What antihypertensive medications can be crushed and administered via a Gastrostomy tube (G-tube)?

Antihypertensive Medications That Can Be Crushed and Administered via G-tube

Most calcium channel blockers, ACE inhibitors, and ARBs can be safely crushed and administered via G-tube, while extended-release formulations and enteric-coated medications should be avoided. 1

Suitable Antihypertensive Medications for G-tube Administration

Calcium Channel Blockers

• Immediate-release formulations:
  • Amlodipine tablets (can be crushed)
  • Nicardipine immediate-release (not extended-release)
  • Clevidipine (liquid formulation)

ACE Inhibitors

• Lisinopril tablets
• Enalapril tablets (not enteric-coated)
• Captopril tablets

Angiotensin Receptor Blockers (ARBs)

• Losartan tablets
• Valsartan tablets (when not in extended-release form)
• Candesartan tablets

Alpha Blockers

• Doxazosin immediate-release tablets
• Prazosin capsules (contents can be emptied)

Beta Blockers

• Metoprolol immediate-release tablets (not sustained-release)
• Carvedilol immediate-release tablets

Diuretics

• Furosemide tablets
• Hydrochlorothiazide tablets
• Chlorthalidone tablets

Medications to Avoid for G-tube Administration

Extended-Release Formulations

• Metoprolol succinate (extended-release)
• Felodipine extended-release
• Nifedipine extended-release
• Any medication labeled as CR, SR, XL, XR, LA, or ER

Enteric-Coated Medications

• Some formulations of aspirin (often used with antihypertensives)
• Certain ACE inhibitors with enteric coating

Administration Guidelines

1. Proper Crushing Technique:

   • Use a pill crusher or mortar and pestle to create a fine powder
   • Crush one medication at a time to avoid interactions

2. Dilution and Administration:

   • Mix crushed medication with 15-30 mL of water
   • Flush G-tube with 15-30 mL of water before medication administration
   • Administer each medication separately
   • Flush with 15-30 mL of water between medications
   • Flush with 30-60 mL of water after the last medication 2

3. Timing Considerations:

   • Administer medications at least 1 hour before or 2 hours after enteral nutrition when possible
   • For continuous tube feedings, consider pausing the feeding 30 minutes before and after medication administration

Special Considerations

1. Medication Alternatives:

   • For medications that cannot be crushed, consider liquid formulations when available
   • Consult with a pharmacist about therapeutic alternatives in appropriate formulations

2. Monitoring Requirements:

   • Monitor blood pressure regularly to ensure efficacy of crushed medications
   • Watch for tube occlusion, which may occur with inadequately crushed or diluted medications

3. Tube Placement Considerations:

   • Medications administered through jejunostomy tubes may have altered absorption compared to gastrostomy tubes
   • Some medications may be better absorbed in the stomach than in the jejunum 2

Common Pitfalls to Avoid

1. Never crush extended-release or enteric-coated formulations as this can lead to dose dumping and potential toxicity 1

2. Avoid crushing multiple medications together as this may lead to physical or chemical incompatibilities

3. Be cautious with medications that may clog the tube, such as those that form a gel when mixed with water

4. For newly placed G-tubes (less than 7-10 days old), ensure the tube is mature before administering crushed medications to prevent complications from accidental displacement 2

By following these guidelines, antihypertensive medications can be safely and effectively administered via G-tube while maintaining blood pressure control and minimizing complications.