Nutrition Initiation and Advancement Clinical Pathway — PICU/PCU

Enteral Medications Requiring Holding of Feeds

Enteral Medications That Require Holding of Enteral Feeds

Medication	Rationale	Duration
Levothyroxine	Decreased medication absorption	Hold continuous feeds 30 minutes before and after administration of medication
Phenytoin	Decreased medication absorption and sub-therapeutic concentrations	Hold continuous feeds 2 hours before and after administration of medication
Rifampin	Decreased medication absorption	Hold continuous feeds 30 minutes before and after administration of medication

Enteral Medications That May Require Holding of Enteral Feeds

Medication	Rationale	Duration
Amoxicillin	Decreased medication absorption. May consider holding feeds if clinical effect is not achieved.	Hold continuous feeds 30 minutes before and after administration of medication
Ciprofloxacin
Doxycycline	Decreased serum concentrations. Noted to have increased GI side affected if administered on an empty stomach, but may consider holding feeds if clinical effect is not achieved.
Isoniazid
Levofloxacin	Decreased medication absorption. May consider holding feeds if clinical effect is not achieved.
Sirolimus *	Ingestion with high-fat meals decreases peak concentrations but increases AUC by 35%	Continue home feed regimen with medication administration. Consider holding continuous feeds 30 minutes before and after administration of medication
Tacrolimus *	Decreased medication absorption and sub-therapeutic concentrations
Warfarin *
*Patient specific recommendation. Some patients require holding of feeds for 30 minutes before and after administration to assist in preventing erratic levels. Determination of need to hold feeds is patient specific. Recommendation: to continue with home feeding regimen unless noted to have erratic therapeutic drug concentrations. Check Lexicomp for updates.

Consult the CHOP Formulary for additional administration guidelines and additional medications that require feeds to be held prior to administration.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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