Can tofacitinib (Xeljanz) be administered through a jejunostomy (JEJ) tube?

Administration of Tofacitinib Through a Jejunostomy Tube

Tofacitinib (Xeljanz) can be administered through a jejunostomy (JEJ) tube by dispersing the tablets in water, as the medication can be dispersed in water for administration via nasogastric tube according to enteral nutrition guidelines.

Medication Properties and Administration Method

Tofacitinib is an oral Janus kinase (JAK) inhibitor that is typically administered as tablets. When considering administration through a JEJ tube:

• Tofacitinib tablets can be dispersed in water for administration through feeding tubes 1
• The medication is administered orally twice daily as tablets and can be dispersed in water or administered via nasogastric tube 2
• Standard procedure for medication administration through feeding tubes involves:
  • Flushing the tube with 30 mL water before medication administration
  • Crushing or dispersing the medication in water
  • Administering the medication through the tube
  • Flushing with 30 mL water after medication administration 1

Considerations for JEJ Administration

When administering medications through a jejunostomy tube, several factors should be considered:

• Jejunostomy tubes typically have smaller diameters (8-12 F) than gastrostomy tubes, increasing the risk of clogging 2
• Medications should be administered through the jejunostomy port with proper flushing to prevent tube occlusion 2
• Tube occlusion is a significant problem with reported rates of 3.5-35% in jejunostomy tubes 2
• To prevent tube clogging:
  • Use liquid medications when possible
  • Ensure tablets are completely dispersed in water
  • Flush the tube adequately before and after medication administration 1

Potential Complications and Monitoring

When administering medications through a JEJ tube, be aware of potential complications:

• Tube occlusion is the most common complication, requiring vigilant flushing protocols 2
• The average longevity for a jejunostomy tube is 3-6 months, with tube dysfunction being a common issue 2
• Monitor for signs of feeding intolerance or tube malfunction, including:
  • Abdominal distension
  • Nausea or vomiting
  • Tube blockage or dislodgement 1

Administration Protocol for Tofacitinib via JEJ

1. Stop any continuous feeding 30 minutes before medication administration
2. Flush the JEJ tube with 30 mL of water
3. Disperse the tofacitinib tablet(s) in 15-30 mL of water until completely dissolved
4. Draw up the dispersed medication in a syringe
5. Administer the medication through the JEJ tube
6. Flush the tube with 30-50 mL of water after administration
7. Resume feeding 30 minutes after medication administration if appropriate

Important Precautions

• Ensure the JEJ tube is properly positioned before administering medication
• Never crush extended-release or enteric-coated formulations (standard tofacitinib tablets can be dispersed)
• Be aware that direct administration into the jejunum may affect drug absorption compared to oral administration
• Monitor for efficacy and adverse effects, as jejunal administration might potentially alter the medication's pharmacokinetics

By following these guidelines, tofacitinib can be safely and effectively administered through a jejunostomy tube while minimizing the risk of tube occlusion and ensuring proper medication delivery.