Ensure Clear

There are 0 contraindications.

There are 0 severe interactions.

There are 1 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Selected Quinolones/Enteral Nutrition SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Absorption of orally administered quinolones may be decreased with concurrent enteral nutrition administration. CLINICAL EFFECTS: Administration of a quinolone during enteral nutritional therapy may result in a decrease in clinical effect of the quinolone as a result of lower serum and urine levels. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Quinolone blood levels should be carefully monitored if the patient is receiving concurrent enteral nutrition. An alternate antibiotic agent may need to be considered. DISCUSSION: In a study, concurrent administration of ciprofloxacin, levofloxacin, and ofloxacin with Ensure resulted in average decreases in quinolone serum levels of 82.5%, 61.3% and 45.7% respectively.(1) In another study, concurrent Ensure reduced the percent of relative bioavailability of ciprofloxacin significantly more than ofloxacin.(2) In a study in 26 hospitalized patients, administration of ciprofloxacin via jejunostomy tube with an enteral formula decreased ciprofloxacin mean bioavailability by 67%.(3) Conversely, a study showed that ciprofloxacin is well absorbed after administration via a nasogastric tube in the presence of enteral feeding compared with an orally administered tablet.(4) Gatifloxacin administration with concomitant gastric tube feeding did not affect gatifloxacin bioavailability, but critical illness resulted in significant variability in bioavailability.(5) Conversely, administration with Ensure significantly decreased gatifloxacin maximum concentration (Cmax) by 44.6%, time to reach Cmax (Tmax) by 60%, area-under-curve (AUC) by 26.2%, and relative oral bioavailability by 26%.(6) In a study, the oral bioavailability of moxifloxacin administered as a crushed tablet was not affected by concomitant enteral feeding through a nasogastric tube.(7) The relative bioavailability of temafloxacin was not affected by enteral nutrition.(8)	BAXDELA, CIPRO, CIPROFLOXACIN, CIPROFLOXACIN HCL, GATIFLOXACIN SESQUIHYDRATE, LEVOFLOXACIN, OFLOXACIN

Drug Interaction

Drug Names

Selected Quinolones/Enteral Nutrition

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Absorption of orally administered quinolones may be decreased with concurrent enteral nutrition administration.

CLINICAL EFFECTS: Administration of a quinolone during enteral nutritional therapy may result in a decrease in clinical effect of the quinolone as a result of lower serum and urine levels.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Quinolone blood levels should be carefully monitored if the patient is receiving concurrent enteral nutrition. An alternate antibiotic agent may need to be considered.

DISCUSSION: In a study, concurrent administration of ciprofloxacin, levofloxacin, and ofloxacin with Ensure resulted in average decreases in quinolone serum levels of 82.5%, 61.3% and 45.7%

respectively.(1) In another study, concurrent Ensure reduced the percent of relative bioavailability of ciprofloxacin significantly more than ofloxacin.(2) In a study in 26 hospitalized patients, administration of ciprofloxacin via jejunostomy tube with an enteral formula decreased ciprofloxacin mean bioavailability by 67%.(3)

Conversely, a study showed that ciprofloxacin is well absorbed after administration via a nasogastric tube in the presence of enteral feeding compared with an orally administered tablet.(4) Gatifloxacin administration with concomitant gastric tube feeding did not affect gatifloxacin bioavailability, but critical illness resulted in significant variability in bioavailability.(5) Conversely, administration with Ensure significantly decreased gatifloxacin maximum concentration (Cmax) by 44.6%,

time to reach Cmax (Tmax) by 60%, area-under-curve (AUC) by 26.2%, and relative oral bioavailability by 26%.(6) In a study, the oral bioavailability of moxifloxacin administered as a crushed tablet was not affected by concomitant enteral feeding through a nasogastric tube.(7) The relative bioavailability of temafloxacin was not affected by enteral nutrition.(8)

BAXDELA, CIPRO, CIPROFLOXACIN, CIPROFLOXACIN HCL, GATIFLOXACIN SESQUIHYDRATE, LEVOFLOXACIN, OFLOXACIN

ENSURE CLEAR (lactose-free food)