Fluconazole Tablets Can Be Administered via Nasogastric Tube
Yes, fluconazole tablets can be safely crushed and administered through a nasogastric or feeding tube with excellent bioavailability, making this a clinically appropriate and cost-effective alternative to intravenous administration. 1, 2
Evidence Supporting NG Tube Administration
Bioavailability Data
- Fluconazole maintains 97% bioavailability when crushed and administered via feeding tube, even with concomitant enteral feeds in critically ill ICU patients 2
- A separate trauma/surgical ICU study demonstrated 77% relative bioavailability, with peak concentrations occurring within 2 hours after enteral dosing 1
- The oral bioavailability of fluconazole is excellent (~90% of IV concentrations) and is not affected by food consumption, gastric pH, or disease state 3
Clinical Advantages
- Enteral administration costs only 10% of intravenous fluconazole, offering tremendous cost savings while maintaining therapeutic efficacy 1
- Reduces risk of secondary infections from indwelling IV catheters 2
- Any nonsignificant trends toward lower systemic availability can be overcome with slightly higher doses if needed 1
Proper Administration Technique
Step-by-Step Protocol
- Crush the fluconazole tablet and dissolve it in water before administration 1, 2
- Flush the tube with at least 30 mL of water before, between, and after each medication to prevent tube occlusion 3
- Administer medications individually through the tube—never mix multiple drugs together 3
- Use appropriate ENFit-standard syringes and connectors to avoid misconnection errors 3
Timing Considerations
- Peak serum concentrations occur within 2 hours after enteral dosing (compared to 15 minutes after IV dosing) 1
- Fluconazole can be administered with or without concomitant enteral feeding without significant impact on absorption 2
Important Caveats and Pitfalls
Site of Delivery Matters
- Confirm the tube tip location is in the stomach, as fluconazole absorption occurs primarily in the stomach and proximal small bowel 3
- Administration distal to the stomach (e.g., directly into duodenum) may result in reduced drug availability 3
Drug Losses During Administration
- Be aware that drug losses of 4-38% can occur during NG tube administration depending on technique 4
- Flushing the drug through the NGT causes the major losses compared to crushing and transfer 4
- Do not shake low-dose ENFit syringes to remove drug moat, as this exposes people to the drug and affects the dose delivered 3
Patient Selection
- Ensure patients have normal gastrointestinal motility for optimal absorption 2
- Consider renal function, as fluconazole elimination is almost entirely renal and dose reduction is needed when creatinine clearance is <50 mL/minute 3
Clinical Context
When to Use This Route
- Patients unable to take oral medications but with functioning GI tract 1, 2
- Cost-containment situations where IV access is not essential 1
- Long-term antifungal therapy in ICU or post-surgical patients 1, 2