Your Trusted Guide to Medications with Special Handling

[Off-label] Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Open the capsule and carefully pour the powder contents into a disposable medicine cup. 4. Add 15mL of Water for Injection, and stir to disperse the powder. 5. Draw the liquid into an appropriate syringe (eg. 20mL Terumo syringe) and administer via the feeding tube. 6. Add another 15mL Water for Injection to the medicine pot. Stir to ensure that any powder remaining in the pot is mixed with water. 7. Draw up this dispersion and flush down tube. This will ensure that the whole dose is given. 8. Finally, flush with the recommended volume of water.

[Off-label] Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

[Off-label] Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water. 8. Dispose the syringe as cytotoxic waste.

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

1. Tablets should NOT be used to prepare Cyclosphosphamide solution for tube feeding. Instead, Cyclophosphamide (Endoxan) 1g injection vial should be used to form oral solution for administration

2. Oral solution to be prepared by Pharmacy Lab. Please contact the ward pharmacist or call Pharmacy Lab for more information Info for Pharmacy Lab (Use of Reconstituted Cyclophosphamide Solution for Oral Administration)- Reconstitute Cyclophosphamide 1g injection vial with 100mL of 0.9% Sodium Chloride (NS) to form a solution with final concentration of 10mg/mL- Reconstituted solution (with NS) is stable for up to 24 hours at room temperature, and up to 6 days when refrigerated at 2 -8°CReferences:(i) Email Correspondence with Baxter (Oct 2015); (ii) Cyclophosphamide Prescribing Information - Baxter (accessed from FDA)

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

Note: administer the disperson immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Open the capsule and carefully pour the powder contents into a disposable medicine cup. 4. Add 15mL of Water for Injection, and stir to disperse the powder. 5. Draw the liquid into an appropriate syringe (eg. 20mL Terumo syringe) and administer via the feeding tube. 6. Add another 15mL Water for Injection to the medicine pot; Stir to ensure that any powder remaining in the pot is mixed with water. 7. Draw up this dispersion and flush down tube. This will ensure that the whole dose is given. 8. Finally, flush with the recommended volume of water. 9. Dispose the syringe as cytotoxic waste.

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush. this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water. 8. Dispose the syringe as cytotoxic waste.

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

Potentially teratogenic based on animal studies. Absorption of molnupiravir through the skin is not likely based on its PK properties, but pregnant women are advised to avoid direct handling of opened capsules to minimise risk of exposure.

[Off-label]

Note: administer the suspension immediately after preparing

Preparation of oral suspension dose for NGT administration

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water.

2. Gloves and mask should be worn in case of accidental spillage and exposure.

3. Open the capsules and carefully transfer contents into a clean cup. Discard empty capsules.

4. Add approximately 40mL of water to the plastic cup.

5. Mix/stir the capsule contents and water for 3 minutes. NOTE: the prepared mixture may have visible undissolved particulates and are acceptable for administration. This is because capsule contents may not dissolve completely.

6. Using a Terumo syringe, draw up entire contents of the plastic cup and administer immediately through the NGT.

7. If any portion of the capsule contents are left in the cup/syringe, add 10 mL of water to the cup/syringe, mix, and administer again through the NGT.

8. Repeat steps 6 to 7 as needed until no capsule contents are left in the cup or syringe.

9. Flush the NGT with 5 mL of water twice (10 mL total) after administration of the mixture.

References:

1) FDA Emergency Use Authorisation (Lagevrio) & Merck Lagevrio Fact Sheet, 2023

Last updated: 4 Jul 2023

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

[Off-label] Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush. this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water. 8. Dispose the syringe as cytotoxic waste.

Note: the manufacturer does not suggest opening the capsule or crushing the tablets for administration. Some degree of drug loss and/or altered pharmacokinetics may be anticipated. Depending on the indication, please first consult the primary team or Drug Information service on the suitability of doing so.

[Off-label]

Note: administer the dispersion immediately after preparing. Pregnant nurses or nurses who may be pregnant are not to prepare MMF for administration.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water.

2. Gloves and mask should be worn in case of accidental spillage and exposure.

3. Open the capsule and carefully pour the powder contents into a disposable medicine cup.

4. Add 15mL of Water for Injection, and stir gently to disperse the powder.

5. Draw the liquid into an appropriate syringe (eg. 20mL Terumo syringe) and administer via the feeding tube.

6. Add another 15mL Water for Injection to the medicine cup; stir to ensure that any powder remaining in the cup is mixed with the water.

7. Draw up this dispersion and flush down tube. This will ensure that the whole dose is given.

8. Finally, flush with the recommended volume of water.

Note: the manufacturer does not suggest opening the capsule or crushing the tablets for administration. Some degree of drug loss and/or altered pharmacokinetics may be anticipated. Depending on the indication, please first consult the primary team or Drug Information service on the suitability of doing so.

[Off-label]

Note: administer the dispersion immediately after preparing. Pregnant nurses or nurses who may be pregnant are not to prepare MMF for administration.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water.

2. Gloves and mask should be worn in case of accidental spillage and exposure.

3. Gently wet the tablet before pounding to crush (to minimise dispersion of free powder from dry tablet).

4. Transfer the crushed tablet/powder into a medicine cup. Add 15mL of Water for Injection into the medicine cup and stir gently to disperse the powder.

5. Draw the liquid into an appropriate syringe (eg. 20mL Terumo syringe) and administer via the feeding tube.

6. Add another 15mL Water for Injection to the medicine cup; Stir to ensure that any powder remaining in the cup is mixed with the water.

7. Draw up this dispersion and flush down the tube. This will ensure that the whole dose is given.

8. Finally, flush the tube with the recommended volume of water.

[Off-label]

Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Place the tablet in the barrel of an appropriate size and type of syringe (eg. 20mL Terumo syringe). 4. Draw 10mL of Water for Injection into the syringe and allow the tablet to dissolve, shaking if necessary. 5. Flush the medication dose down the feeding tube. 6. Draw another 10mL of Water for Injection into syringe and flush this via feeding tube (this will rinse the syringe and ensure that total dose is administered). 7. Finally, flush with the recommended volume of water.

Note: Manufacturer does not suggest opening of capsules as there are no available PK studies to support extemporaneous oral formulation of immediate-release tacrolimus (email correspondence with Prograf, Astellas Pharma 2020)

[Off-label]

Note: administer the dispersion immediately after preparing. DO NOT USE PVC containing tube, syringe or cup to prepare/administer tacrolimus products e.g. Ryle's brand. Administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Open the capsule and carefully pour the powder contents into an appropriate-sized Terumo syringe (e.g. 20mL). 4. Add 15mL of Water for Injection into the syringe, and shake gently to disperse the powder. 5. Administer the mixture in the syringe via the feeding tube. 6. Add another 15mL Water for Injection to the Terumo syringe and shake gently to ensure that any powder remaining in the syringe is mixed with water. 7. Flush the water in the syringe down the tube. This will ensure that the whole dose is given. 8. Finally, flush the tube with the recommended volume of water.

[Off-label] Note: administer the dispersion immediately after preparing.

1. Stop enteral feed. Flush the enteral feeding tube with the recommended volume of water. 2. Gloves and mask should be worn in case of accidental spillage and exposure. 3. Open the capsule and carefully pour the powder contents into a disposable medicine cup. 4. Add 15mL of Water for Injection, and stir to disperse the powder. 5. Draw the liquid into an appropriate syringe (eg. 20mL Terumo syringe) and administer via the feeding tube. 6. Add another 15mL Water for Injection to the medicine pot. Stir to ensure that any powder remaining in the pot is mixed with water. 7. Draw up this dispersion and flush down tube. This will ensure that the whole dose is given. 8. Finally, flush with the recommended volume of water.