Welcome to the crushing tablets and drug administration via enteral feeding tubes section for pharmacists. This section includes links to clinical practice resources on crushing tablets for patients with dysphagia / swallowing difficulties, medication administration via enteral feeding tubes and drug-enteral feeding interactions.

Swallowing Difficulties
Prescriber Information

This section is designed to help you prescribe appropriately for patients with dysphagia and those with enteral feed tubes. In both instances basic guidance on what should be considered is provided.

Additionally for those patients where you have decided that crushing is the only option available for you to recommend we have provided information on different types of tablet, different coatings and modified formulations so that you can determine whether crushing may be appropriate or not.

Information on the effect of crushing in both clinical and legal terms is provided as well as information on other formulations which you may choose to prescribe instead.

  • Source: swallowingdifficulties.com
  • Clinical Resource: Various
  • Register to Access Content: No

Swallowing Difficulties – Specialist Pharmacy Service

All our advice on using medicines safely and effectively in patients with swallowing difficulties

  • Source: sps.nhs.uk
  • Clinical Resource: Clinical Various
  • Register to Access Content: No

Safe administration of medications for adults with Swallowing Difficulties (Dysphagia)

Dysphagia can make taking medication more difficult leading to medications remaining in the mouth, being spat out or getting stuck in the pharynx or oesophagus. If a dysphagia assessment recommends thickened liquids, all fluids consumed should be thickened, including those taken with or as part of medication.

  • Source: westessexccg.nhs.uk
  • Clinical Resource: Clinical Guideline
  • Register to Access Content: No

Optimising Medicines Administration for Patients with Dysphagia in Hospital: Medical or Nursing Responsibility?

This article considers the clinical and legal issues surrounding administration of medicines to people with dysphagia from a UK perspective and debates whether medicines optimisation should be the primary responsibility of the prescriber when initiating therapy on the ward or the nurse who administers the medicine.

  • Source: nih.gov
  • Clinical Resource: Journal Article
  • Register to Access Content: No

”Do Not Crush” List

The List of Oral Dosage Forms That Should Not Be Crushed, commonly referred to as the “Do Not Crush” list, contains medications that should not be crushed because of their special pharmaceutical formulations or characteristics, such as oral dosage forms that are sustained-release in nature.

  • Source: ismp.org
  • Clinical Resource: List
  • Register to Access Content: Yes – registration is FREE

”Primary Care Guidance: Prescribing medicines for adults who are unable to swallow oral solid dosage forms
Betsi Cadwaladr University Health Board

Some adults have difficulty swallowing oral solid dosage forms such as tablets and capsules; therefore prescribers must work with the patient and/or carer(s) to address their needs. This guideline provides a framework for healthcare professionals to support their prescribing decisions in response to the increased demand, complexity and cost of some “specials”. This guidance was developed by Betsi Cadwaladr University Health Board and endorsed by AWMSG as an example of good practice.

  • Source: awmsg.org
  • Clinical Resource: Guidance
  • Register to Access Content: No

What are the therapeutic options for patients unable to take solid oral dosage forms?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

This Medicines Q&A reviews the therapeutic options for adult patients unable to take solid oral dosage forms, and gives advice on how to choose the most appropriate preparation for a patient.

  • Source: sps.nhs.uk
  • Clinical Resource: Medicines Question and Answer
  • Register to Access Content: No

Experimental COVID-19 Antiviral Therapies
Administration in Cases of Swallowing Difficulties

Advice for administering experimental COVID-19 therapies to patients who cannot swallow is given

  • Source: covid19-druginteractions.org
  • Clinical Resource: Advice
  • Register to Access Content: No

Crushing guide for oral medication in Residential Aged Care

This is to guide decisions about crushing oral medicines for residents who have swallowing difficulties in Residential Aged Care.

  • Source: saferx.co.nz
  • Clinical Resource: Guide
  • Register to Access Content: No

Guide for Crushing Oral Medication for Residents with Swallowing Difficulties in Residential Aged Care

  • Source: saferx.co.nz
  • Clinical Resource: List
  • Register to Access Content: No

Guidance on Crushing Tablets or Opening Capsules in a Care Home Setting

This document has been prepared in response to queries generated by care homes and GP practices regarding rules and regulations surrounding crushing tablets or opening capsules for residents in a care home setting

  • Source: hertsvalleysccg.nhs.uk
  • Clinical Resource: Guidance
  • Register to Access Content: No

Which injections can be given orally or via enteral feeding tubes?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

This Medicines Q&A aims to provide information on injections which may be administered either orally or via an enteral feeding tube.

  • Source: sps.nhs.uk
  • Clinical Resource: Medicines Question and Answer
  • Register to Access Content: No

Oral Antiretroviral Administration: Information on Crushing and Liquid Drug Formulations

  • Source: hivclinic.ca
  • Clinical Resource: Table
  • Register to Access Content: No

Antiretroviral Dosage Forms for Swallowing Difficulties

  • Source: hiv-druginteractions.org
  • Clinical Resource: Table
  • Register to Access Content: No

When Patients Cannot Take Pills: Antiretroviral Drug Formulations for Managing Adult HIV Infection

A thorough search of several drug databases, a literature search of MEDLINE through Ovid, and a review of full prescribing information for each currently available antiretroviral drug, was performed to obtain insight into the bioavailability of antiretrovirals. Implications for the findings are discussed as they relate to adherence, resistance, alternative methods of administration, and the sometimes conflicting information on bioavailability that exists for various antiretroviral agents.

  • Source: iasusa.org
  • Clinical Resource: Journal Article
  • Register to Access Content: No

Administrating medicines via enteral feeding tubes

Administering medication via an enteral feeding tube requires thought and exercise of clinical judgement

  • Source: bapen.org.uk
  • Clinical Resource: Article
  • Register to Access Content: No

American Society for Parenteral and Enteral Nutrition Enteral Nutrition Practice Recommendations > VII. Medication Administration

  • Source: nutritioncare.org
  • Clinical Resource: Guideline
  • Register to Access Content: No

NHS East Suffolk and North Essex Guidelines for Tablet Crushing in Patients With Swallowing Difficulties

  • Source: neessexccg.nhs.uk
  • Clinical Resource: Guideline
  • Register to Access Content: No

Medication Administration Through Enteral Feeding Tubes

Drug therapy can be complicated in hospitalized patients requiring an enteral feeding tube (EFT). Some medications may be given via an EFT while others are unsuitable for this form of administration. Inappropriate drug selection for EFT administration can cause potential toxicity, reduced efficacy, and tube obstruction. Therefore, it is important to know which drugs may be altered for EFT administration as well as appropriate therapeutic alternatives that can temporarily be substituted for those that may not be given via that route.

  • Source: clevelandclinicmeded.com
  • Clinical Resource: Newsletter
  • Register to Access Content: No

Medication Administration Through Enteral Feeding Tubes

An overview of enteral feeding tubes, drug administration techniques, considerations for dosage form selection, common drug interactions with enteral formulas, and methods to minimize tube occlusion is given.

  • Source: medscape.com
  • Clinical Resource: Newsletter
  • Register to Access Content: Yes – registration is FREE

Medication administration via enteral feeding tubes

Presentation by Tom Richardson, Alfred clinical pharmacists

  • Source: alfredhealth.org.au
  • Clinical Resource: Presentation
  • Register to Access Content: No

Therapeutic options for adult patients unable to take solid oral dosage forms

  • Source: niformulary.hscni.net
  • Clinical Resource: Table
  • Register to Access Content: No

Choosing medicines for patients unable to take solid oral dosage forms

Selecting suitable formulations for adult patients with swallowing difficulties or feeding tubes

  • Source: mm.wirral.nhs.uk
  • Clinical Resource: Guide
  • Register to Access Content: No

To Hold (Enteral Feeding) or Not to Hold: That IS the Question; A Commentary and Tutorial

The purpose of this paper is to serve as a tutorial to guide clinical decision making rather than a comprehensive review of the existing literature. Clinicians are strongly encouraged to review the literature concerning drug-specific management approaches that have been published and exercise good clinical judgment to individualize the patient care plan.

  • Source: virginia.edu
  • Clinical Resource: Journal Article
  • Register to Access Content: No

Drug Interactions with Enteral Nutrition (general use) NHS Lanarkshire

Guidance regarding enteral administration of medicines and interactions
between medicines and enteral feeds, including feeding breaks

  • Source: nhslcg.scot.nhs.uk
  • Clinical Resource: Guidance
  • Register to Access Content: No

Drug-Nutrient Considerations in Patients Receiving Parenteral and Enteral Nutrition

This article will focus on basic knowledge needed for identification and appropriate management of drug-nutrient interactions in patients requiring enteral nutrition (EN) and parenteral nutrition (PN). Drug-nutrient interactions will be divided into four categories based upon their mechanisms: 1) ex vivo biopharmaceutical inactivations; 2) interactions affecting absorption; 3) interactions affecting systemic/physiologic dispositions; and 4) interactions affecting elimination/clearance. Each category will be discussed separately and examples will be given to illustrate the use of alternative methods to assure safe drug administration.

  • Source: virginia.edu
  • Clinical Resource: Journal Article
  • Register to Access Content: No

Management of Phenytoin with Enteral Tube Feeding

Though the interaction between enteral tube feeding and phenytoin was first described 30 years ago, the mechanism of the interaction is still poorly understood.
In the discussions below, we will highlight some drug – enteral tube feeding interactions which have been found to be clinically important.

  • Source: cpnp.org
  • Clinical Resource: Article
  • Register to Access Content: No

Enteral administration of protein supplement and valproate: A potential pharmacokinetic interaction

Valproic acid (VPA) and its derivatives are highly protein bound. Certain highly protein bound medications (eg, phenytoin) have specific administration instructions for patients on enteral nutrition supplements to optimize absorption of the medication. Pharmacokinetic interactions between VPA and enteral nutrition or protein supplements demonstrating impaired absorption have not been published to date.

  • Source: cpnp.org
  • Clinical Resource: Article
  • Register to Access Content: No

How Does Warfarin Interact With Enteral Nutrition?

How does warfarin interact with enteral nutrition, and can this interaction be minimized?

  • Source: medscape.com
  • Clinical Resource: Question and Response
  • Register to Access Content: Yes – registration is FREE

Tube feeding and Pancreatic Enzymes (Creon)

  • Source: virginia.edu
  • Clinical Resource: Instructions
  • Register to Access Content: No

Tube Feeding and Pancreatic Enzymes (Zenpep)

  • Source: virginia.edu
  • Clinical Resource: Instructions
  • Register to Access Content: No

Use of Proton Pump Inhibitors in PEG tubes

  • Source: pharmacy.olemiss.edu
  • Clinical Resource: Table
  • Register to Access Content: No

 

Resources last checked: 08/09/2021