What medications can be administered via Percutaneous Endoscopic Gastrostomy (PEG) tube?

From the Guidelines

Medications and nutritional formulas can be administered via a percutaneous endoscopic gastrostomy (PEG) tube, with liquid formulations preferred for medications and commercially prepared enteral nutrition formulas tailored to specific patient needs. For medications, tablets may be crushed and capsules opened and mixed with water if liquid forms aren't available, but extended-release, enteric-coated, sublingual, and buccal medications should not be crushed 1. Each medication should be administered separately with 15-30 mL of water flushes between them to prevent interactions and tube clogging.

Key Considerations

• Nutritional formulas can include commercially prepared enteral nutrition formulas tailored to specific patient needs.
• When administering anything through a PEG tube, it's essential to verify tube placement, flush with 30 mL of water before and after administration, and ensure medications are properly diluted 1.
• This approach maintains tube patency and ensures proper medication delivery while preventing complications like tube obstruction.
• Some medications may require dose adjustments when administered via PEG tube due to altered absorption compared to oral administration.

Administration Guidelines

• After feed or medication administration, the tube should be flushed with about 40 ml of drinking or still mineral water 1.
• Preparation of an individual nutrition plan is required, including calculation of the patient’s daily calorie and fluid requirement, choice of the appropriate nutrient preparations, etc. 1.
• Patients and their relatives may need to be trained in care of the tube and administration of medications and nutritional formulas 1.

Important Precautions

• To avoid the most commonly occurring complication, i.e., wound infection, it is crucial to take general measures such as ensuring the incision at the puncture site is sufficiently large and using a Y-compress to avoid the formation of a moist cavity under the external fixation plate 1.
• The external fixation plate should retain the tube but not exert any tension on the stoma canal and allow free movement of the tube of at least 5 mm 1.

From the FDA Drug Label

ADMIXTURES COMPATIBILITIES Metoclopramide Injection, USP is compatible for mixing and injection with the following dosage forms to the extent indicated below: The FDA drug label does not answer the question.

From the Research

Administration via PEG Tube

• Medications can be administered through a PEG tube, but several issues must be considered to ensure safe and effective administration 2.
• Liquid medications, such as elixirs and suspensions, are preferred for enteral administration via PEG tube, but may be hypertonic or contain large amounts of sorbitol, increasing the potential for adverse effects 2, 3.
• Solid dosage forms can be administered through a PEG tube, but it should be determined if the medications are suitable for manipulation, such as crushing a tablet or opening a capsule 2.
• Medications should not be added directly to the enteral formula, and feeding tubes should be properly flushed with water before and after each medication is administered 2, 4.
• Nurses should consider the use of liquid form medications to minimize tube occlusions, and be aware of the sorbitol content of some liquid medications, which can cause diarrhea 3.
• A non-touch technique should be used when administering enteral feed via PEG to reduce the risk of bacterial contamination 4.

Common Medications Administered via PEG Tube

• Phenytoin, carbamazepine, warfarin, fluoroquinolones, and proton pump inhibitors require special considerations when administered via PEG tube due to potential drug-nutrient interactions 2.
• Omeprazole can be administered via PEG tube and has been shown to be effective in treating gastroesophageal reflux disease (GERD) 5.

Nursing Considerations

• Nurses should have the knowledge and skills required to administer enteral feeding via PEG safely and effectively, and work within their level of competence 4.
• Management of the PEG feeding tube and care of the stoma site are vital, and nurses should be able to recognize common complications of PEG feeding 4.