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NP-007 Recommendations for administration of immunosuppressants via enteral feeding tube according to their in-vitro administration
  1. K Lajtmanová1,
  2. K Szmicseková1,
  3. S Porubcová1,2
  1. 1Hospital Pharmacy, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
  2. 2Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia


Background and Importance Immunosuppressants (IS) are used in the treatment and prevention of graft rejection after solid organ or tissue transplantation.1 Their administration via an enteral feeding tube (EFT) is problematic regarding their narrow therapeutic index, cytotoxic, teratogenic potential, and occupational hazard. Incomplete absorption due to incorrect administration via EFT may lead to graft rejection.2 Appropriate drug forms of IS for administration via EFT are missing in our country.

Aim and Objectives Despite multiple published guidelines for the administration of medicines via EFT, available drug forms differ between countries. Our aim was to create local recommendations for the safe administration of IS via EFT reflecting the available medicines in our country, while preventing EFT occlusion and preserving optimal effect.

Materials and Methods A literature search was aimed to determine the site of absorption, incompatibilities, and measures to decrease the occupational hazard. The practical part consisted of dissolving tablets, capsules’ content, and their administration via EFTs of diameters 10, 8, and 6 Fr. The administration of IS was realized by the adapted protocol by White et al., 2015.3 We evaluated the rate of disintegration of tablets and tube occlusion.

Results Only one brand of mycophenolate mofetil tablets and two brands of azathioprine tablets disintegrated in a syringe. All the other tablets need to be crushed. Two of the studied IS caused the occlusion of a 6 Fr EFT, no EFT of wider diameter was occluded. We summaries our recommendations in a table.

Conclusion and Relevance Crushing tablets or opening capsules is often the only possibility for IS administration via EFT. In these cases, using personal protective equipment is always needed. Ciclosporin, mycophenolate mofetil, and azathioprine can be administered relatively safely. Special attention is needed when an EFT of 6 Fr is used due to its easy occlusion.

References and/or Acknowledgements Our project was supported by the National Institute of Cardiovascular Diseases, EduPharm pri NÚSCH, Bausch Health, Novartis, Nutricia, Roche.

1. Hartono et al., Cold Spring Harb Perspect Med., 2013.

2. Silva et al., J Clin Pharm Ther., 2020.

3. White et al., Handbook of drug administration via enteral feeding tubes, 2015.

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