1. Medication Considerations for Individuals with Ostomies
Colleen O’Connell, PharmD
TMC Pharmacist
September 25, 2016

2. Objectives Describe potential medication concerns with ostomies
List factors that influence medication availability and absorption with ostomies
Review important medication considerations with ostomies

3. Ileostomy vs. Colostomy
Explain the two types of ostomies briefly and why it affects medication absorption.
From TUCSON Support Group: (
What is an Ostomy? An ostomy is a surgically-created intestinal or urinary tract diversion that modifies the normal pathway for  waste elimination. In a classical ostomy, an opening called a "stoma" is made through the abdominal wall  and the patient must usually wear an appliance (plastic bag) to collect waste that flows out from the stoma  (stoma is derived from the Greek for "mouth"). An ostomy may be temporary or permanent. There are  three kinds of classical ostomies: Colostomy An abdominal opening from any part of the large intestine (colon), made because part of the colon has  been removed or must be bypassed. The most common type is a sigmoid colostomy, where only the  rectum has been removed or must be bypassed, and the stoma is usually on the lower-left abdomen.  Output from a sigmoid colostomy has nearly the same consistency as normal stool because it has passed  through the whole small intestine and most of the large intestine. Colostomies of this type are often  managed successfully with irrigation (enemas through the stoma). Colostomies from the transverse or  ascending colon have a less solid output--more like an ileostomy. Ileostomy An abdominal opening from the terminal small intestine (ileum), made because the entire colon has been  removed or must be bypassed. An ileostomy stoma is usually on the lower-right abdomen. Its output has  passed through all or most of the small intestine, but none of the large intestine; consistency of this output  may vary from very liquid to a semi-solid paste. Ileostomies are never managed with irrigation.

4. Potential Medication Concerns
Medications in stoma output
Laxative ingredients in medications
Medications not absorbed
Medications with side effects
Other concerns?
Ask audience what types of problems they have with medications and ostomies

5. Individual Factors The type of stoma
More ileum lost = absorption
The amount of small bowel that remains and the quality of the remaining bowel
Descending/sigmoid colostomies have the same medication absorption as patients without stomas

6. Individual Factors The type and volume of stoma output
Intestinal content transit times
Medication forms
Tablets, liquids, sublingual, topical, injections
Size of the tablet

7. Specific Medication Considerations
Avoid enteric-coated and slow-release medications
Avoid laxatives
Sorbitol, found in liquid formulations, should be avoided as it is has a laxative effect
Bowel preparations to cleanse the bowel are not needed
Clear liquids for 24 hours prior to procedures
Bowel cleanses and laxatives risk of electrolyte imbalances

8. Specific Medication Considerations
Suitable medication forms include solutions, suspensions, gelatin capsules, and uncoated tablets
Should also consider sublingual and transdermal
Simethicone and Beano can reduce gas production related to the breakdown of complex sugars
Act faster, more guaranteed absorption

9. Specific Medication Considerations
Detailed individual assessment is important especially if you have epilepsy, chronic pain, or Parkinson’s disease
Specific drugs with documented absorption
Oral contraceptives
Digoxin
Levothyroxine
Mesalamine
Monitor medication levels as appropriate

10. Helpful Medication Tips
Inform each provider that you have an ostomy
Look for remnants of undigested medications when you empty your pouch and report what you observe (if present)
Do not crush pills unless a doctor or pharmacist says it is okay

11. Resources United Ostomy Associations of America
Ostomy Support Group of Tucson, AZ
tml
Are there any other resources that you use?

12. Summary
Factors that affect medication availability and absorption include:
Stoma type, quality and quantity of small bowel, and medication forms
Avoid enteric-coated and slow release medications and laxatives
Use liquids, sublingual, or transdermal medication delivery forms if possible
ONLY use Sorbitol-free liquids (mention when speaking)

13. References
Moore S. Medication absorption for patients with an ileostomy. Br J Nurs. 2015;24(5):S12-5.
Turnbull GB. The issue of oral medications and a fecal ostomy. Ostomy Wound Manage. 2005;51(3):14, 16.
United Ostomy Associations of America, Inc. Diet and Nutrition Guide uide.pdf?direct=1. Accessed May 19, 2016.
Ostomy Support Group of Tucson, Arizona. Accessed May 19, 2016.
United Ostomy Associations of America, Inc. Accessed May 19, 2016.
Medications and your Ostomy. Stomawise. The Ostomy Support Charity. and-your-ostomy. Accessed May 19, 2016.

14. Questions?