Download PDF
Z Gastroenterol 2005; 43(11): 1231-1241
DOI: 10.1055/s-2005-858737
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Enterale Ernährung: Medikamentenapplikation über Sonden

Enteral Nutrition: Drug Administration via Feeding TubeI. Behnken1 , T. Gaschott1 , J. Stein1
  • 1Medizinische Klinik I (Direktor: Prof. Dr. W. F. Caspary), J.-W.-Goethe-Universität Frankfurt, Frankfurt/Main
Further Information

Publication History

Manuskript eingetroffen: 29.3.2005

Manuskript akzeptiert: 1.9.2005

Publication Date:
03 November 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Enterale Ernährung über eine Sonde ist eine bevorzugte und weit verbreitete künstliche Ernährungsform für Patienten, bei denen eine adäquate orale Nahrungsaufnahme nicht mehr gewährleistet ist. Diese Patienten benötigen häufig zusätzlich eine medikamentöse Therapie, so dass die Gefahr von Interaktionen zwischen Arzneistoff und Sondenkost hoch ist. Trotz der breiten Anwendung dieser Ernährungsform sind das Bewusstsein und die Kenntnis über die richtige Medikamentenapplikation via Sonde im medizinischen Alltag sehr eingeschränkt. Inkompatibilitäten zwischen Nahrungs- und Arzneimitteln können einerseits zu einer Okklusion der Sonde führen und andererseits eine veränderte Bioverfügbarkeit des Arzneistoffes zur Folge haben mit direkten Auswirkungen auf den therapeutischen Erfolg. Um dies zu verhindern, wurden Empfehlungen zur korrekten Arzneimittelapplikation via Sonde entwickelt.

Abstract

Enteral nutrition support via a feeding tube is a preferred and broadly applied way of artificial nutrition in patients who cannot take up orally an adequate amount of nutrients. These patients often need simultaneous drug therapy as well. Thus, there is a high risk of drug-nutrient interactions. Although enteral nutrition is commonly used there is a lack of awareness and knowledge about the appropriate handling and drug administration via the feeding tube. On the one hand, drug-nutrient interactions can lead to clogging of the tube, on the other hand, the change in bioavailability of the drug can have a direct effect on the therapeutic effort. To optimise safety and efficacy of drug therapy in patients with feeding tubes, some basic rules have been set up.

Schlüsselwörter

Enterale Ernährung - Arzneistoffe - Wechselwirkungen - Pharmakokinetik

Key words

Enteral feeding - drugs - nutrients - interactions - pharmacokinetics

Literatur

  • 1 Schröder O, Hoepffner N, Stein J. Enteral Nutrition by Endoscopic Means; I. Techniques, Indications, Types of Enteral Feed.  Z Gastroenterol. 2004;  43 1385-1392
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Probst W. Arzneimitteltherapie bei Patienten mit Ernährungssonde.  PZ Prisma. 1997;  43 31-41
    PubMedSearch in Google Scholar
  • 3 Gilbar P J. A guide to enteral drug administration in palliative care.  J Pain Symptom Manage. 1999;  43 197-207
    PubMedSearch in Google Scholar
  • 4 Klang M, Kochevar M, Rollins C. Medications via feeding tube: issues and controversies. Nashville, Tennessee; Workshop on ASPEN Congress 23. - 26.1.2000 429-440
  • 5 Williams L, Hill D P, Davis J A. et al . The influence of food on the absorption and metabolism of drugs: an update.  Eur J Drug Metab Pharmacokinet. 1996;  43 201-211
    PubMedSearch in Google Scholar
  • 6 Hoepffner N, Schröder O, Stein J. Enteral Nutrition by Endoscopic Means; II. Complications and Management.  Z Gastroenterol. 2004;  43 1393-1398
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Lourenco R. Enteral Feeding: Drug/Nutrient Interaction.  Clin Nutr. 2001;  43 187-193
    PubMedSearch in Google Scholar
  • 8 Thomson C A, Rollins C J. Nutrient-Drug Interactions. Rombeau JL, Rolandelli RH. 3rd ed Clinical Nutrition - Enteral and Tube Feeding Philadelphia; W. B. Saunders Company 1997: 523-539
    Search in Google Scholar
  • 9 Utermohlen V. Diet, Nutrition, and Drug Interactions. Maurice E, Shils I. 9th ed Modern Nutrition in Health and Disease Baltimore; Williams & Wilkins 1999: 1619-1641
    Search in Google Scholar
  • 10 Rollins C A, Thomson C, Crane T. Pharmacotherapeutic Issues. Rolandelli RH, Bankhead R, Baellata JI, Compher CW. Clinical Nutrition - Enteral and Tube Feeding Philadelphia; Elsevier Saunders 2005: 291-305
    Search in Google Scholar
  • 11 Maka D A, Murphy L K. Drug-nutrient interactions: a review.  AACN Clin Issues. 2000;  43 580-589
    PubMedSearch in Google Scholar
  • 12 Beckwith M C, Feddema S S, Barton R G. et al . Guide to drug therapy in patients with feeding tubes: dosage form selection and administration methods.  HospPharm. 2004;  43 225-237
    PubMedSearch in Google Scholar
  • 13 Estoup M. Approaches and limitations of medication delivery in patients with enteral feeding tubes.  Crit Care Nurse. 1994;  43 68-72, 77 - 79
    PubMedSearch in Google Scholar
  • 14 Mitchell J F. Oral solid dosage forms that should not be crushed: 1996 revision.  Hosp Pharm. 1996;  43 27-37
    PubMedSearch in Google Scholar
  • 15 Parker W A. Canadian oral solid dosage forms that should not be crushed.  Can Pharm J . 1983;  43 465-474
    PubMedSearch in Google Scholar
  • 16 Varella L, Jones E, Meguid M M. Drug-Nutrient Interactions in Enteral Feeding: A Primary Care Focus.  Nurse Pract. 1997;  43 98-104
    PubMedSearch in Google Scholar
  • 17 Thomas J A. Drug-nutrient Interactions.  Nutr Rev. 1995;  43 271-282
    PubMedSearch in Google Scholar
  • 18 Bauer L A. Interference of oral phenytoin absorption by continuous nasogastric feedings.  Neurology. 1982;  43 570-572
    PubMedSearch in Google Scholar
  • 19 Maynard G A, Jones K M, Guidry J R. Phenytoin absorption from tube feedings.  Arch Intern Med. 1987;  43 1821-1823
    PubMedSearch in Google Scholar
  • 20 O’Hagan M, Wallace S J. Enteral formula feeds interfere with phenytoin absorption.  Brain Dev. 1994;  43 165-167
    PubMedSearch in Google Scholar
  • 21 Saklad J J, Graves R H, Sharp W P. Interaction of oral phenytoin absorption from tube feedings.  J Parenter Enter Nutr. 1986;  43 322-323
    PubMedSearch in Google Scholar
  • 22 Chan L N. Drug-nutrient interaction in clinical nutrition.  Curr Opin Clin Nutr Metab Care. 2002;  43 327-332
    PubMedSearch in Google Scholar
  • 23 Miller S W, Strom J r G. Stability of phenytoin in three enteral nutrient formulas.  Am J Hosp Pharm. 1988;  43 2529-2532
    PubMedSearch in Google Scholar
  • 24 Cacek T, DeVito J M, Koonce J R. In vitro evaluation of nasogastric administration methods for phenytoin.  Am J Hosp Pharm. 1986;  43 689-692
    PubMedSearch in Google Scholar
  • 25 Adams D. Administration of drugs through a jejunostomy tube.  British Journal of Intensive Care. 1994;  43 10-17
    PubMedSearch in Google Scholar
  • 26 McCarthy M S, Fabling J C, Bell D E. Drug-nutrient interaction. In: ASPEN Nutritional considerations in the intensive care unit - Science, rationale and practice. Iowa; Kendall/Hunt Publishing Company 2002: 153-173
    Search in Google Scholar
  • 27 Marcuard S P, Stefall K S. Unclogging feeding tubes with pancreatic enzyme.  J Parenter Enter Nutr. 1990;  43 198-200
    PubMedSearch in Google Scholar
  • 28 Pfaff A. Anwendungshinweise zu Peroralia. München; Nestle Clinical Nutrition 11/01
  • 29 Nelson O, Levitt J. Aspirin absorption from a feeding jejunostomy.  J Am Geriatr Soc. 1980;  43 556-557
    PubMedSearch in Google Scholar
  • 30 www.pharmatrix.de. 
  • 31 Bass J, Miles M V, Tennison M B. et al . Effects of enteral tube feeding on the absorption and pharmacokinetic profile of carbamazepine suspension.  Epilepsia. 1989;  43 364-369
    PubMedSearch in Google Scholar
  • 32 Clark-Schmidt A L, Garnett W R, Lowe D R. et al . Loss of carbamazepine suspension through nasogastric feeding tubes.  Am J Hosp Pharm. 1990;  43 2034-2037
    PubMedSearch in Google Scholar
  • 33 Geigy Pharma .Persönliche Mitteilung Ciba-Geigy GmbH,. Wehr; 07/96
  • 34 Healy D P, Brodbeck M C, Clendening C E. Ciprofloxacin absorption is impaired in patients given enteral feedings orally and via gastrostomy and jejunostomy tubes.  Antimicrob Agents Chemother. 1996;  43 6-10
    PubMedSearch in Google Scholar
  • 35 Mueller B A, Brierton D G, Abel S R. et al . Effect of enteral feeding with Ensure on oral bioavailabilities ofloxacin and ciprofloxacin.  Antimicrob Agents Chemother. 1994;  43 2101-2105
    PubMedSearch in Google Scholar
  • 36 Engle K K, Hannawa T. Techniques for administering oral medications to critical care patients receiving continuous enteral nutrition.  Am J Health Syst Pharm. 1999;  43 1441-1444
    PubMedSearch in Google Scholar
  • 37 Nicolau D P, Crowe H, Nightingale C H. et al . Bioavailability of fluconazole administered via a feeding tube in intensive care unit patients.  J Antimicrob Chemother. 1995;  43 395-401
    PubMedSearch in Google Scholar
  • 38 Liefhold J, Heun G, Hermann-Hirche E. Applikation von retardiertem Morphinsulfat bei künstlicher Ernährung.  Z Allg Med. 1996;  43 707-709
    PubMedSearch in Google Scholar
  • 39 www.astrazeneca.ch/produkte/alphabet. 
  • 40 Miyagawa C I. Drug-nutrient interactions in critically ill patients.  Crit Care Nurse. 1990;  43 69-72, 77 - 82, 84 - 90
    PubMedSearch in Google Scholar
  • 41 Holtz L, Milton J, Sturek J K. Compatibility of medications with enteral feedings.  J Parenter Enter Nutr. 1987;  43 183-186
    PubMedSearch in Google Scholar
  • 42 Nishimura L Y, Armstrong E P, Plezia P M. et al . Influence of enteral feedings on phenytoin sodium absorption from capsules.  Drug Intell Clin Pharm. 1988;  43 130-133
    PubMedSearch in Google Scholar
  • 43 Gal P, Layson R. Interference with oral theophylline absorption by continuous nasogastric feedings.  Ther Drug Monit. 1986;  43 421-423
    PubMedSearch in Google Scholar
  • 44 Kuhn T A, Garnett W R, Wells B K. et al . Recovery of warfarin from an enteral nutrient formula.  Am J Hosp Pharm. 1989;  43 1395-1399
    PubMedSearch in Google Scholar
  • 45 Penrod L E, Allen J B, Cabacungan L R. Warfarin resistance and enteral feedings: 2 case reports and a supporting in vitro study.  Arch Phys Med Rehabill. 2001;  43 1270-1273
    PubMedSearch in Google Scholar
  • 46 Petretich D A. Reversal of Osmolite-warfarin interaction by changing warfarin administration time.  Clin Pharm. 1970;  43 93
    PubMedSearch in Google Scholar

Jürgen Stein

Medizinische Klinik I-ZAFES, J.-W.-Goethe-Universität Frankfurt

Theodor-Stern-Kai 7

60590 Frankfurt/Main

Germany

Phone: ++ 49/69/63 01-59 17

Fax: ++ 49/69/63 01-8 31 12

Email: J.Stein@em.uni-frankfurt.de