Suggestions for giving Pentasa via G-Tube

[brandik]

I work as a Pediatric Home Care nurse and my client has just received a new medication, Pentasa. The order is to empty capsule into water and give via g tube. The problem is that the inside of the capsule is loaded with little beads, and when added to water, they are lighter than the water and either don't go through the syringe to the tube, only the water goes through, or it clogs the tube for what few of the beads escape with the water, and the rest of the beads are left in the syringe. (The beads float).

Does anyone have any suggestions on how to administer this medication through a g tube? It cannot be dissolved as it is a sustained release medication, and I toyed with it for over an hour trying to figure out how to get the beads to flow with the water.

If we cannot figure out how to get this medication to work, my client will have to travel an hour away to have it administered IV. For an 8 year old, this can be pretty traumatic and we are trying to avoid this option.

Any suggestions would be greatly appreciated.

Thank you so much,

Brandi

[ChocoholicRN]

There are a few medications like this which have beads in the capsule making it very difficult to push through a PEG tube. What I have tried, and this doesn't always work, is make sure to draw up plenty of water with the medication and as you push it into the G-tube, jiggle the syringe so it loosens the beads and they will sort of float around. This gives the medication more of a chance to get in rather than just stick to the syringe. Hope this makes sense!

[Penelope_Pitstop, BSN, RN]

I have never given this medication, but I consulted my facility's formulary.

"Swallow capsules or tablets whole, do not break, chew, or crush" - these are the first words in the "administration" section.

Apparently it is also available in suppository and retention enema forms, so perhaps an order can be obtained for that?

[brandik]

Hey Jerzeytech,

Yes I tried using more water. They still floated to the top of the water letting just the water exit and the beads remained. Thanks for the tip though. It's very frustrating. If we could use warm water the beads may flow better but the problem with that is they will dissolve and we want it to dissolve in the intestines not stomach.

[ZippyGBR, BSN, RN]

i think jerzytechs idea has some merit, as i recall doing similar before with that kind of med

large enteral syringe , pour the med in , then replace the plunger expel the air fill, with water and give it a good shake to get the beads suspended, then given reasonable quickly ... assuming there's not an issue over volumes given you can always stop, and put more water in the syringe if the there's loads of the beads of med left in the syringe.

[brandik]

The beads are coated, and as much as you would think the Dr. and pharmacist (who warned it may clog the tube) would know the difficulty of giving this drug via g tube, he still ordered it this way. Thanks for the suggestion on suppository though. I will run it by Mom and see what she thinks. Retention enema will not work as child is developmentally delayed and would not understand that. Thank you.

[Forever Sunshine, ASN, RN]

Try taking the piston syringe and giving the beads a push through with the water.

It might take a couple of refills but that usually works for me because one of my patients is on depakote sprinkle. Those beads are a pain in the tush.

[PediLove2147, BSN, RN]

I also take care of a young boy with a G-Tube. Colazal is very similar to Pentasa and could possibly eliminate the problem of both the beads and having to get it given IV. I don't know the case but it could be something to look into.. we just give it with his feed (empty the powder into the syringe and shake, well) and usually there are no problems as long as you shake immediately.

[chloecatrn]

We had to give something like this once and mixed it in baby applesauce, then mixed the applesauce with water to make it viscous enough to go down the g-tube without clogging.

[ChristineN, BSN, RN]

We had to give something like this once and mixed it in baby applesauce, then mixed the applesauce with water to make it viscous enough to go down the g-tube without clogging.

That was going to be my suggestion. I know the applesauce trick is recommended for Pancreatic Enzymes, but I don't know if it would affect the absorption of Pentesa.

[JStollRN]

This may sound silly, but do you think you could put the pill in a little pureed applesauce or something so the beads will stick and then flush with water? I would imagine that may work, although quite cumbersome.

[CoffeeRTC, BSN, RN]

What about plain apple juice. The name of the med is escaping me right now but it was a stomach med that came this way and it only disolved in apple juice. Let it sit for a while.