What is a suitable reflux medication, such as omeprazole (proton pump inhibitor), that can be administered via a Percutaneous Endoscopic Gastrostomy (PEG) tube, and are there any available liquid vitamin D supplements, like Puria (colecalciferol), for a patient with a history of Neurofibromatosis type 2?

From the FDA Drug Label

The enteric-coated tablet is not suitable to give by enteral feeding tube. Option 1 Use the oral liquid if available. Suitable for nasogastric and PEG tubes size 6 French and larger. Stop the feed and flush the tube with 5 mL of water. Shake the bottle well for 20 seconds, then draw the required dose into an enteral syringe and give into the tube. Flush the tube with 5 mL of water.

For a patient with a history of Neurofibromatosis type 2, a suitable reflux medication that can be administered via a PEG tube is omeprazole oral liquid. This is suitable for nasogastric and PEG tubes size 6 French and larger 1.

Regarding liquid vitamin D supplements, the provided information does not directly address the question, therefore, The FDA drug label does not answer the question about liquid vitamin D supplements.

From the Research

For a patient with a PEG tube and neurofibromatosis type 2, the most suitable reflux medication that can be administered via the PEG tube is a liquid formulation of a proton pump inhibitor, such as lansoprazole oral disintegrating tablets or esomeprazole granules for oral suspension. When considering the administration of medications through a PEG tube, it's crucial to prioritize formulations that can be safely and effectively delivered through this route.

• Liquid formulations of proton pump inhibitors, such as lansoprazole oral disintegrating tablets or esomeprazole granules for oral suspension, are preferred due to their ease of administration and reduced risk of clogging the tube 2.
• Omeprazole can also be considered, but it requires specific preparation, such as opening the capsule and mixing the granules with acidic juice or water, which is technically off-label. Regarding vitamin D supplementation,
• liquid vitamin D3 (cholecalciferol) preparations like Puria D3 drops are appropriate and can be easily administered through the PEG tube 3. The typical adult dose for vitamin D supplementation is 1000-2000 IU daily, though patients with deficiency may require higher doses initially. It's essential to flush the tube with 30ml of water before and after each medication to prevent clogging and ensure complete delivery. Neurofibromatosis type 2 itself doesn't specifically affect the choice of these medications, but the presence of a PEG tube necessitates using liquid formulations or properly prepared solid medications that can be safely administered through the tube. In terms of specific guidance for the patient's situation,
• the use of omeprazole or other proton pump inhibitors should be tailored to the individual's needs, considering factors such as the severity of reflux symptoms and the presence of any potential interactions with other medications 4, 5, 6.