Administration of Gabapentin and Amitriptyline Through G-Tubes

General Principles for Medication Administration

The American Society for Parenteral and Enteral Nutrition recommends that crushing medications should be avoided whenever possible due to risks of drug exposure to healthcare workers and inaccurate dosing, with liquid formulations strongly preferred when available 1, 2
Consult a pharmacist before crushing any medication to confirm appropriateness and proper technique, as recommended by the Clinical Nutrition society 1, 2
Verify that the medication's Summary of Product Characteristics does not contraindicate crushing, as using products outside these terms carries additional legal responsibility, according to the Clinical Nutrition guidelines 1

Flush the tube with 30 mL of water before medication administration, as recommended by the Clinical Nutrition and Praxis Medical Insights societies 1, 2, 3
Administer each medication individually through the tube, with a flush of 30 mL of water between each medication, as recommended by the Clinical Nutrition and Praxis Medical Insights societies 1, 2, 3
Use appropriate ENFit-standard syringes and connectors to prevent fatal misconnection errors, according to the Clinical Nutrition and Praxis Medical Insights guidelines 1, 2, 3

Higher incidence of tube occlusions occurs when using crushed solid dosage forms through feeding tubes, as reported by the Clinical Nutrition society 1, 2
Do not shake low-dose ENFit syringes to remove drug residue, as this exposes people to the drug and alters the delivered dose, according to the Clinical Nutrition and Praxis Medical Insights societies 1, 2, 3

Confirm the G-tube tip location before administering medications, as the site of drug delivery significantly affects efficacy, as recommended by the Clinical Nutrition society 4, 2
Gastric delivery (standard G-tube) typically provides adequate absorption for both gabapentin and amitriptyline, according to the Clinical Nutrition guidelines 4, 2

Lack of patient/caregiver education is a common issue, with over 30% of caregivers receiving no information about proper medication administration through feeding tubes, as reported by the Clinical Nutrition society 1