What Proton Pump Inhibitors (PPIs) are available in liquid form for easy Percutaneous Endoscopic Gastrostomy (PEG) tube administration?

PPIs Available in Liquid Form for PEG Tube Administration

Lansoprazole orally disintegrating tablet (ODT) is the most reliable PPI formulation for administration through PEG tubes, achieving approximately 86% active ingredient recovery when properly prepared with adequate water volumes. 1

Recommended PPI Formulations for Enteral Tubes

First-Line Choice: Lansoprazole ODT

• Lansoprazole orally disintegrating tablet delivers the best results through 8 French or larger nasogastric/PEG tubes, with mean recovery of 86.2% of active ingredient 1
• Optimal administration protocol requires dissolving in 5 mL of water and flushing with 10 mL of water to ensure complete dose delivery 1
• This formulation avoids the tube obstruction problems seen with standard capsule formulations 1

Alternative Option: Esomeprazole

• Esomeprazole microgranules can be administered through 8 French or larger tubes with approximately 37% recovery of active ingredient 1
• Best administration conditions involve 5 mL water for suspension and 5 mL flush volume, though only about half of administered microgranules are recovered 1
• This represents a less reliable option compared to lansoprazole ODT 1

Formulations to Avoid Through PEG Tubes

Do Not Use Standard Capsule Formulations

• Standard omeprazole capsules achieve only 3.9% active ingredient recovery through nasogastric tubes and should not be used 1
• Standard lansoprazole capsules similarly fail with only 7.1% recovery 1
• All 6 French tubes become obstructed by PPI formulations; minimum 8 French diameter is required 1

Administration Protocol for PEG Tubes

Proper Technique

• Pharmacist involvement is strongly recommended when administering any medication through enteral tubes to ensure appropriate formulation selection and dosing 2
• Flush the tube with water before and after medication administration to prevent obstruction 2
• Use appropriate ENFit-compatible syringes to avoid misconnection errors 2
• Avoid crushing tablets or opening capsules whenever possible due to exposure risks and dosing inaccuracies 2

Volume Considerations

• Liquid medicines may contain sorbitol contributing to diarrhea (48% of osmotic diarrhea cases in one study) or have osmolality >500-600 mOsm/kg causing gut disturbances 2
• Adequate water volumes are critical: minimum 5 mL for dissolution and 10 mL for flushing when using lansoprazole ODT 1

Important Clinical Caveats

Tube Specifications Matter

• Tubes smaller than 8 French diameter will obstruct with PPI administration and should not be used 1
• Tube length (50 cm vs 125 cm) does not significantly affect PPI delivery 1
• Polyurethane tubes were used in validation studies 1

Legal and Safety Considerations

• Using PPIs through enteral tubes constitutes off-label use in most cases, requiring prescriber awareness of additional responsibility for adverse events 2
• Consult the Summary of Product Characteristics to understand the legal position regarding individual prescriptions 2
• Adequate information must be provided to patients and caregivers, as over 30% receive no information about medication administration through feeding tubes 2

Dosing Accuracy

• When using low-dose ENFit tip syringes, do not shake the syringe to remove drug moat, as this can alter the administered dose 2
• Measures must be taken to ensure correct dosing when administering drugs through enteral tubes 2