From North Central Oklahoma Ostomy Outlook May 2008:

Drug Therapy For The Ostomate

by John J. Wroblewsky, RPh; via Ostomy Management and Evansville (IN) Ostomy News

The most well-adjusted ostomate can run into trouble when he or she starts taking medication. The potential of side effects or adverse reaction increases as the number of medications the patient is taking goes up. Compounding the risk is that consumers today are turning to over-the-counter medication and are prescribing for themselves to offset rocketing health-care costs. A few basic principles of drug use are, therefore, important to keep in mind.

A drug can’t do any good unless it gets to its target organ. This simple idea is all that’s behind the concept of bio-availability. In almost every case, a drug must be absorbed into the systemic circulation before it can exert a therapeutic effect. Since drugs are absorbed primarily through the intestines, ostomates can be at a particular disadvantage.

Many factors influence the absorption of drugs. These factors include the chemical nature of the drug, the dosage form in which it is introduced into the system, and the condition of the patient who is taking the drug. Iron, for instance, is absorbed in the duodenum, and vitamin B12 in the terminal ileum. While the chemical nature of most drugs allows absorption along a significant length of the intestinal tract, the shorter the functional intestine, the less will be absorbed. Only a very few drugs, such as alcohol, can be absorbed to any great extent through the stomach.

Another chemical factor involved in bio-availability is the intrinsic solubility of the drug. Some drugs are rather insoluble in the digestive juices and absorption into the bloodstream will vary greatly, even in patients with an intact bowel. Clearly, a patient with a shortened ileum is at risk for mal-absorption of any poorly absorbed drug.

The dosage form, too, is a major factor in bio-availability. As a general rule, the smaller the particle size provided to the GI tract, the easier it is absorbed. True solutions have the best bio-availability by the oral route and suspensions are almost as good. Chewable tablets have a pretty good record if they are chewed well; in most cases they are better than capsules or compressed tablets.

Ostomates who have had a significant portion of their intestine removed may achieve better absorption by emptying the contents of a capsule into applesauce, or crushing a compressed tablet and adding the powder to food.

A word of caution though—not all tablets can be safely crushed, and not all capsules should be emptied. Generally speaking, time release tablets should not be crushed, nor should time release capsules be emptied. The result could be 12 to 24 hours worth of medication being released all at once.

Certain drugs can react chemically with foods. Tetracycline is notorious for combining with heavy metals and with ions such as calcium which is present in milk, yogurt, ice cream and other dairy products.

Enteric-coated tablets should never be crushed. The reason those tablets are coated is to prevent acid degradation in the stomach or to protect the mucosa from irritation. Enteric-coated tablets are a poor choice for ostomates. Entire tablets have been recovered intact in an ostomy pouch.

A patient’s diet can affect the drug absorption too, either by absorption of the medication into the food, chemical interaction, or by delaying gastric emptying. Since many drugs are affected by acid, prolonged exposure to stomach acid may decompose the medication.

Physicians, pharmacists and especially enterostomal therapists have an important role in educating ostomy patients so they’ll know what to expect and avoid in drug therapy. Ostomates owe it to themselves to be informed and alert, to minimize risks and to ask when there remains the slightest doubt.

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This page last revised 2008-05-11
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