Drug Interactions With Enteral Nutrition (general Use)
Drug Interactions with EnteralNutrition (general use)Guidance regarding enteral administration of medicines and interactionsbetween medicines and enteral feeds, including feeding breaksGeneral points: This list is not exhaustive – contact ward pharmacist, practice pharmacist or MedicinesInformation (01355 584879 or medicines.information@lanarkshire.scot.nhs.uk) for adviceregarding other medicines.In general, crushing / dispersing tablets and administering them via enteral feeding tubesrenders their use off label.Even if liquid available, it is not always the best option for administration via enteral tubesBe careful with sodium content of effervescent / dispersible preparationsWithholding enteral feeds can compromise nutrition and interfere with blood glucosemanagement.Written by: Medicines Information Team, Hairmyres HospitalApproved by: Area Drugs and Therapeutics CommitteeUpdated: September 2019May 2016Review date: September 2021
DRUGCiprofloxacinFORMULATIONAntimicrobialsDisperse tablets (suspension –high risk of tube blockage)ACTION Co-amoxiclavFor NG/PEG use liquid mixedwith an equal volume of water FlucloxacillinUse liquid LevofloxacinCrush tablets and mix withwater MetronidazoleCrush tablets and mix withwater Written by: Medicines Information Team, Hairmyres HospitalApproved by: Area Drugs and Therapeutics CommitteeUpdated: September 2019Use higher end of doserange (especially ifjejunal)Withhold feed 2 hoursbefore and 2 hours afterdose (especially if jejunal)No feeding breakrequiredNot suitable for jejunaladministrationWithhold feed 2 hoursbefore and 1 hour afterdosePossibly not compatiblewith enteral feeding dueto QID dosingConsider IV or alternativeantibiotic.Contact Pharmacy forfurther advice if neededUse higher end of doserange (especially ifjejunal)Withhold feed 2 hoursbefore and 2 hours afterdoseNo feeding breakrequired if crushed tabletsare usedSuspension available butcontains a different saltwhich requires a feedingbreak and is not suitablefor jejunal administration.If suspension is used,withhold feed for 2 hoursbefore and 1 hour afterdose.May 2016Review date: September 2021
DRUGPenicillin s (cont)Use liquidACTION Withhold feed 2 hoursbefore and 1 hour afterdose Possibly not compatiblewith enteral feeding due toQID dosing. Consider IV or alternativeantibiotic Contact Pharmacy forfurther advice if neededTrimethoprimUse liquid Withhold feed ½ hourbefore and ½ hour afterdose if possible for optimalabsorption.VoriconazoleUse liquid Withhold feed 2 hoursbefore and 2 hours afterdose If liquid is unavailable,tablets may be crushed andmixed with water.DigoxinCardiologyUse liquid (don’t dilute) If high fibre feed, withholdfeed 2 hours before and 1hafter dose62.5 microgram digoxintablet 50 microgramdigoxin liquidUse crushed tablets forjejunal administration ifosmotic diarrhoea is aproblem LercanidipineCrush tablets and mix withwater Written by: Medicines Information Team, Hairmyres HospitalApproved by: Area Drugs and Therapeutics CommitteeUpdated: September 2019Withhold feed ½ hourbefore and ½ hour afterdoseConsider changing toamlodipineMay 2016Review date: September 2021
DRUGPerindoprilFORMULATIONCardiology (cont)Crush tablets and mix withwaterACTION WarfarinCrush tablets and mix withwater LansoprazoleCarbamazepineGastro medicinesUse orodispersible tabletsEpilepsy medicinesUse liquid mixed with an equalvolume of waterWritten by: Medicines Information Team, Hairmyres HospitalApproved by: Area Drugs and Therapeutics CommitteeUpdated: September 2019 Withhold feed ½ hourbefore and ½ hour afterdoseConsider changing toLisinoprilPerindopril erbumine maynot be effective in jejunaladministration due todecreased absorptionIf feeding regime is keptas stable as possible, abreak is probably notrequired.Where possible withholdfeed 1-2 hours beforeand 1-2 hours after doseKeep intake consistentand monitor INR whenregime is changed.Reduced risk ofabsorption if drug is givenvia tubes terminatingbeyond the stomach.Withhold feed ½ hourbefore and ½ hour afterdose. No feeding break required Enteral feed interactionshould be considered ifpatient fails to achieveadequate levels If daily dose 400mg,divide into 4 equal doses.May 2016Review date: September 2021
DRUGPhenytoinIt is recommended thatphenytoin should NEVERbe administered via enteralfeeding tubes. Absorption isextremely unpredictable.Only use if there is nosuitable alternative routeor drug e.g. IV phenytoin.FORMULATIONEpilepsy medicines (cont) Give by parenteralinjection if possible For NG/PEG use liquidmixed with an equalvolume of waterACTION If using phenytoin viaenteral tube, withholdfeed for 2 hours beforeand 2 hours after doseNot suitable for jejunaladministration100mg phenytoin capsule 90mg phenytoin liquidCan usually be given as asingle daily dose at night Must discuss with medicalstaff before giving enteralphenytoin.LevothyroxineMiscellaneousCrush tablets and mix withwater Monitor thyroid functionEnteral feed interaction orbinding to feeding tubeshould be considered ifpatient fails to achieveadequate response.Consider withholding feedfor 1 hour before and 1hour after dose, or adjustdose. Parkinsons Disease medicinesAlso refer to:NHSL Acute management of PD patientswho are NBMMadoparDo not open capsules. Usedispersible tablets.SinemetDo not crush modified releasetablets.Disperse standard tablets inwater. No feeding break requiredAbsorption may be alteredby enteral feedsTiming of feed and doseshould be as consistent aspossible to reducefluctuations in dailyresponse. StalevoCrush tablets and mix withwaterTheophylline Seek specialist adviceregarding alternatives. Modified release tabletsare not suitable forcrushingAminophylline injectionmay be given enterally(draw up via filter straw).Written by: Medicines Information Team, Hairmyres HospitalApproved by: Area Drugs and Therapeutics CommitteeUpdated: September 2019 Despite the lack ofconsistent data, it iscurrently recommendedto give theophyllineduring a break in feedingwhere possible.If the feed is to beMay 2016Review date: September 2021
Aminophylline is a salt oftheophylline. Dosechange required contact pharmacy foradvice. withheld, it should bestopped for one hourbefore and one hourafter each dose.Enteral feed interactionshould be considered ifpatient fails to achieveadequate levelsInformation prepared using: NEWT Guidelines. Accessed online at www.newtguidelines.com, September 2019.White R, Bradnam V. Handbook of Drug Administration via Enteral Feeding Tubes. Accessedonline via www.medicinescomplete.com, September 2019.Stockleys Drug Interactions. Accessed online via www.medicinescomplete.com, September2019.Written by: Medicines Information Team, Hairmyres HospitalApproved by: Area Drugs and Therapeutics CommitteeUpdated: September 2019May 2016Review date: September 2021
Drug Interactions with Enteral Nutrition (general use) Guidance regarding enteral administration of medicines and interactions between medicines and enteral feeds, including feeding breaks General points: This list is not exhaustive - contact ward pharmacist, practice pharmacist or Medicines Information (01355 584879 or medicines.information .
Product Criteria The enteral nutrition product requested on an authorization must be on the List of Enteral Nutrition Products and the beneficiary must meet the medical criteria for the specific product category and, if applicable, product-specific criteria. Products are listed in one or more of the followi
teral nutrition therapy, enteral nutrition is approximately two- to fourfold cheaper on an inpatient or out-patient basis.2,3,9,25-27 Based on US Medicare charges, the annual cost of provid-ing enteral nutrition per patient is approximately US 9,605 US 9,327 compared with US 55,193 US 30,596 for parenteral solu-
Daily Nutrition Data 40‐43 Daily Enteral Nutrition (EN) Data (Enteral Nutrition, Protein Supplements, Non‐ProteinModular Supplements, EN Interruptions) 44‐49 Daily IV Nutrition Data (Parenteral Nutrition) 50‐53 Daily Protein Data (Day 13‐28, if applicable) 54‐57 Daily Nutritional Adequacy (automatically calculated by REDCap )
of a non-feeding tube device being connected to a feeding tube port. All enteral access devices, including feeding tubes, administration sets and enteral syringes will be impacted by these changes. The New ENFit Connector Provides a way to reduce the risk of enteral tube feeding misco
hati lebih dianjurkan daripada pemberian nutrisi parenteral karena pemberian nutrisi enteral mempercepat membaiknya keseimbangan nitrogen dan berkurangnya infeksi. Penambahan prebiotik dan probiotik dalam nutrisi enteral pasca-operasi juga dapat menurunkan laju infeksi dibandingkan dengan pemberian nutrisi enteral saja. 5.
LSS/DIS Holdings Updated 2/6/15 Page 3 sjb The Pharmacist’s Guide to Drug Eruptions and Interactions (Litt) 6 Managing Clinically Important Drug Interactions, 2005 (Hansten & Horn) 7 Herbal-Drug Interactions and Adverse Effects (Philp) 8 Handbook of Food-Drug Interactions (McCabe, Frankel, Wolfe) 9 Neoral Drug Interactions, Novartis 2006 Literature Review (Novartis) 10
receiving prepyloric gastric feeds and no cases were observed in the 19 patients receiving post-pyloric feeds through a jejunal tube. To avoid continuous alkalinization and intragastric Gram-negative growth associated with enteral feeding, intermittent enteral nutrition was compared with con-tinuous enteral nutrition in one trial [28]. Five of
archaeological resource within a particular area or 'site' in order to make an assessment of its merit in context (using the HER, historic maps and other resources) Post-excavation Assessment (PXA) It is fairly unlikely that you will need to produce one of these as they are generally a planning requirement and/or for large sites with lots of finds. A post- excavation assessment report should .
