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How to manage drugs and PEGs

Michelle Jenkins BPharm
Anne Duggan BA(Hons) Bmed MPH FRACP PhD

Patients who are being fed via gastrostomy tubes often need medicines to be administered by the same route.

• Use alternatives to solid oral formulations of medicines for patients with a percutaneous endoscopic gastrostomy (PEG) whenever possible. Parenteral alternatives are generally only a short term solution. Liquid oral medications should be mixed with a small volume of water prior to administartion via a PEG if they are viscous. Topical alternatives include transdermal patches, enemas and suppostitories.
• Consider the effect of food. Administer drugs whose gastrointestinal absorption is impaired in the presence of food either half and hour before or two hours after a feed. Decreased absorption of such drugs, and possibly subtherapeutic responses, may occur in patients undergoing a continuous feeding regimen.

Problem drugs

Phenytoin is the classic offender when considering specific drugs interactions with enteral feeds. Administering Phenytoin with an eternal feed can result in decreased phenytoin absorption. Steady state serum concentrations in patients receiving phenytoin concomitantly with eteral feeds are 70 - 80% lower than in patients not receiving continuous eteral feeding.