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This page was last updated on 19 July, 2010
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Linezolid Mandatory Order Form (103)
Linezolid Patient Information (103)
Inpatient Management of Severe Colitis (102)
Ascites due to Cirrhosis (101)
Penicillins in Syphilis (100)
Thromboprophylaxis in Orthopaedics (99)
Out of Hours Enteral Feeding (98)
Oral Health (97)
Infliximab (96)
Antibiotic Management Policy (95)
Influenza Type A or B virus - Prophylaxis and Treatment of (94)
Antibiotic Guidelines
Phenytoin IV Administration (93)
Heart Failure (91)
Starting Feeding after Gastrostomy Placement (90)
Refeeding Syndrome (89)
Adult Laxative Guidelines (88)
Analgesic Ladder in Acute Pain - 3rd Edn (87)
Cytotoxic Drug Spillage (86)
Fondaparinux (85)
Ward Preparation of Syringes for SC Infusions (84)
Anticoagulation - Oral (83)
Alcohol Withdrawal and Vitamin Prophylaxis (82)
Safe Sedation Practice for Endoscopy (81)
Combivent Inhaler Discontinuation (80)
Diabetes Surgical Guidelines (79)
Splenectomy Guidelines (76)
Clostridium Difficile (75)
Cellulitis (73)
Benzodiazepine Guidelines - 2nd Edition (72)
Contact with the Pharmaceutical Industry (71)
Isoprenaline Infusion (68)
Penicillins in Syphilis (63)
Medication and Enteral Feeding - 2nd Edition (62)
Evra (61)
Prednisolone (59)
Sucrose in Neonates (55)
Tetracaine Gel (54)
Acute Coronary Syndrome (53)
Antiplatelet Therapy in the Prevention of Ischaemic
Stroke/TIA (51)
Hormone Replacement Therapy (50)
Proton Pump Inhibitor - 3rd Edition (49)
Low Molecular Weight Heparins - 2nd Edition (47)
Teriparatide (46)
Antiemetic Policy and Regimens (45)
Mouth Care - Oncology (44)
Admin of IV & Oral Cytotoxics (42)
Helicobacter pylori (40)
Strontium (39)
Non-Steroidal Anti-inlammatory Drugs - 2nd Edition (38)
Pleurodesis (18)
Osteoporosis (12)

MEDICATION AND ENTERAL FEEDING GUIDELINES

A full copy of the guidance can be opened by selecting this link

NB - Always refer to BNF to check availability of alternative formulations eg dispersible tablets , liquid formulations, suppositories, patches etc
Please contact the Pharmacy Department or Medicines Information if there is no information available for the medication you need.

Acknowledgments: further information for this edition has been taken from the NEWT Guidelines 1st Edition 2006 North East Wales NHS Trust.


Drug Formulation and administration advice
Top of Page
Acetazolamide
  • MR should not be crushed. Non-MR tablets can be dispersed in water.
Alendronate
  • No liquid preparation available.
  • Tablets should only be crushed and administered via NG/PEG tube if it is absolutely essential that treatment continues.
  • NB care must be taken to ensure taken on empty stomach ie after a four hour fast, and 30 minutes before any other medication or food.
  • ALWAYS REFER TO PHARMACY FOR ADVICE.
  • Consider strontium if treatment of post menopausal osteoporosis.
Alfuzosin
  • MR tablets should not be crushed.
  • Change to non-MR alfuzosin tablets 2.5mg THREE times daily which can be crushed and dispersed in water.
Allopurinol
  • Crush, mix with water and administer.
Alverine
  • Capsules can be opened and dispersed in water.
Aminophylline
  • No liquid formulation available.
  • Patient could be changed to equivalent dose of theophylline liquid - 60mg/5ml
  • Seek advice on dosing from pharmacy (for in-patients) or Medicines Information Centre (if in the community).
  • If theophylline is substituted, it is advisable to stop feeds for one hour before and two hours after administration and to monitor plasma levels of the drug
Amiodarone
  • Tablet will disperse in water.
  • The tablets have a bitter taste and can be mixed with fruit juice if not administered via enteral feeding tube.
Amlodipine
  • Tablets will disperse in water – administer immediately as light sensitive.
Anastrazole
  • Crush, mix with water and administer.
Antacids
  • Aluminium containing antacids may interact with feeds leading to the development of a plug. Contact pharmacy for advice.
Atorvastatin
  • Can be crushed and mixed with water though not very soluble so should be flushed well after administration to avoid blocking enteral feeding tube.
Azathioprine
  • Cytotoxic drug – must be handled with care!
  • The tablets may only be crushed or dissolved in water following advice from pharmacy – staff must wear gloves and dispose of container and clean up spillages as per cytotoxics.
Drug Formulation and administration advice
Top of Page
Bendroflumethiazide
  • Tablets disperse readily in water.
Betahistine
  • Tablets disperse in water.
Bezafibrate
  • Non MR tablets can be crushed or will dissolve slowly in water.
Bisoprolol
  • Crush finely and mix with water.
  • Flush enteral feeding tube well after administration for avoid blocking feeding tube.
Buspirone
  • Crush and disperse in water.
Drug Formulation and administration advice
Top of Page
Cabergoline
  • Crush, mix with water and administer.
Calcium/vitamin D3
  • If unable to chew preparation then change to Calfovit D3 sachets at equivalent dose.
Candesartan
  • Crush, mix with water and administer.
Captopril
  • Tablets will disperse in water
Carbimazole
  • Crush and disperse in water.
Carvedilol
  • Crush and will form a suspension in water.
Celecoxib
  • Capsules should not be opened as will affect stability of drug.
Chlordiazepoxide
  • Open capsules and mix with water.
Cinnarizine
  • Tablets will disperse in water.
Ciprofloxacin
  • Suspension is too thick for administration via enteral feeding tubes. Tablets will disperse in water.
Citalopram
  • Drops available NB 8mg (4 drops) may be considered to be equivalent in therapeutic effect to 10mg citalopram tablets. Mix with water before administering
Clindamycin
  • Capsules can be opened and the contents dispersed in water.
Clobazam
  • Tablets can be dispersed in water. Unpleasant taste for oral administration.
Clonazepam
  • Tablets can be dispersed in at least 30ml water.
Clopidogrel
  • The tablets can be dispersed in water - they disperse in 1 to 5 minutes (1)
Coamilozide
  • Tablets can be crushed and dispersed in water.
Cobeneldopa
  • Dispersible tablets available. Contact pharmacy for advice on converting from MR capsules to dispersible tablets.
Cocareldopa
  • Crush, mix with water and administer. Consider changing to cobeneldopa dispersible – see cobeneldopa.
Cophenotrope
  • Tablets can be crushed and dispersed in water.
Cyclizine
  • Tablets can be crushed and dispersed in water. The crushed tablets have a bitter taste.
Cyproterone
  • Tablets can be dispersed in water.
Drug Formulation and administration advice
Top of Page
Dantrolene caps
  • Open capsule and mix with orange juice (to maintain acidity)
Demeclocyline
  • Do not open capsules as do not disperse in water. The capsule contents may cause severe irritation to the mucosa so should not be opened for oral administration. Contact pharmacy for advice.
Digoxin
  • Liquid formulation available NB bioavailability is different between tablets and liquids. 62.5mcg tablet = 50mcg liquid
Diltiazem
  • Once and twice daily MR preparations should not be crushed. The 60mg MR three times daily formulation is not slow release can be crushed.
Dipyridamole
  • Syrup available .
  • Capsules may be opened if patient has swallowing difficulties but not suitable for enteral feeding tube and should not be crushed.
Donepezil
  • Crush, mix with water and administer.
Doxazosin
  • Tablets can be dispersed in sterile (not tap) water.
Drug Formulation and administration advice
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Entacapone
  • Tablets will partially disperse in water. Flush well through enteral feeding tube. May stain orange.
Eprosartan
  • Tablets can be crushed and dispersed in water.
Escitalopram
  • Consider switching to citalopram which is available in a liquid form.
Esomeprazole
  • Will dissolve in water but will leave pellets which should not be crushed. May be preferable to change to alternative PPI.
Ethambutol
  • Crush, mix with water and administer.
Exetimibe
  • Not suitable for administration through enteral feeding tube as does not mix well with water.
Drug Formulation and administration advice
Top of Page
Felodipine
  • MR tablets should not be crushed. Consider changing to amlodipine.
Ferrous sulphate
  • Change to equivalent dose of sodium feredetate (55mg/10ml = ferrous sulphate 200mg)
Finasteride
  • Place the tablet in the barrel of an oral or bladder-tipped syringe, draw up water, and allow to dissolve.
  • NB women of child bearing age should not handle crushed, broken or dissolved tablets.
Fludrocortisone
  • Will dissolve in water.
Forceval
  • If unable to swop to alternative liquid preparation then snip off the end of the capsule and withdraw contents using an oral syringe. Take care when administering via enteral feeding tube as does not mix well with water. Tastes unpleasant.
Drug Formulation and administration advice
Top of Page

Gabapentin

  • Open the capsules and dissolve the contents in water – administer immediately.
Glibenclamide
  • Crush, mix with water and administer.
Gliclazide
  • Crush non – MR tablets well and mix with orange juice.
Glimepiride
  • Tablets should not be crushed as bioavailability may be affected. Contact pharmacy for advice.

Glipizide

  • Crush and disperse in water.
Drug Formulation and administration advice
Top of Page
Hydrocortisone
  • Insoluble tablet – can be crushed finely and mixed with water.
Hydroxyurea
  • Cytotoxic drug – must be handled with care!
  • Contact pharmacy for advice before giving.
  • The capsules may be opened and dissolved in water – staff must wear gloves and dispose of container and clean up spillages as per cytotoxics.
Hyoscine butylbromide
  • Do not crush tablet.
  • Administer injection orally if necessary.
Hyoscine hydrobromide
  • Patch available.
Drug Formulation and administration advice
Top of Page
Irbesartan
  • Crush and disperse in water.
Isosorbide dinitrate
  • Non-MR will disperse in water.
Isosorbide mononitrate
  • Non-MR tablets can be crushed and dispersed in water.
Drug Formulation and administration advice
Top of Page

Labetalol

  • Injection can be used orally, mix with orange if necessary to disguise bitter taste.

Lansoprazole

  • Suspension (sachets) available but not suitable for enteral feeding tube (liquid sticks to the tube).
  • Lansoprazole fast-tabs can be either swallowed whole, allowed to dissolve in the mouth, or can be dissolved in water if necessary.

Levomepromazine

  • Tablets can be dispersed in water or use injection orally
Levothyroxine
  • Crush, mix with water and administer.
Lisinopril
  • Disperse in water.
Lorazepam
  • Crush, mix with water and administer.
Lormetazepam
  • Tablets can be dispersed in water or change to alternative eg temazepam

Losartan

  • Crush, mix with water and administer.
Drug Formulation and administration advice
Top of Page
Menadiol
  • Crush, mix with water and administer.
Mesalazine
  • Granules available – these are modified release and will contain small particles so may not be suitable to go down enteral feeding tube.
Metformin
  • Tablets may be crushed for patients with swallowing difficulties or PEG tubes.
  • Metformin sachets are available in 500mg and 1G
Methylprednisolone
  • Disperse in water.
Metolazone
  • Crush, mix with water and administer.
Metoprolol
  • Crush, mix with water, will disperse slowly, or use injection orally
Mirtazepine
  • Orodispersible tablets will disperse in water.
Monteleukast
  • Use chewable tablets and disperse in water.
Moxonidine
  • Tablets can be crushed finely and dispersed in water.
Morphine Sulphate MR caps (Zomorph)
  • Capsules may be opened but do not crush contents.
  • Alternatively change to 4 hourly oramorph
Drug Formulation and administration advice
Top of Page
Naftidrofuryl
  • Open capsules and disperse in water.
  • Risk of oesophageal stricture if used orally in patients with swallowing difficulties – to avoid this the patient should drink 4-5 glasses of water after each dose.
Nicardipine
  • Non- MR capsules can be opened and dispersed in orange juice
Nicorandil
  • Tablets may be crushed and suspended in water
  • NB as the tablets are hygroscopic they should be used with care in enteral feeding tube as may cause blockage.
Nifedipine
  • Modified release preparations should not be crushed. As short acting nifedipine preparation are not recommended for treatment of angina or long term control of hypertension, it is better to change to an alternative calcium channel blocker eg amlodipine.
Nimodipine
  • Crush tablets and flush down enteral feeding tube immediately.
Nizatadine
  • Not suitable for use down an enteral feeding tube – consider changing to ranitidine.
Drug Formulation and administration advice
Top of Page

Olanzapine

  • Use velotabs and disperse in water.
Drug Formulation and administration advice
Top of Page
Pantoprazole
  • Not suitable for crushing. Consider changing to alternative PPI
Phenelzine
  • Tablets can be crushed, dispersed in water and administered immediately (unstable in water).
Phenytoin
  • Convert to syrup: 90mg syrup = 100mg capsules.
  • Single daily dose is preferable.
  • To avoid adsorption to the tubing mix with equal volume water and flush with 30ml water before and after administering phenytoin.
  • To avoid interaction with feeds it is necessary to stop feed to 2 hours before and 2 hours after administering phenytoin.
Pramipexole
  • Crush, mix with water and administer.
Pravastatin
  • Crush, mix with water and administer
Prazosin
  • Crush, mix with water and administer – take care to flush tube well.
Drug Formulation and administration advice
Top of Page
Quetiapine
  • Not soluble – can try to crush and dissolve in warm water. For oral use mix crushed tablet with yoghurt as has bitter taste.
Drug Formulation and administration advice
Top of Page
Ramipril
  • Tablets can be crushed, capsules can be opened and dispersed in water.
  • Capsules can be opened and contents dispersed in water.
Riluzole
  • Tablets can be crushed and dispersed in water for enteral tube administration – for oral use can be mixed with soft food (eg yoghurt) to aid swallowing.
Risedronate
  • No liquid preparation available. Tablets should only be crushed and administered via NG/PEG tube if it is essential that treatment continues. NB care must be taken to ensure taken on empty stomach ie after a four hour fast, and 30 minutes before any other medication or food.
Rosiglitazone
  • Crush tablets and disperse in water.
Drug Formulation and administration advice
Top of Page
Sertraline
  • Tablets can be dispersed in water.
  • Crush and mix with food for patients with swallowing difficulties.
Simvastatin
  • Crush, mix with water and administer.
Sotalol
  • Crush, mix with water and administer.
Drug Formulation and administration advice
Top of Page
Tamsulosin
  • MR tablets should not be crushed. Change to alternative alpha-blocker.
Theophylline
  • Liquid- seek advice on dosing from pharmacy (for in-patients) or Medicines Information Centre (if in the community).
  • Theophylline liquid 60mg/5ml available
  • It is advisable to stop feeds for one hour before and two hours after administration and to monitor plasma levels of the drug.
Tolbutamide
  • Crush, mix with water and administer.
Tolterodine
  • Disperse in water..
Tranexamic acid
  • Crush tablets and dissolve in water – can take 2-5 minutes to dissolve. Injection can be used orally.
Drug Formulation and administration advice
Top of Page
Valsartan
  • Capsules can be opened and dispersed in water. Use immediately.
Vancomycin
  • Injection can be used orally.
Venlafaxine
  • Non-MR tablets can be crushed and mixed with water.
Drug Formulation and administration advice
Top of Page
Warfarin
  • Crush, mix with water and administer.
Drug Formulation and administration advice
Top of Page
Zopiclone
  • Tablets are not suitable for crushing or dissolving – consider changing to temazepam liquid.
  1. The NEWT Guidelines 1st Edition