Interactions between Medications and Nutrients in Patients Receiving Pareneteral and Enteral Nutrition

Kim, Hyunah

Abstract

Interactions between medications and nutrients are frequently known to occur in patients receiving enteral nutrition (EN) and parenteral nutrition (PN). The risk of pharmacological and nutritional interactions can be significant and can have a detrimental effect on the therapeutic outcomes in patients. The purpose of this study is to provide fundamental knowledge about the identification and management of clinically significant medication-nutrient interactions related to EN and PN. Precautions to be undertaken for medication administered with enteral nutrition. When medication is administered to a patient with EN, the following factors should be carefully considered: enteral tube feeding access site, characteristics of tube feeding, physiochemical incompatibilities related to medication dosage form, and prevention of occlusion of enteral tube feeding. Medications with special formulations should not be crushed and administered to EN patients as it can lead to higher serum concentrations and clinical toxicity. The feeding tube needs to be flushed with water before and after administering medication. Assessment of PN-medication interactions should importantly take into account the stability and compatibility of medication with both two-in-one and three-in-one formulations of PN admixture. The stability of PN is affected significantly in an intravenous (IV) lipid emulsion in a three-in-one admixture. Calcium, potassium phosphate, sodium phosphate, or magnesium should not be administered through IV Y-site with PN as these substances can cause changes in solubility and may result in the formation of precipitants. Understanding the potential risks of these interactions could help in minimizing the adverse effects and optimizing a patient's pharmacotherapy and specialized nutrition support.