Enteral feeding formulation

TABLE 58-2 Adult Enteral Feeding Formulation Classification System ... 

The interaction of oral phenytoin with enteral feeding formulations has been reviewed (83). Four prospective, randomized, controlled trials in healthy volunteers showed no interaction. However, numerous anecdotal reports and studies have shown dramatic reductions in serum phenytoin concentrations in patients receiving enteral feeding formulations. The authors therefore concluded that this interaction occurs in patients but not in healthy volunteers. 

Selection of the enteral feeding formulation depends on nutritional requirements, the patient s primary disease state and related complications, and nutrient digestibility and... 

Newer enteral feeding formulations have been designed to meet specific nutrient requirements and manage metabolic abnormalities... 

In general, no more than one product is necessary per category of enteral feeding formulations and it may be possible to omit certain categories based on the specific population and physician prescribing practices within a given institution. The selection of product should be based on meeting patient nutritional requirements. Additional selection criteria include container size and type, liquid or powder form, shelf life, ease of use, and cost. 

Mixing liquid medications with certain enteral feeding formulations has been associated with several types of physical incompatibilities including granulation, gel formation, separation, and precipitation. Not only can these physical incompatibilities inhibit drug absorption, gel formation potentially may clog small-bore enteral feeding tubes. Physical incompatibility with medications is more common in formulations that contain intact protein than in those with hydrolyzed protein. Also, medication and enteral formula incompatibilities are more common with the use of acidic pharmaceutical syrups. The most prudent recommendation is to avoid the routine admixture whenever possible, especially for nonaqueous preparations and syrups. In the... 

Wright DH, Pietz SL, Konstantinides FN, Rotschafer JC. Decreased in vitro fluoroquinolone concentrations after admixture witii an enteral feeding formulation. JParenter Enteral Nutr (2000) 24,42-8. 

Marvel ME, Bertino JS. Comparative effects of an elemental and a complex enteral feeding formulation on the absorption of phen3doin smpension. J Parenter Enteral Nutr ( 99 ) 15, 316. ... 

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