Abstracts

RATIONALE: The availability of extended-release formulations has contributed significantly to improved management of epilepsy and may contribute to improved seizure control, reduced clinical toxicity, and improved compliance. Of the two available extended release formulations, Carbatrol[tm] might be suited for administration through feeding tubes as the capsules can be pulled apart to release the small granules. However, after encouraging several parents to use the new formulation, we were informed that the drug occluded some tubes. We have performed a series of in vitro tests during which we ran the drug through various sizes and types of tubes, and suspended the medication in differing fluids. These tests in the laboratory demonstrated that tube occlusion could be avoided by suspending the granules in cold water or apple juice and rapidly administering.
METHODS: We have administered the granules through feeding tubes to five children. 10cc[ssquote]s of water was used to flush the tube before administration. One capsule of Carbatrol[tm] (200mg) was added to the feeding (15 mL) followed by an additional 10cc water flush.
RESULTS: For three children, minimal problems have occurred. In these three children, 152 out of 154 doses were given without occlusion. In the other two children, occlusions occurred in more than half of the administrations (failing in 12 of 20 doses). In one child, this formulation is no longer used. There were no adverse experiences identified other than tube occlusion in any child. The two children with frequent tube occlusions had long standing problems with constipation or rigidity which may have increased intrabdominal pressure and slowed the rate of administration.
CONCLUSIONS: Use of Carbatrol[tm] granules for children with feeding tubes can be useful. Occlusion frequently occurs in some children however.