Giving parenteral medications po

[mustang sally]

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Just wanted to get your opinion on giving IV medications po or sublingually...is it usually okay to do so?

The main medications I have seen this done with are obviously vancomycin and also dexamethasone in children. I have tried searching for info online regarding this and the only main points I can come up with are:

a) bioavailability of the drug via the oral route
b) considerations regarding preservatives/alcohol content if it's a pediatric patient and
c) palatability

Any thoughts or experience with this?

 

[sakigt]

http://forums.studentdoctor.net/threads/iv-medications-that-can-be-given-po.1070259/

I think its fine, and in a lot of cases makes more sense than trying to split tabs. I say its fine as long as we have good data, but unfortuantly Ive only seen that for dex and vit k. Havent seen the articles for vanco po (although apparenly its ok! also I havent looked very hard). Ive read/heard/seen zofran and naloxone used po.... and interesting to see that zofran given po is meant to be absorbed and naloxone given po is meant to stay in the gut (to relieve opioid induced constipation).

Id LOOOOOVE to make a little chart saying whats ok/not ok but of all the manufacturers Ive called they have given me zero info

 

[njac]

Issue is cost.

Dex IV costs more than tablets, but in the ER with tiny kids it's easier to squirt some IV in their mouth than crush a tablet into apple sauce. I believe the oral liquid has too much ethanol.

 

[njac]

I've also done it in tiny kiddos with phenobarbital - the syrup can be a huge volume.

 

[zelman]

Name an excipient that can be given IV and not PO. I can't. Obviously there are concerns related to dosing active ingredients that have no PO formulation (dosing fosphenytoin or whatever), but if there is ANY oral form, I doubt using an IV solution would matter in 99% of cases.

One possible exception for that 1% that comes to mind are acid-labile drugs that are coated to pass through the stomach undissolved, or even one HIV med oral suspension that is reconstituted with maalox to raise pH.

 

[confettiflyer]

Issue is cost.

Dex IV costs more than tablets, but in the ER with tiny kids it's easier to squirt some IV in their mouth than crush a tablet into apple sauce. I believe the oral liquid has too much ethanol.

Yup this is the main issue I see with peds, etoh content.

 

[Dred Pirate]

Name an excipient that can be given IV and not PO. I can't. Obviously there are concerns related to dosing active ingredients that have no PO formulation (dosing fosphenytoin or whatever), but if there is ANY oral form, I doubt using an IV solution would matter in 99% of cases.

One possible exception for that 1% that comes to mind are acid-labile drugs that are coated to pass through the stomach undissolved, or even one HIV med oral suspension that is reconstituted with maalox to raise pH.

exactly - this is something I am so surprised I have to explain to new grads. If it is "clean enough" for lack of a better term for it to go in the vein, it can go in the stomach. It sure won't sure at the least.

Another one we do is zofran for peds, robinul in terms of shortage, atropine eye drops sub-lingual (although not iv)