Types of feed
Most people with an enteral feeding tube will receive some, or all their nutrition via the tube.
How the feed is given can impact the medicine timing and absorption:
- bolus feeding mimics normal eating patterns and are commonly used with gastric tubes
- continuous feeding is preferred for jejunal tubes and the feed will need to be paused when medicines are given
- cyclic feeding delivers the feed for a continuous set period, such as overnight
- intermittent feeding involves longer gaps between feeds than cyclic feeding
Reducing interactions with enteral feeds
Medicines administration should be separated from enteral feeds to avoid:
- physical incompatibilities
- reduced drug absorption
- tube blockages
- microbial contamination
Medicines with no known food interactions
Enteral feeds generally do not affect medicines that do not interact with food.
A long gap in enteral feeding is not required.
Medicines with known food interactions
Medicines which interact with food may also interact with enteral feeds.
A longer gap in enteral feeding may be required for these medicines, as for oral administration.
To find out if the medicine interacts with food, use our article Checking if medicines can be given with food
Managing common medicines-feed interactions
Medicines that commonly interact requiring caution with enteral feeding are discussed. This list is not exhaustive.
Digoxin
High-fibre feeds, such as Jevity, reduce digoxin absorption.
Withold high fibre enteral feeds for 2 hours before and 1 hour after each dose.
For monitoring advice, refer to Digoxin monitoring.
Fluoroquinolones
Chelation with multivalent cations including aluminium, calcium, iron, magnesium and zinc reduces absorption of fluoroquinolones.
Consider parenteral administration, or an alternative antibiotic.
If fluroquinolone must be given via the enteral feeding tube, prescribe doses at the upper end to compensate for lower absorption.
Withold enteral feeds for 2 hours before and after each dose.
Phenoxymethylpenicillin
Absorption of phenoxymethylpenicillin decreases significantly when given with enteral nutrition.
Consider parenteral administration, or an alternative antibiotic.
If phenoxymethylpenicillin must be given via the enteral feeding tube, prescribe doses at the upper end to compensate for lower absorption.
Withhold the feed for 2 hours before and 1 hour after each dose.
Phenytoin
Phenytoin absorption decreases significantly when given with enteral nutrition.
Avoid enteral feeding tube administration unless no alternative exists.
If phenytoin must be given via the enteral feeding tube, monitor serum levels closely and adjust the dose accordingly.
Withold enteral feeds for 2 hours before and after each dose.
For monitoring advice, refer to Phenytoin monitoring.
Warfarin
Warfarin absorption and clinical effect decreases when given with enteral nutrition, including low vitamin K feeds.
Withold enteral feeds for 1 to 2 hours before and after each dose.
Monitor the INR closely and adjust the dose accordingly.
For monitoring advice, refer to Warfarin monitoring.
Update history
- Republished
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