Question

What are the advantages of tablets, capsules, or liquids? Which medications should not be diluted in 15 to 30 mL of water for tube feedings?

Answer 1

Q1) What are the advantages of tablets, capsules, or liquids

A) Tablets and Capsules

A well-made tablet or capsule provides a very effective delivery system, making it the chosen form of most pharmaceutical medications. This is because years of carefully controlled clinical studies have confirmed they’re reliable, efficient delivery systems for medications.

These products can also provide an increased amount of active ingredient (much more than a liquid, gel, or gummy). This results in fewer excipients. An excipient, is an ingredient that does not serve an active nutritional purpose. They may be included for stability, digestibility, manufacturing, or other similar purposes.

In general, the stability and shelf-life of tablets are also superior to liquids or gummy vitamins.

Tablets and capsules are best used for vitamin, mineral, and antioxidant supplements that do not need large (> 2 grams) doses. Vitamin C, B vitamins, iron, iodine, etc., all have typical daily doses small enough to easily be included. Many of these nutrients also have a bad taste that can be difficult to hide in other forms.

Tablet and Capsule Pros:

Long shelf-life

Concentrated delivery of active ingredients (fewer excipients)

Hides bad tastes

Tablet and Capsule Cons:

Difficult for some to swallow

Not appropriate for large active ingredient doses

Chewable Tablets

Like other tablets, chewables are best used for ingredients only taken in smaller (< 2 grams) doses. They also share the benefit of a long shelf-life. Chewables may be the best supplement for those who have trouble swallowing whole tablets or capsules.

Because the tablets are chewed up, bad-tasting ingredients must be masked with sweeteners and flavorings. This limitation means chewable tablets typically have some sugar in them. Some chewable multi-vitamin, multi-mineral products are also missing essential minerals—like selenium, chromium, magnesium, and zinc—because it is hard to mask their flavors.

Chewable Tablet Pros:

Easy to consume

Long shelf-life

Chewable Tablet Cons:

Not as concentrated as swallowed tablets

May be missing key ingredients

Added sweeteners (although typically very small amounts)

Gummy Vitamins

Gummy vitamins, like chewable tablets, are much better tasting for children and those who have trouble swallowing tablets. Despite their taste, gummy vitamins are not candy and should not be taken beyond the recommended dosage.

They are even more limited than chewable tablets in what types of ingredients they can contain. Gummies often have very few minerals, and most essential minerals are usually absent. For the ingredients they do contain, doses are often much smaller, as well.

The best uses for gummy vitamins are typically select ingredients that are compatible with gummy vitamins, that only need to be taken in very small doses (< 100mg).

Gummy Pros:

Easy to consume

Great tasting

Gummy Cons:

Not compatible with many ingredients

Added sweeteners

Liquids

Liquid supplements generally have the same types of ingredients, benefits, and drawbacks as powdered supplements. The one difference is they are already mixed with a liquid.

Liquid supplements are best for ingredients often found in powders, like protein, branched chain amino acids (BCAAs), creatine, and caffeine. Micronutrients often found in liquid supplements include most vitamins and minerals, and other antioxidants.

Since they are already mixed, liquid supplements typically have a shorter shelf-life than their powdered equivalent. Liquid supplements may also require many more “other” ingredients. This includes emulsifiers, solvents, preservatives, stabilizing agents, coloring, flavoring, and more.

Liquids Pros:

More convenient than mixing powders

Can include large doses of active ingredients

Liquids Cons:

More expensive and difficult to transport

Difficult to add non-soluble ingredients

Less concentrated active ingredients (more excipients)

Added sweeteners and EXCIPIENTS

Q2) Which medications should not be diluted in 15 to 30 mL of water for tube feedings?

A) If the medications are needed and alternative routes of drug delivery are not options, then the medications may be given through enteral feeding tubes. Several factors should be considered before administering medications concomitantly with EN. As discussed previously, feeding tube size and placement site should be considered. Gastric access is generally preferred over jejunal administration because gastric tubes are larger and less prone to clogging and because the stomach may be more tolerant of hypertonic medications. Gastric feedings may be administered by bolus or intermittent methods; EN and medications may thus be given at separate times.

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