What is the best medication to give to a patient with a sore throat who is nothing by mouth (NPO) with a nasogastric (NG) tube in place?

Management of Sore Throat in NPO Patients with NG Tubes

For patients with sore throat who are NPO with an NG tube in place, liquid acetaminophen administered through the NG tube is the best first-line treatment option.

Assessment and Initial Management

• Sore throat in patients with NG tubes is common and can significantly impact patient comfort and quality of life 1
• Before administering any medication through an NG tube, verify proper tube placement by checking gastric pH or radiographic confirmation to prevent aspiration 1
• Ensure the NG tube is properly positioned without coiling in the pharynx, as misplacement can worsen throat discomfort 1

First-Line Medication Options

• Liquid acetaminophen administered through the NG tube is the preferred first-line treatment for sore throat in NPO patients 2, 3

  • Advantages: Well-tolerated, can be easily administered through NG tubes, minimal drug-nutrient interactions 3
  • Dosing: Standard liquid formulation (typically 250 mg/5 mL) at appropriate intervals based on patient's clinical condition 2

• When administering medications through NG tubes:

  • Temporarily stop enteral feeding 30 minutes before and after medication administration to prevent drug-nutrient interactions 3, 4
  • Flush the tube with 15-30 mL of water before and after medication administration to prevent tube obstruction 3
  • Dilute liquid medications if necessary to reduce osmolality and prevent gastrointestinal intolerance 4

Alternative Options

• If acetaminophen is contraindicated or ineffective, consider:

  • Liquid NSAIDs (if not contraindicated by patient's condition) 5, 6
  • Topical anesthetics like lidocaine (administered as oral rinse prior to becoming NPO, or as a swish-and-spit if patient can safely do so) 7, 6

• For severe cases where oral medications are ineffective:

  • Consider systemic analgesics administered through alternative routes (IV, transdermal) 8
  • Address underlying causes of throat irritation (e.g., repositioning the NG tube if possible) 1

Special Considerations

• Small diameter NG tubes (8 French) should be used when possible to minimize throat irritation 1
• Patients with NG tubes should be assessed daily for continued need of the tube to minimize duration of discomfort 1
• Maintain adequate hydration through the NG tube to prevent further throat irritation 1
• Monitor for signs of aspiration or infection, which may worsen throat discomfort 1

Common Pitfalls to Avoid

• Avoid crushing extended-release or enteric-coated medications, as this can alter drug pharmacokinetics and potentially cause harm 3, 4
• Do not administer medications that specifically warn against crushing or opening on their package inserts without consulting pharmacy 3
• Avoid using thick, viscous liquid medications that may obstruct the NG tube 4
• Remember that bioequivalence between oral and nasogastric administration cannot be assumed for all medications 3