Can furosemide (Lasix) and spironolactone (Aldactone) be administered via a Nasogastric Tube (NGT)?

Administration of Furosemide and Spironolactone via Nasogastric Tube

Both furosemide and spironolactone can be safely administered via nasogastric tube (NGT) after proper preparation, though care must be taken to ensure appropriate dosing and administration techniques.

Medication Preparation for NGT Administration

Furosemide

• Furosemide tablets can be crushed and dissolved in water for NGT administration
• The oral bioavailability of furosemide remains good in cirrhotic patients when administered via this route 1
• Guidelines specifically note the "good oral bioavailability of furosemide in the patient with cirrhosis" which supports its use via enteral routes

Spironolactone

• Spironolactone tablets can be crushed and mixed with water to create a suspension for NGT administration
• No specific contraindications exist for administering spironolactone via NGT

Administration Technique

1. Proper preparation:

   • Crush tablets completely into a fine powder
   • Mix with 15-30 mL of water to create a suspension
   • Ensure complete dissolution/suspension to prevent tube clogging

2. Administration sequence:

   • Stop enteral feeding 30 minutes before medication administration
   • Flush tube with 15-30 mL of water before medication administration
   • Administer each medication separately with water flushes between medications
   • Flush with 15-30 mL of water after administration
   • Resume feeding 30-60 minutes after medication administration

Important Considerations

Potential Complications

• Tube obstruction if medications are not properly crushed and dissolved 2, 3
• Potential for drug-nutrient interactions if administered with enteral feeds 4
• Risk of altered bioavailability compared to standard oral administration 2

Clinical Monitoring

• Monitor electrolytes closely, particularly potassium, sodium, and magnesium levels
• Watch for appropriate diuretic response
• Assess for signs of dehydration or electrolyte imbalances

Dosing Considerations

• Standard dosing can be maintained when switching from oral to NGT administration
• The usual diuretic regimen consists of single morning doses of oral spironolactone and furosemide, beginning with 100 mg of spironolactone and 40 mg of furosemide 1
• Maintain the 100 mg:40 mg ratio (spironolactone:furosemide) when adjusting doses to maintain normokalemia 1

Avoiding Common Pitfalls

1. Never administer extended-release or enteric-coated formulations via NGT

   • Use immediate-release formulations of both medications

2. Prevent drug-nutrient interactions

   • Always hold enteral feeding before and after medication administration
   • Separate medication administration from feeding times

3. Prevent tube clogging

   • Ensure complete crushing of tablets
   • Use adequate dilution with water
   • Flush tube thoroughly before and after medication administration

By following these guidelines, furosemide and spironolactone can be effectively and safely administered via nasogastric tube while maintaining their therapeutic efficacy.