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Tafinlar & Mekinist

Tafinlar & Mekinist

Posted By
Donna C
12/16/2019 11:37am
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Replies: 11

Looking for any help with giving Tafinlar and Mekinist Targeted drugs through a G-tube feeding tube. We are aware that they are supposed to be given on an empty stomach as well as not crushed. Pharmacist at hospital and doctor are aware that we are crushing and giving with a tablespoon of applesauce through the tube. My concern is that they aren't effective like this OR harmful? Has anyone any insight or experience?

Bubbles - (12/16/2019 - 12:11pm)

Through the years we have had several patients who had to take their meds in this manner due to their status, Donna. I have no reason to think they would be harmful in that circumstance. You could make a biochemical argument that they are less effective when administered as you are. However, the patients that took them in that manner did respond and not taking them at all will certainly garner NO response so sometimes working with "the good" is better than "the perfect". Sorry you have to deal with this at all. Wishing you my best. celeste

Donna C - (12/17/2019 - 9:59am)

Thank you for responding! Ive spent the day on the phone, finally heard from an oncology pharmacist....My understanding now is that when crushing we are possibly crushing the binders in the pill and this could make it "stronger" or more toxic ...........found out that we can maybe do blood tests to see how much is being absorbed ? Feel like everything is a crapshoot!

Bubbles - (12/17/2019 - 10:17am)

My response should have been that giving them in that manner might make them "less or more effective"! Glad someone with more definitive knowledge got back to you. Yes, melanoma doesn't make anything easy in any way does it???? Sorry you are having to make such choices. I wish you my best. Celeste

gopher38 - (12/17/2019 - 10:41am)

Dumb question, but shouldn't there be a professional to help with this? Do you live in a very isolated area?

Donna C - (12/17/2019 - 11:24am)

Not dumb! Actually we are in Chicago at one of the best hospitals........But because of the manufacturers guidelines there isn't any way to do this according to them through a gtube. But because this is our only option with these drugs we need to do it..... I have found that other patients and caregivers sometimes have the best solutions or ideas

Dwright - (12/17/2019 - 4:17pm)

Hi Donna,

Sorry you are dealing with this added barrier into already trying to fight melanoma. I'm a Speech-Language Pathologist (SLP) and work on a daily basis with patients who have tube feedings for a wide variety of reasons (almost exclusively due to complications with their ability to adequate protect their airway when they swallow foods and liquids). There are occasionally rare cases where a patient who cannot take anything by mouth (food, liquids, medications), that the doctors will beg us to accelerate our recommendations to allow for medications to be taken orally, usually because a certain medication may only come in solid form and cannot be manipulated (crushed, liquified, etc.). At that point, we'll usually revisit or perform new diagnostic imaging swallowing tests specifically for the purpose of testing the feasibility of administering the medications whole by mouth. I won't begin to make any assumptions as to why a tube has been placed, and the severity of the condition with the upper or lower alimentation (swallowing/digestive) tract. But I do know there have been times when we have needed to keep patients NPO (no foods or liquids by mouth), but we will make the exception under the most strict of circumstances with very strict instructions for safety to provide medications orally. Maybe you've already explored this possibility, but just in case you haven't, I wanted to highlight that this does and can happen.

All the best,
Derek

Dwright - (12/17/2019 - 4:20pm)

What I meant to say is I won't begin to make assumptions IN YOUR PERSONAL CASE as to why a tube has been placed, and the severity of your condition with the upper or lower alimentation tract. If you read that another way, it makes it sound like that would be the approach I would take with all of my patients, and that would make me a terrible clinician. Sorry for posting too quickly without editing. : )

Donna C - (12/17/2019 - 4:35pm)

Thank you for your input!!!! I figured there are others out there with this issue!. The doctor spoke to our speech therapist today in fact, to revisit a swallow study to see if there have been some improvements so swallowing the pills safely might be an option.......Right now, applesauce and nectar liquids are approved in small amounts for therapeutic reasons, not caloric.

Dwright - (12/18/2019 - 9:13am)

If there is a recreational diet order in place (like what you have described, a few simple items for pleasure/quality of life), then I would push to get clearance by the SLP and MD for the meds to be taken orally, maybe with a sip of nectar thickened liquids. Very best of luck to you!!!

Dwright - (12/18/2019 - 9:13am)

If there is a recreational diet order in place (like what you have described, a few simple items for pleasure/quality of life), then I would push to get clearance by the SLP and MD for the meds to be taken orally, maybe with a sip of nectar thickened liquids. Very best of luck to you!!!

marta010 - (12/18/2019 - 10:44am)

Hi Donna - my husband had a feeding tube placed while he was taking Zelboraf. We crushed the tablets and added to liquid through the feeding tube. At the time, his oncology/pharmacy team wasn't sure how the efficacy would be affected but we really didn't have any other choice as he was unable to swallow much more than tiny sips of water. No way he was downing any meds by mouth at that time.

Ann