Dilantin (phenytoin) & food/enteral feedings?

Nurses General Nursing

Published

I am reading Davis's Drug Guide and don't understand something.

It says for PO Dilantin: "Adminster with or immediately after meals to minimize GI irritation" ... "Capsules may be opened and mixed with food or fluids for patients with difficulty swallowing".

and for Enteral Feedings it says: "If patient is receiving enteral tube feedings, 2 hr should elapse between feeding and phenytoin administration"

If they take the PO version opened and mixed with food, how is that different from Capsules opened and and mixed with Enteral (PEG) feeding, and why must I have the 2hr before if it's enteral feeding, but not if it's opened and mixed with food they eat?

:confused:

Specializes in Critical Care/Coronary Care Unit,.

This question is better asked to a pharmacist.

Specializes in acute/critical care.

"The bioavailability of liquid phenytoin ( Dilantin ) is often reduced by the drug's ability to bind with the enteral feeding's protein component, leading to less free drug availability and inadequate therapeutic levels."

Good article written by an APRN on this subject linked in medscape: Log In Problems

Yes, dilantin with TFs is a pain. You have to hold the feeding 2 hours before and two hours after a dose of dilantin is administered and it's usually BID.

I'm having a tough time getting the medscape link to work. The article number is 498270.

Specializes in Critical Care.

Why in the world would you say this is better asked of a pharmacist? Nurses are empowered to look up meds..that's what pharmacists do too. They don't walk around with a mental catalog of EVERY med made.

Specializes in Critical Care.
Why in the world would you say this is better asked of a pharmacist? Nurses are empowered to look up meds..that's what pharmacists do too. They don't walk around with a mental catalog of EVERY med made.

I think it was just a suggestion to use available resources to answer the question. If the drug guide isn't answering the question, then maybe someone who has a degree specifically in pharmacology would be able to help.

Why in the world would you say this is better asked of a pharmacist? Nurses are empowered to look up meds..that's what pharmacists do too. They don't walk around with a mental catalog of EVERY med made.

I empower myself to ask questions of our pharmacists frequently. They are well-versed in the policies of our facility, and they have access to more comprehensive information about incompatibilities and so forth than I have readily available.

Specializes in acute/critical care.

I have actually had incorrect information regarding infusion compatibilities given to me straight from a pharmacist's mouth. I will call them as a last resort to consult if I have a question I cannot figure out. I think in most hospitals these days, there are great resources like Micromedex that will tell you everything you need to know. But that's just me -- I prefer hard and fast, researched, printed data to what may be anecdotal or misinterpreted by the pharmacist from their giant drug books. I also feel that the less steps you need to do and the fewer people you need to go through to get this type of information is safer.

You are wise to be cautious and evaluate any information you receive, no matter what the source. However, just because you received incorrect information from a pharmacist once doesn't make it a good reason to avoid using them as a resource now.

Micromedex has errors too, I guarantee. This isn't the easiest job we have, for sure.

I have actually had incorrect information regarding infusion compatibilities given to me straight from a pharmacist's mouth. I will call them as a last resort to consult if I have a question I cannot figure out. I think in most hospitals these days, there are great resources like Micromedex that will tell you everything you need to know. But that's just me -- I prefer hard and fast, researched, printed data to what may be anecdotal or misinterpreted by the pharmacist from their giant drug books. I also feel that the less steps you need to do and the fewer people you need to go through to get this type of information is safer.

brand name dilantin caps should never be opened, the contents is caustic.....that is why they are sealed!

I ask the pharmacists stuff a lot... I like different points of view and opinions... I like to take an weighted average of all the responses I get (weighted on how much I trust the person's knowledge level) and then add my discretion and read a bit and then decide... Heck, I even ask PCAs/CNAs their opinions (when appropriate)... I've been known to ask Environmental Services stuff too.... I'm an inquisitive boy... or so I've been told....

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