Oral Medications That Can Be Administered Via Tube in the Inpatient Setting
Most oral medications can be administered through nasogastric (NG) or gastrostomy (G) tubes when properly prepared, with the exception of extended-release, enteric-coated formulations, and certain specialized dosage forms. 1
General Principles for Tube Administration
Preparation Guidelines
- Flush tube with at least 30 mL of water before and after medication administration 1
- Use appropriate ENFit syringes that comply with ISO 80369-3 standards 1
- Administer medications individually, not mixed with other drugs 1
- Liquid formulations are preferred when available 1
- For tablets, crush thoroughly until a fine powder, mix with 15-30 mL of water 1
Types of Tubes
- Nasogastric (NG) tubes
- Nasojejunal (NJ) tubes
- Orogastric (OG) tubes
- Gastrostomy (G) tubes
- Jejunostomy (J) tubes
Medications Suitable for Tube Administration
Preferred Formulations
- Liquid formulations - ideal for tube administration 1
- Immediate-release tablets - can be crushed and dissolved 1
- Capsules with powder contents - can be opened and contents dissolved 1
Specific Medications Documented for Tube Administration
Proton Pump Inhibitors:
- Omeprazole - can be administered through NG tube by opening capsule and mixing pellets with applesauce 2
Probiotics:
Emergency Medications:
- Epinephrine, naloxone, atropine, and lidocaine can be administered via tracheostomy tubes in emergency situations 3
Medications to Avoid or Use with Caution
Contraindicated Formulations
- Extended-release (ER/CR/SR/XR) formulations - crushing destroys controlled-release mechanism 1
- Enteric-coated formulations - crushing removes protective coating 1
- Sublingual or buccal tablets - designed for absorption through oral mucosa 1
- Chewable tablets - may not dissolve properly 1
Special Considerations
- Levothyroxine: Interrupt enteral nutrition for at least 1 hour before and 30-40 minutes after administration 1
- Propranolol: Avoid administration distal to the stomach if possible 1
Administration Technique
Step-by-Step Process
- Verify tube placement before medication administration
- Pause enteral feeding if required (medication-specific)
- Flush tube with 30 mL water
- Prepare medication:
- For liquid medications: Draw up required dose
- For tablets: Crush to fine powder and mix with 15-30 mL water
- For capsules: Open and dissolve contents in water
- Administer each medication separately
- Flush between medications with 15 mL water
- Final flush with 30 mL water after all medications
- Resume feeding as appropriate
Common Pitfalls and How to Avoid Them
Potential Errors
- Tube occlusion - Ensure complete crushing of tablets and adequate dilution 4
- Drug-nutrient interactions - Consider pausing feeds for certain medications 1
- Reduced drug efficacy - Avoid mixing incompatible medications 1
- Medication errors - Consult with pharmacist before crushing medications 4
Prevention Strategies
- Consult pharmacy for medication-specific guidance
- Never crush extended-release or enteric-coated formulations
- Avoid using carbonated beverages or acidic juices to dissolve medications 1
- Monitor for therapeutic effect and adjust administration technique as needed
Special Situations
Chemotherapy Agents
- Limited data available for most oral chemotherapies via enteral tubes 5
- Only 4 out of 87 chemotherapy drugs have specific NG or G tube administration instructions in their prescribing information 5
- Consult oncology pharmacist before administering any chemotherapy via tube
Tracheostomy Tubes
- Emergency medications (epinephrine, naloxone, atropine, lidocaine) can be administered via tracheostomy tubes 3
- Dose should be 2-3 times the usual IV dose, diluted to 3-5 mL 3
By following these guidelines, healthcare providers can safely administer appropriate oral medications through feeding tubes while minimizing risks of tube occlusion, medication interactions, and reduced drug efficacy.