From the Guidelines
Patients with a nasogastric tube (NGT) should not take medications orally (PO) as a general rule, due to the risk of aspiration and other complications, and instead, medications should be administered through the NGT itself after confirming proper tube placement. The presence of an NGT typically indicates that the patient has difficulty swallowing, has an impaired gag reflex, is unable to protect their airway, or cannot meet their nutritional needs through normal oral intake. These same conditions that necessitated the NGT placement also make oral medication administration unsafe. However, certain medications can be administered through an NGT, such as apixaban, rivaroxaban, and edoxaban, which can be crushed and suspended in water for administration through the tube, as noted in the guidelines for cancer-associated venous thromboembolic disease 1.
- Key considerations for NGT medication administration include:
- Confirming proper tube placement before administering medications
- Consulting with a pharmacist to determine appropriate medication forms for NGT administration
- Avoiding certain formulations like extended-release tablets, enteric-coated pills, or sublingual medications, which should not be crushed
- Being aware of specific medication guidelines, such as those for apixaban, rivaroxaban, and edoxaban, which can be found in the guidelines for cancer-associated venous thromboembolic disease 1 In rare cases where a patient has an NGT for reasons other than swallowing difficulties and has been cleared by their healthcare provider, oral medications might be permitted, but this is not the standard approach and requires specific medical evaluation and approval. It's also important to note that some medications, like dabigatran, should not be administered through an enteral feeding tube 1.
From the Research
Administration of Oral Medications via Nasogastric Tube (NGT)
- The administration of oral medications to patients with a nasogastric tube (NGT) is a complex issue that requires careful consideration of the medication's formulation, the patient's condition, and the potential risks and benefits of NGT administration 2.
- Some medications can be safely administered via NGT, while others may not be suitable due to concerns about bioavailability, stability, or interactions with enteral nutrition 3.
- It is essential to consult the medication's package insert and relevant literature to determine the appropriateness of NGT administration for a particular medication 2, 4.
Considerations for NGT Administration
- Liquid medications, such as elixirs and suspensions, are generally preferred for NGT administration, but may require special handling to avoid tube occlusion or other complications 3.
- Solid dosage forms, such as tablets or capsules, may need to be crushed or opened before administration via NGT, but this can affect the medication's bioavailability and efficacy 2, 4.
- The patient's swallowing function and ability to tolerate oral medications should be assessed before initiating NGT administration, and regular monitoring is necessary to minimize the risk of complications 5, 6.
Potential Risks and Complications
- NGT administration can be associated with risks such as tube occlusion, aspiration, and interactions with enteral nutrition, which can lead to decreased efficacy or increased adverse effects of the medication 3, 5.
- Patients with prolonged dysphagia may require oral diet training to transition from NGT feeding to exclusive oral feeding, and this should be done under the guidance of a healthcare professional 6.
- Regular assessment and monitoring of the patient's condition and the NGT administration process are crucial to minimize the risk of complications and ensure the safe and effective use of oral medications via NGT 2, 4.