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Drug-Nutrient Interactions in Patients Receiving Enteral Nutrition

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Handbook of Drug-Nutrient Interactions

Part of the book series: Nutrition and Health ((NH))

Abstract

Malnourished patients and those at risk of malnutrition are candidates for nutrition intervention. This includes previously well-nourished patients who have been or will be without oral intake for 3 to 5 d (pediatric populations) or 5 to 10 d (adults). Enteral nutrition (EN), which is synonymous with tube feeding, should be considered when a patient cannot, will not, or should not consume appropriate quantities of nutrients by mouth to prevent malnutrition. There are few absolute contraindications to tube feeding other than a bowel obstruction that cannot be bypassed. However, conditions such as diffuse peritonitis, intractable vomiting, intractable diarrhea, and ischemia of the small bowel may be contraindications to EN therapy (1). Most other conditions allow at least some nutrients to be delivered enterally.

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References

  1. A.S.P.E.N. Board of Directors. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr 2002;26(suppl.):S1–S138.

    Google Scholar 

  2. Howard L, Hassan N. Home parenteral nutrition 25 years later. Clin Nutr 1998; 27: 481–512.

    CAS  Google Scholar 

  3. DeLegge MH. Enteral access: the foundation of feeding. J Parenter Enteral Nutr 2001; 25: S8 - S13.

    Article  CAS  Google Scholar 

  4. Safadi BY, Marks JM, Ponsky JL. Percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am 1998; 8: 551–568.

    CAS  Google Scholar 

  5. Dive A, Moulan M, Jonard P, et al. Gastroduodenal motility in mechanically ventilated critically ill patients: a manometric study. Crit Care Med 1994; 22: 441–447.

    Article  CAS  Google Scholar 

  6. Lazarus BA, Murphy JB, Culpepper L. Aspiration associated with long-term gastric versus jejunal feeding: a critical analysis of the literature. Arch Phys Med Rehab 1990; 71: 46–53.

    CAS  Google Scholar 

  7. Spain DA, DeWeese C, Reynolds MA, Richardson JD. Transpyloric passage of feeding tubes in patients with head injuries does not decrease complications. J Trauma 1995; 39: 1100–1102.

    Article  CAS  Google Scholar 

  8. Levy H, Esparza JE, Hartshorne M. Aspiration pneumonia rates in gastric vs jejunal feeding. [abstract from Society of Critical Care Medicine 21st Educational and Scientific Symposium, San Antonio, TX] Crit Care Med 1992; 20: S63.

    Google Scholar 

  9. Nicolau DP, Davis SK. Carbonated beverages as irrigants for feeding tubes. Ann Pharmacother 1990; 24: 840.

    CAS  Google Scholar 

  10. Wilson MF, Haynes-Johnson V. Cranberry juice or water? A comparison of feeding-tube irrigants. Nutr Support Serv 1987; 7: 23–24.

    Google Scholar 

  11. Metheny N, Eisenberg P, McSweeney M. Effect of feeding tube properties and three irrigants on clogging rates. Nurs Res 1988; 37: 165–169.

    CAS  Google Scholar 

  12. Semple HA, Koo W, Tam YK, Ngo LY, Coutts RT. Interactions between hydralazine and oral nutrients in humans. Ther Drug Monit 1991; 13: 304–308.

    Article  CAS  Google Scholar 

  13. Mitchell JF. Oral dosage forms that should not be crushed: 2000 update. Hosp Pharm 2002; 35: 553–567.

    Google Scholar 

  14. Goliber PA, Dukes EM, Murphy DG, Park M, Carrig BA. Alternative method of Palladone (hydromorphone hydrochloride extended release) administration: characterization of a feeding tube study. [abstract from American Society of Health-Systems Pharmacists Midyear Clinical Meeting] Am J Health-System Pharm 2001;35:P-31E.

    Google Scholar 

  15. Beckwith MC, Barton RG, Graves C. A guide to drug therapy in patients with enteral feeding tubes: dosage form selection and administration methods. Hosp Pharm 1997; 32: 57–64.

    Google Scholar 

  16. Hyams JS. Sorbitol intolerance. An unappreciated cause of functional gastrointestinal complaints. Gastroenterology 1983; 84: 30–33.

    CAS  Google Scholar 

  17. Duncan B, Barton LL, Eicher ML, Chmielarczyk VT. Medication induced pneumatosis intestinalis. Pediatrics 1997; 99: 633–636.

    Article  CAS  Google Scholar 

  18. Houlihan GM, Calhoon PH. Ingredient labeling of prescription drug products. Am J Hosp Pharm 1993; 50: 443.

    CAS  Google Scholar 

  19. Veerman MW. Excipients in valproic acid syrup may cause diarrhea: case report. Drug Intell Clin Pharm 1990; 24: 832–833.

    CAS  Google Scholar 

  20. Kumar A, Weatherly MR, Beaman DC. Sweeteners, flavorings, and dye in antibiotic preparations. Pediatrics 1991; 87: 352–360.

    CAS  Google Scholar 

  21. Feldstein TJ. Carbohydrate and alcohol content of 200 oral liquid medications for use in patients receiving ketogenic diets. Pediatrics 1996; 97 (4): 506–511.

    CAS  Google Scholar 

  22. Johnston KR, Govel LA, Andritz MH. Gastrointestinal effects of sorbitol as an additive in liquid medications. Am J Med 1994; 97: 185–191.

    Article  CAS  Google Scholar 

  23. Lutomski DM, Gora ML, Wright SM, Martin JE. Sorbitol content of selected oral liquids. Ann Pharmacother 1993; 27: 269–274.

    CAS  Google Scholar 

  24. Dickerson RN, Melnick G. Osmolality of oral drug solutions and suspensions. Am J Hosp Pharm 1988; 45: 832–834.

    CAS  Google Scholar 

  25. Niemec PW, Vanderveen TW, Morrison JL, Hohenwarter MW. Gastrointestinal disorders caused by medication and electrolyte solution osmolality during enteral nutrition. J Parenter Enteral Nutr 1983; 7: 387–389.

    Article  Google Scholar 

  26. White KC, Harkavy KL. Hypertonic formula resulting from added oral medications. Am J Dis Child 1982; 136: 931–933.

    CAS  Google Scholar 

  27. Rollins CJ. General pharmacologic issues. In: Matarese LE, Gottschlich MM, eds. Contemporary Nutrition Support Practice: A Clinical Guide ( 2nd ed. ). WB Saunders, Philadelphia, PA, 2003, pp. 315–336.

    Google Scholar 

  28. Altman E, Cutie AJ. Compatibility of enteral products with commonly employed drug additives. Nutr Support Serv 1984; 4: 8–17.

    Google Scholar 

  29. Cutie AJ, Altman E, Lenkel L. Compatibility of enteral products with commonly employed drug additives. J Parenter Enteral Nutr 1983; 7: 186–191.

    Article  CAS  Google Scholar 

  30. Fagerman KE, Ballou AE. Drug compatibilities with enteral feeding solutions co-administered by tube. Nutr Support Serv 1988; 8: 31–32.

    Google Scholar 

  31. Burns PE, McCall L, Wirsching R. Physical compatibility of enteral formulas with various common medications. J Am Diet Assoc 1988; 88: 1094–1096.

    CAS  Google Scholar 

  32. Strom JG, Miller SW. Stability of drugs with enteral nutrient formulas. Drug Intell Clin Pharm 1990; 24: 130–134.

    CAS  Google Scholar 

  33. Holtz L, Milton J, Sturek JK. Compatibility of medications with enteral feedings. J Parenter Enteral Nutr 1987; 11: 183–186.

    CAS  Google Scholar 

  34. Rollins CJ. Tube feeding formula and medication characteristics contributing to undesirable interactions. [abstract from American Society for Parenteral and Enteral Nutrition 23rd Clinical Congress, San Diego, CA] J Parenter Enteral Nutr 1999; 21: S13.

    Google Scholar 

  35. Clark-Schmidt AL, Garnett WR, Lowe DR, et al. Loss of carbamazepine suspension through nasogastric feeding tubes. Am J Hosp Pharm 1990; 47: 2034–2037.

    CAS  Google Scholar 

  36. McGoodwin PE, Seifert CF, Bradberry JC, Allen LV. Recovery of phenytoin from a percutaneous endoscopic gastrostomy pezzar catheter following in vitro delivery of multiple doses of phenytoin suspension and phenytoin capsules. [abstract from American College of Clinical Pharmacy 11th Annual Meeting, San Francisco, CA] Pharmacotherapy 1990;10:233, no. 152.

    Google Scholar 

  37. Cacek AT, DeVito JM, Koonce JR. In vitro evaluation of nasogastric administration methods for phenytoin. Am J Hosp Pharm 1986; 43: 689–692.

    CAS  Google Scholar 

  38. Splinter MY, Seifert CF, Bradberry JC. Recovery of phenytoin suspension after in vitro administration through percutaneous endoscopic gastrostomy Pezzer catheters. Am J Hosp Pharm 1990; 47: 373–377.

    CAS  Google Scholar 

  39. Cullen J, Kelly K. Gastric motor physiology and pathophysiology. Surg Clin North Am 1993; 73: 1145–1160.

    CAS  Google Scholar 

  40. Fleischer D, Li C, Zhou Y. Drug, meal and formulation interactions influencing drug absorption after oral administration. Clin Pharmacokinet 1999; 36: 233–254.

    Article  Google Scholar 

  41. Singh BN. Effects of food on clinical pharmacokinetics. Clin Pharmacokinet 1999; 37: 213–255.

    Article  CAS  Google Scholar 

  42. Kintzel PE, Rollins CJ, Yee WJ, List A. Low itraconazole serum levels following administration of itraconazole suspension to critically ill allogeneic bone marrow transplant recipients. Ann Pharmacother 1995; 29: 140–143.

    CAS  Google Scholar 

  43. Magnusson JO. Metabolism of digoxin after oral and intrajejunal administration. Br J Clin Pharmacol 1983; 16: 741–742.

    Article  CAS  Google Scholar 

  44. Staib AH, Beerman D, Harder S, Fuhr U, Lierman D. Absorption differences of ciprofloxacin along the human gastrointestinal tract determined using a remote-control drug delivery device. Am J Med 1989; 87 (suppl 5A): 66S–69S.

    Article  CAS  Google Scholar 

  45. Yuk JH, Nightingale CH, Quintiliani R, Yeston NS, Orlando R III, Dobkin ED, Kambe JC, Sweeney KR, Buonpane EA. Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition. Diag Microbiol Infect Dis 1990; 13: 99–102.

    Article  CAS  Google Scholar 

  46. Sahai J, Memish Z, Conway B.Ciprofloxacin pharmacokinetics after administration via a jejunostomy tube. J Antimicrob Chemother 1991; 28: 936–937.

    Article  CAS  Google Scholar 

  47. Healy DP, Brodbeck MC, Clendening CE. Ciprofloxacin absorption is impaired in patients given enteral feedings orally and via gastrostomy and jejunostomy tubes. Antimicrob Agents Chemother 1996; 40: 6–10.

    CAS  Google Scholar 

  48. Williams L, Davis JA, Lowenthal DT. The influence of food on the absorption and metabolism of drugs. Med Clin N Am 1993; 77: 815–829.

    CAS  Google Scholar 

  49. Anderson KE: Influences of diet and nutrition on clinical pharmacokinetics. Clin Pharmacokinet 1988; 14: 325–346.

    Article  CAS  Google Scholar 

  50. National Research Council. Recommended Dietary Allowances ( 10th ed. ). National Academy Press, Washington, DC, 1989.

    Google Scholar 

  51. O’Reilly RA, Rytand DA. “Resistance” to warfarin due to unrecognized vitamin K supplementation. [letter] N Engl J Med 1980; 303: 160–161.

    Google Scholar 

  52. Lader E, Yang L, Clarke A. Warfarin dosage and vitamin K in Osmolite.[letter] Ann Intern Med 1980; 93: 373–374.

    Article  CAS  Google Scholar 

  53. Lee M, Schwartz RN, Sharifi R. Warfarin resistance and vitamin K. [letter] Ann Intern Med 1981; 94: 140–141.

    Article  CAS  Google Scholar 

  54. Watson AJM, Pegg M, Green JRB. Enteral feeds may antagonize warfarin. Br Med J 1984; 288: 557.

    Article  CAS  Google Scholar 

  55. Kutsup JJ. Update on vitamin K content of enteral products. [letter] Am J Hosp Pharm 1984; 41: 1762.

    Google Scholar 

  56. Petretich DA. Reversal of Osmolite-warfarin interaction by changing warfarin administration time.[letter] Clin Pharm 1990; 9: 93.

    CAS  Google Scholar 

  57. Penrod LE, Allen JB, Cabacungan LR. Warfarin resistance and enteral feedings: 2 case reports and a supporting in vitro study. Arch Phys Med Rehabil 2001; 82: 1270–1271.

    Article  CAS  Google Scholar 

  58. Bauer LA. Interference of oral phenytoin absorption by continuous nasogastric feedings. Neurology 1982; 32: 570–572.

    Article  CAS  Google Scholar 

  59. Au Yeung SC, Ensom MHH. Phenytoin and enteral feedings: does evidence support an interaction? Ann Pharmacother 2000; 34: 896–905.

    Article  Google Scholar 

  60. Doak KK, Curtis EH, Dunnigan KJ, et al. Bioavailability of phenytoin acid and phenytoin sodium with enteral feedings. Pharmacotherapy 1998; 18: 637–645.

    CAS  Google Scholar 

  61. Guidry JR, Eastwood TF, Curry SC. Phenytoin absorption on volunteers receiving selected enteral feedings. West J Med 1989; 150: 659–661.

    CAS  Google Scholar 

  62. Fleisher D, Sheth N, Kou JH. Phenytoin interaction with enteral feedings administered through nasogastric tubes. J Parenter Enteral Nutr 1990; 14: 513–516.

    Article  CAS  Google Scholar 

  63. Hooks MA, LongeRL, Taylor AT, Francisco GE. Recovery of phenytoin from an enteral nutrient formula. Am J Hosp Pharm 1986; 43: 685–688.

    CAS  Google Scholar 

  64. Olsen KM, Hiller FC, Ackerman BH, McCabe BJ. Effect of enteral feedings on oral phenytoin absorption. Nutr Clin Pract 1989; 4: 176–178.

    Article  CAS  Google Scholar 

  65. Marvel ME, Bertino JS: Comparative effects of an elemental and a complex enteral feeding formulation on the absorption of phenytoin suspension. JPEN 1991; 15: 316–318.

    Article  CAS  Google Scholar 

  66. Hatton J, Magnuson B. How to minimize interaction between phenytoin and enteral feedings: two approaches—therapeutic options. Nutr Clin Pract 1996; 11: 30–31.

    Google Scholar 

  67. Faraji B, Yu PP. Serum phenytoin levels of patients on gastrostomy tube feeding. J Neurosci Nurs 1998; 30: 55–59.

    Article  CAS  Google Scholar 

  68. Nishimura LY, Armstrong EP, Plezia PM, Iacono RP. Influence of enteral feeding on phenytoin sodium absorption from capsules. Drug Intell Clin Pharm 1988; 22: 130–133.

    CAS  Google Scholar 

  69. Bass J, Miles MV, Tennison MB, Holcombe BJ, Thorn MD. Effects of enteral tube feeding on the absorption and pharmacokinetic profile of carbamazepine. Epilepsia 1989; 30: 364–369.

    Article  CAS  Google Scholar 

  70. Kassam RM, Friesen E, Locock RA. In vitro recovery of carbamazepine from Ensure. JPEN 1989; 13: 272–276.

    Article  CAS  Google Scholar 

  71. Estoup M. Approaches and limitations of medication delivery in patients with enteral feeding tubes. Crit Care Nurse 1994; 14: 68–79.

    CAS  Google Scholar 

  72. Engle KK, Hannawa TE. Techniques for administering oral medications to critical care patients receiving continuous enteral nutrition. Am Society Health-Syst Pharm 1999; 56: 1441–1444.

    CAS  Google Scholar 

  73. Yuk JH, Nightingale CH, Sweeney KR, Quintiliani R, Lettieri JT, Frost RW. Relative bioavailability in healthy volunteers of ciprofloxacin administered through a nasogastric tube with and without enteral feeding. Antimicrob Agents Chemother 1989; 33: 1118–1120.

    Article  CAS  Google Scholar 

  74. Mueller BA, Brierton DG, Abel S, Bowman L. Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin. Antimicrob Agents Chemother 1994; 38: 2101–2105.

    Article  CAS  Google Scholar 

  75. Piccolo ML, Toossi Z, Goldman M. Effect of coadministration of a nutritional supplement on ciprofloxacin absorption. Am J Hosp Pharm 1994; 51: 2697–2699.

    CAS  Google Scholar 

  76. Mimoz O, Binter V, Jacolot A, et al. Pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding to critically ill patients. Intensive Care Med 1998; 24: 1047–1051.

    Article  CAS  Google Scholar 

  77. de Marie S, VandenBergh MFQ, Buijk SL, et al. Bioavailability of ciprofloxacin after multiple enteral and intravenous doses in ICU patients with severe gram-negative intra-abdominal infections. Int Care Med 1998; 24: 343–346.

    Article  Google Scholar 

  78. Cohn SM, Sawyer MD, Burns GA, Tolomeo C, Miller KA. Enteric absorption of ciprofloxacin during tube feeding in the critically ill. J Antimicrob Chemother 1996; 38: 871–876.

    Article  CAS  Google Scholar 

  79. Wright DH, Pietz SL, Konstantinides MT, Rotschafer JC. Decreased in vitro fluoroquinolone concentrations after admixture with an enteral feeding formulation. J Parenter Enteral Nutr 2000; 24: 42–48.

    Article  CAS  Google Scholar 

  80. Druckenbrod RW, Healy DP. In vitro delivery of crushed ciprofloxacin through a feeding tube. Ann Pharmacother 1992; 26: 494–495.

    CAS  Google Scholar 

  81. CIPRO (ciprofloxacin) 5% and 10% oral suspension. Bayer Corporation Pharmaceutical Division, West Haven, CT.

    Google Scholar 

  82. Welling PG, Lyons LL, Craig WA, Trochta GA. Influence of diet and fluid on bioavailability of theophylline. Clin Pharmacol Ther 1975; 7: 45–480.

    Google Scholar 

  83. Gal P, Layson R. Interference with oral theophylline absorption by continuous nasogastric feedings. Ther Drug Monit 1986; 8: 421–423.

    Article  CAS  Google Scholar 

  84. Plezia PM, Thronley SM, Kramer TH, Armstrong EP. The influence of enteral feedings on sustained-release theophylline absorption. Pharmacother 1990; 10: 356–361.

    CAS  Google Scholar 

  85. Bhargava VO, Schaaf LJ, Berlinger WG, Jungnickel PW. Effect of an enteral nutrient formula on sustained-release theophylline absorption. Ther Drug Monit 1989; 11: 515–519.

    Article  CAS  Google Scholar 

  86. Maka DA, Murphy LK. Drug-nutrient interactions: a review. Nutrition 2000; 11: 580–589.

    CAS  Google Scholar 

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Rollins, C.J. (2004). Drug-Nutrient Interactions in Patients Receiving Enteral Nutrition. In: Boullata, J.I., Armenti, V.T. (eds) Handbook of Drug-Nutrient Interactions. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-781-9_26

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  • DOI: https://doi.org/10.1007/978-1-59259-781-9_26

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