Administration of Carbatrol to children with feeding tubes

An extended-release formulation of carbamazepine (Carbatrol) might be suited for administration through feeding tubes because 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. The purpose of this study was to determine if a protocol could be developed to administer Carbatrol without occlusion of the tubes. We administered the granules through feeding tubes to six children. Ten milliliters of water was used to flush the tube before administration. One capsule of Carbatrol was added to the 15 mL of liquid followed by an additional 10 mL water flush. For four children, 152 of 154 doses were administered without difficulty; however, two children were withdrawn from the study because of frequent tube occlusions. No adverse experiences occurred other than tube occlusion. The two children with frequent tube occlusions had long-standing problems with constipation or rigidity, which may have increased intra-abdominal pressure and slowed the rate of administration. We conclude that the use of Carbatrol granules for children with feeding tubes can be useful. However, some children are prone to frequent occlusion.