For patients who require anticoagulation but are unable to swallow tablets, administering medication through a gastrostomy (G) tube is a common alternative. This method is effective for Eliquis (apixaban) but requires specific preparation and adherence to guidelines to maintain the medication's efficacy.
Preparing Eliquis for G-Tube Administration
Administering Eliquis via a G tube involves crushing the tablet and mixing it with a suitable liquid to create a suspension. Following manufacturer instructions and medical guidance is crucial for safe and effective administration.
Step-by-Step Preparation and Delivery
Proper G-tube administration involves the following steps:
- Gather equipment: You will need Eliquis tablets, a pill crusher, a medicine cup, an oral syringe, and water or 5% dextrose in water (D5W).
- Crush the tablet(s): Grind the tablet(s) into a fine powder using a pill crusher.
- Prepare the suspension: Mix the crushed powder with 60 mL of water or D5W. Stir to disperse the powder evenly.
- Draw up the dose: Use the oral syringe to draw up the entire mixture. Administer the suspension within four hours of mixing.
- Administer the dose: Connect the syringe to the G tube with the patient upright or slightly inclined. Slowly push the plunger to deliver the dose.
- Flush the tube: After administration, flush the G tube with an additional 20 mL of water or D5W to ensure the full dose is delivered and prevent clogging.
Bioavailability and the Importance of Correct Tube Placement
Apixaban is primarily absorbed in the upper gastrointestinal tract. Therefore, G tubes or nasogastric (NG) tubes that deliver the drug directly to the stomach are necessary. Bioavailability is significantly reduced if Eliquis is administered through a tube that ends past the stomach. Mixing Eliquis with nutritional supplements has also been shown to reduce drug exposure, so direct mixing with food or formula is generally not recommended.
Comparing DOAC Administration via Enteral Tube
Administering anticoagulants through feeding tubes varies among different direct oral anticoagulants (DOACs). The table below compares common DOACs and their enteral tube administration characteristics.
| Feature | Eliquis (Apixaban) | Xarelto (Rivaroxaban) | Pradaxa (Dabigatran) |
|---|---|---|---|
| Crushable for G-Tube? | Yes, tablets can be crushed and suspended. | Yes, tablets can be crushed and suspended. | No, capsules cannot be crushed or opened. |
| Compatible Liquid | Water or D5W. | Water, applesauce, or juice. | N/A (must be swallowed whole). |
| Ideal Tube Location | Gastric (stomach). | Gastric (stomach). | N/A (must be swallowed whole). |
| Effect of Distal Placement | Bioavailability is significantly reduced. | Bioavailability is reduced. | N/A. |
| Impact of Food/Nutrition | Can be mixed with applesauce orally but not recommended with nutritional supplements in tube. | Higher doses (15/20mg) require administration with food. | N/A. |
Important Safety Precautions
Several precautions are necessary when administering Eliquis via a G tube:
- Do not double a dose: If a dose is missed, take it the same day if possible, but do not take two doses at once.
- Ensure proper tube placement: Verify the G tube is in the stomach before giving medication.
- Avoid mixing with feeds: Interrupt continuous enteral feeding around the time of administration.
- Monitor for bleeding: Be aware of the increased risk of bleeding and report any signs to a healthcare provider.
- Consult a professional: Always consult a healthcare provider before changing medication administration methods.
Conclusion
Administering Eliquis via a G tube is a viable option for patients unable to swallow tablets. The tablets must be crushed and suspended in water or D5W and delivered directly to the stomach. Proper technique, including flushing the tube and avoiding mixing with nutritional supplements, is essential for maintaining the drug's effectiveness and patient safety. Always follow healthcare provider instructions and manufacturer guidelines.
