By: Stephanie Temple RDN, LD
Recently, in two different facilities, I was approached by nurses who were having difficulty with clogged enteral feeding tubes. Both times, I was told “I really have a hard time getting that Omeprazole to go through.” Omeprazole comes in a capsule and, when opened, the little beads inside are difficult to get through a feeding tube. A helpful pharmacist at Zellmed Pharmacy provided some guidance (3).
Omeprazole: This is an antisecretory medication that is a proton pump inhibitor. It suppresses gastric acid secretion by inhibiting the H+, K+ – ATPase enzyme system (the proton pump) in the parietal cells. This suppresses gastric acid secretion and relieves gastrointestinal distress and promotes ulcer healing (1).
Prevacid Solutabs: This is also an antisecretory proton pump inhibitor, so it is the same classification as Omeprazole and acts in the same way (1). It is available as a solutab tablet (disintegrating), making it a better choice for enteral tube administration. Prevacid is also available as a packet of granules meant to be mixed with water in order to form a suspension. This suspension, however, contains xanthan gum which can potentially expand in an enteral feeding tube causing blockage (2). Prevacid Solutabs require prior authorization where Omeprazole does not (3).
Zantac Liquid: Like Omepazole and Prevacid, this is an antisecretory medication. It is an H2 receptor antagonist. It inhibits histamine action at H2-receptor sites on parietal cells, blocking gastric acid secretion (1). Because this is a liquid, it will not clog feeding tubes. It is preferable to utilize a liquid dosage form whenever possible for enteral feeding tube administration, especially if the patient has a small-bore feeding tube (2). Zantac Liquid does not require prior authorization (3).
Medications cause obstruction in about 15% of patients receiving enteral tube feedings (2). We, as Registered Dietitian Nutritionists, can assist the nursing staff to avoid this complication.
(1) BillieAnn, W., Margaret, S., & Kelly, S. (2013). Nurse’s Drug Guide. Boston: Pearson.
(2) Wyman, M. (). Medication Administration Through Enteral Feeding Tubes. Cleveland Clinic Pharmocotherapy Update, XI.
(3) Zellmed Pharmacy