zantac (formulations), 464 zopiclone, 39, 548–9 Zarontin (capsules, syrup), 231 Zoton, 317 Zeffix (tablets, oral solution), 314 Zoton FasTabs, 29, 317 Zelapar, 29, 480 Zoton Suspension, 317 Zemzard, 203 Zovirax (formulations), 68 Zerit (capsules, oral solution), 494 Zydol (capsules, soluble tablets), 516 Zestoretic, 332 Zyloric, 75 Zestril, 331 Zyprexa (tablets, injection), 410 zidovudine, 545–7 Zyprexa Velotab, 410 with abacavir, 58 Zyvox (formulations), 330 569 ... 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. .. i Handbook of Drug Administration via Enteral Feeding Tubes 01_1603PP_FM.qxd 26/10/06 7:56 pm Page ii 01_1603PP_FM.qxd 26/10/06 7:56 pm Page iii Handbook of Drug Administration via Enteral Feeding. .. 79 Introduction Types of enteral feeding tubes Flushing enteral feeding tubes Restoring and maintaining patency of enteral feeding tubes 14 Drug therapy review 21 Choice of medication formulation