From the Guidelines
For a patient with a PEG tube who currently takes nifedipine, the best alternative antihypertensive medication is amlodipine, which can be crushed and administered via PEG tube at a starting dose of 5 mg once daily, as recommended by the most recent guidelines 1.
Alternative Options
Other options include:
- Losartan (an angiotensin receptor blocker) starting at 25-50 mg daily
- Lisinopril (an ACE inhibitor) starting at 5-10 mg daily Both of these medications can be crushed and administered via PEG tube.
Administration Guidelines
When administering medications through a PEG tube, it's essential to:
- Crush tablets to a fine powder
- Mix with 15-30 mL of water
- Flush the tube before and after administration with 30 mL of water
- Temporarily stop tube feeding 30 minutes before and after giving the medication to ensure proper absorption
Mechanism of Action
These alternatives work through similar or complementary mechanisms to nifedipine by either:
- Blocking calcium channels
- Inhibiting the renin-angiotensin system
- Blocking angiotensin receptors to reduce blood pressure effectively According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, amlodipine is a preferred calcium channel blocker for patients with hypertension 1.
From the Research
Alternative Antihypertensive Medication for Patients with PEG Tube
For a patient with a Percutaneous Endoscopic Gastrostomy (PEG) tube who is currently taking nifedipine, an alternative antihypertensive medication can be considered due to potential interactions or difficulties in administering nifedipine with a PEG tube.
- Amlodipine is a suitable alternative, as it is another calcium channel blocker that has been compared to nifedipine in several studies 2, 3, 4.
- The study by 2 found that once-daily nifedipine and amlodipine had comparable efficacy and safety in patients with mild-to-moderate essential hypertension.
- Another study by 4 demonstrated that switching patients from nifedipine to amlodipine resulted in improved blood pressure control and significant cost savings.
- Other options may include angiotensin-converting enzyme (ACE) inhibitors, such as benazepril, which can be used in combination with a calcium antagonist like amlodipine, as shown in the study by 3.
- It is essential to consider the patient's individual needs and medical history when selecting an alternative antihypertensive medication, and to monitor their response to the new medication closely.
Key Considerations
- The choice of alternative medication should be based on the patient's specific clinical profile and the potential benefits and risks associated with each option.
- The studies by 5 and 6 provide additional information on the use of long-acting nifedipine and its role in the management of hypertension, but do not directly address the issue of PEG tube administration.