How to administer omeprazole to a patient in New Zealand with an enteral (enteral) feeding tube?

Administering Omeprazole Through an Enteral Feeding Tube in New Zealand

For patients with enteral feeding tubes requiring omeprazole in New Zealand, use a liquid suspension prepared from Losec or Dr. Reddy's brand omeprazole 20mg capsules mixed with 8.4% sodium bicarbonate solution, stored in amber bottles at 4°C for up to 20 days. 1

Preparation Method

Recommended Suspension Preparation

1. Select appropriate brand:

   • Use either Losec or Dr. Reddy's brand omeprazole 20mg capsules 1
   • These brands have demonstrated superior stability when compounded into suspensions

2. Preparation technique:

   • Use the "shaking method" rather than grinding/crushing the pellets 2
   • Prepare a 2mg/mL suspension using 8.4% sodium bicarbonate solution 1
   • Store in amber bottles to protect from light 1
   • Refrigerate at 4°C for maximum stability (up to 20-30 days) 1, 2

3. Do not crush enteric-coated pellets:

   • Crushing reduces stability (stable for only 1 week vs 4 weeks with shaking method at room temperature) 2
   • Crushing may damage the enteric coating, reducing efficacy 3

Administration Procedure

Before Administration

1. Pause enteral feeding:

   • Stop the feed at least 30 minutes before administering omeprazole 4
   • This reduces drug-nutrient interactions and improves absorption 5

2. Flush the tube:

   • Flush with at least 30mL of water before medication administration 4
   • Use appropriate ENFit syringes as per ISO 80369-3 standard 4

During Administration

1. Administer the medication:

   • Shake the suspension well immediately before administration 2
   • Use appropriate ENFit syringes to avoid misconnection errors 4
   • Do not shake low-dose ENFit tip syringes to remove drug moat 4

2. Administration timing:

   • Administer omeprazole before meals for optimal effect 4
   • Keep patient positioned at 30° or more upright during administration 4

After Administration

1. Flush the tube again:

   • Flush with at least 30mL of water after medication administration 4
   • This prevents tube blockage and ensures complete dose delivery 4

2. Timing of feeding restart:

   • Wait at least 30 minutes before restarting enteral feeding 5
   • This allows for optimal drug absorption 5

Important Considerations

Pharmacist Consultation

• Consult with a pharmacist before administering omeprazole via enteral tube 4
• Pharmacists can provide guidance on compatibility with specific enteral formulas and other medications 4

Tube Placement Considerations

• The site of tube placement affects drug absorption 4, 5
• Omeprazole is readily absorbed in the duodenum and upper small bowel 4
• If less than 50cm of jejunum remains, intravenous administration may be needed 4

Avoiding Complications

• Monitor for tube blockage, which is common with medications 4
• Avoid hyperosmolar preparations which may cause gastrointestinal disturbances 4
• Keep patient upright during and for 30 minutes after administration to prevent reflux 4

Storage and Stability

• Refrigerated suspensions (4°C) remain stable for up to 20 days 1
• Room temperature storage (25°C) reduces stability to 7 days 1
• Observe for color changes which may indicate degradation 1

Common Pitfalls to Avoid

• Do not add omeprazole directly to enteral formula 3
• Do not use carbonated drinks, pineapple juice, or sodium bicarbonate solution to unblock tubes as they may cause tube degradation 4
• Avoid crushing enteric-coated pellets which significantly reduces stability 2
• Do not use all brands of omeprazole interchangeably - some brands produce poor quality suspensions 1