Stability of Medications Administered via Enteral Feeding Tubes: A Systematic Review

Feeding tubes are essential for patients unable to maintain adequate oral intake, serving multiple purposes including nutrition delivery and medication administration. The impact of administering medications through feeding tubes on their stability requires systematic investigation. This review aims to systematically evaluate factors affecting medication stability when administered via enteral feeding tubes versus oral administration in healthy populations, focusing on solid dosage forms converted to liquid formulations. A comprehensive search was conducted across PubMed/MEDLINE, Embase, and CINAHL databases from July to October 2024, using a combination of MeSH and non-MeSH terms. Studies that assessed medication stability in enteral feeding tubes were included, while those that did not report on this outcome were excluded. The risk of bias was evaluated using ROBINS-I, RoB- II, Cochrane tools, and the QUIN tool. From 2368 articles, 115 were retained for further assessment, and finally 24 met the inclusion criteria and were included, comprising 16 in vivo, 4 in vitro, and 4 combined studies. Approximately 20.8% of the studies found reduced stability/bioavailability for certain medications, such as warfarin and tolvaptan, while 8.3% of the studies found enhanced absorption, as observed with clopidogrel. Most medications maintained their stability. This systematic review suggests that enteral feeding tube administration can variably affect medication stability, influenced by factors such as tube material and preparation methods. Although most medications remain stable, concerns regarding instability and quality persist. The findings of this review provide a foundation for developing evidence-based guidelines to optimize clinical practice and improve patient outcomes.