Medications through an ileostomy?

[onewithhospiceheart]

Hi all,

Question......have a patient with colon ca....has an ileostomy. He has mets everywhere. Pt is declining fast, I doubt this sweet gentleman will make it to the weekend. He stopped all oral intake last weekend. Has a hx of seizures, was on Dilantin 400mg BID.

Wife is adamant about continuing an anti-seizure med. Spoke with our national hospice pharmacy and they advised Depakote suppositories TID. Was not thinking about no real rectal access at the time of the recommendation/order....along with the dr. who approved the recommendation.

Wife tried inserting the suppository when they arrived, and could not insert all the way.

Phoned our national hospice company and they said the suppository can be inserted through the ileostomy. Is this correct? I cannot find any info online stating that this practice is used.

Help?

[leslie :-D]

it's done all the time (administering through stomas), but it is also one of the least recommended routes.

its absorption is inconsistent and questionable.

but the wife doesn't have to know that...

if it's going to only add stress to her.

prayers for comfort and peace.

leslie

[rnchpn]

i use ativan SL schedule for people with seizure disorders at eol.

[melsch]

Our protocol is also to use ativan 1-2mg sl q4h round the clock when our patients are no longer able to take their antiseizure medications orally. Mix it in a little bit (1/2 cc or less) of water in a syringe and dribble it into the corner of their mouth - if they are mouth breathing and their mouth is dry it helps it to absorb quicker.

[rdsxfnrn]

If I am not mistaken the hospice (for my dad) had the pharmacy mix up a paste that we applied q4 and wrapped c saran wrap........ decadron, valium, and something else that slips my mind. The pharmacy was a "special" pharmacy ie it was not CVS or Walgreens, we had to travel out of town to get it. Hope this helps.

(written down like this it sounds sinister, but it was on the up and up)

[tewdles, RN]

Yup, topical preps are common when folks can no longer tolerate oral meds. It is important to remember that if the person is actively dying they may not have great perfusion and some topicals (including fentanyl) may have unreliable delivery and absorption.

Ileostomies are not the preferred route...the output is often too liquid and frequent to allow adequate absorption. Colostomies will generally provide a better absorption but, as leslie stated, they too can be unreliable.

My experience is that when persons with active seizure disorders and risk are unable to swallow their anticonvulsant we are able to adequately prevent seizures with the scheduled use of ativan SL...as others have commented.