Can gabapentin or amitriptyline be crushed and given through a Gastrostomy (G)-tube?

Gabapentin and Amitriptyline Administration Through G-Tubes

Both gabapentin and amitriptyline tablets can be crushed and administered through a G-tube, but this practice should only be done after consulting with a pharmacist and following proper administration protocols to minimize risks of dosing errors, tube occlusion, and drug exposure. 1, 2

General Principles for Crushing Medications

Crushing medications should be avoided whenever possible due to risks of drug exposure to healthcare workers and inaccurate dosing, with liquid formulations strongly preferred when available. 1, 2 However, when crushing is necessary for patients with G-tubes who cannot swallow:

• Consult a pharmacist before crushing any medication to confirm appropriateness and proper technique 1, 2
• Verify that the medication's Summary of Product Characteristics does not contraindicate crushing, as using products outside these terms carries additional legal responsibility 1
• Consider that crushing may alter drug absorption, potentially causing overdose or underdosing that renders treatment ineffective 3

Specific Considerations for Gabapentin and Amitriptyline

Gabapentin

• Standard immediate-release gabapentin tablets can be crushed for G-tube administration 4, 5
• Do not crush extended-release formulations (if prescribed), as this destroys sustained-release properties and can cause dangerous overdose 3
• Gabapentin is available in liquid formulation, which should be preferentially used if accessible 5

Amitriptyline

• Immediate-release amitriptyline tablets can be crushed for G-tube administration 4, 5
• Be aware that crushing exposes healthcare workers to the drug particles, which may cause allergic reactions in sensitive individuals 3
• Liquid formulations exist and should be considered as alternatives 5

Proper Administration Technique

Follow this step-by-step protocol to minimize complications:

1. Flush the tube with 30 mL of water before medication administration 1, 2, 6

2. Crush each medication separately - never crush multiple drugs together, as this increases risk of interactions and tube occlusion 6, 7

3. Dissolve the crushed medication in water immediately before administration - do not prepare in advance 7

4. Administer each medication individually through the tube 1, 6

5. Flush with 30 mL of water between each medication 1, 2, 6

6. Flush with 30 mL of water after the final medication 1, 2, 6

7. Use appropriate ENFit-standard syringes and connectors to prevent fatal misconnection errors 1, 2, 6

Critical Safety Warnings

• Never add medications directly to enteral formula, as this causes drug-nutrient interactions and tube occlusion 5
• Do not shake low-dose ENFit syringes to remove drug residue, as this exposes people to the drug and alters the delivered dose 1, 2, 6
• Use dedicated crushing equipment for each patient to prevent cross-contamination 7
• Higher incidence of tube occlusions occurs when using crushed solid dosage forms through feeding tubes 1, 2

Site of Delivery Considerations

Confirm the G-tube tip location before administering medications, as the site of drug delivery significantly affects efficacy. 1, 2 For example:

• Gastric delivery (standard G-tube) typically provides adequate absorption for both gabapentin and amitriptyline 1
• If the tube terminates in the duodenum or jejunum (G-J tube), drug bioavailability may be reduced 1

Common Pitfalls to Avoid

• Inadequate flushing is the most common cause of tube occlusion - always use the full 30 mL of water 1, 2, 5
• Crushing medications together creates a "handicraft" practice with frequent errors that compromises drug efficacy 7
• Failing to verify the galenic presentation - approximately 42% of crushed drugs in one study had formulations that should not have been crushed 7
• Lack of patient/caregiver education - over 30% of caregivers receive no information about proper medication administration through feeding tubes 1