What are the feeding tube friendly presentations of Proton Pump Inhibitors (PPIs)?

Feeding Tube-Friendly Presentations of Proton Pump Inhibitors (PPIs)

For patients requiring PPI administration via feeding tubes, lansoprazole orally disintegrating tablets (ODT) are the most appropriate choice as they provide the highest recovery rate (86.2%) through feeding tubes compared to other PPI formulations.

Optimal PPI Options for Enteral Tube Administration

Best Options (In Order of Preference)

1. Lansoprazole orally disintegrating tablets (ODT)

   • Highest recovery rate (86.2%) through 8 French tubes 1
   • Optimal administration: 5mL water for suspension and 10mL flush-through water 1
   • Allows delivery of the full lansoprazole dose administered

2. Esomeprazole granules

   • Moderate recovery rate (36.9%) through 8 French tubes 1
   • Best administered with 5mL water and 5mL rinse volume 1
   • Note: Only about half of the administered dose is recovered

Formulations to Avoid

• Omeprazole capsules (only 3.9% recovery through feeding tubes) 1
• Lansoprazole capsules (only 7.1% recovery through feeding tubes) 1
• Any PPI through 6 French tubes (all cause tube obstruction) 1

Administration Protocol for Enteral Tube PPIs

Pre-Administration

• Pause enteral feeding at least 30 minutes before PPI administration 2
• Flush tube with at least 30mL of water before medication administration 2
• Use appropriate ENFit syringes as per ISO 80369-3 standard 2

Administration Technique

1. Position patient upright (at least 30°) 2
2. For lansoprazole ODT:
   • Mix with 5mL water to create suspension 1
   • Administer through tube (minimum 8 French size) 1
   • Flush with 10mL water after administration 1
3. Keep patient upright for 30 minutes after administration 2

Post-Administration

• Flush tube again with at least 30mL of water 2
• Resume feeding no sooner than 30 minutes after PPI administration 2

Important Considerations and Precautions

Tube Size and Placement

• Use only 8 French or larger tubes for PPI administration 1
• Consider tube placement site - PPIs are best absorbed in duodenum and upper small bowel 2
• If less than 50cm of jejunum remains, intravenous administration may be needed 2

Formulation Considerations

• Avoid crushing enteric-coated pellets, which significantly reduces stability 2
• Do not use all brands interchangeably - some produce poor quality suspensions 2
• Refrigerated suspensions remain stable for up to 20 days, while room temperature storage reduces stability to 7 days 2

Monitoring

• Monitor for tube blockage, which is common with medications 2
• Watch for signs of degradation, such as color changes 2
• Consult with a pharmacist for guidance on compatibility with specific enteral formulas and other medications 2

By following these guidelines, you can optimize PPI delivery through feeding tubes while minimizing the risk of tube obstruction and ensuring adequate medication delivery for effective acid suppression.