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An ostomy can have profound effects on an individuals daily activities, diet and even medication regimen. An individual dealing with an ostomy (an ostomate) must be very careful with their use of over the counter and prescription medications in order to ensure effectiveness of that medication as well as to prevent complications/ side effects.

There are three main types of ostomies:

•ileostomy – a portion of the small intestine is rerouted/ removed
•colostomy – a portion of the large intestine/ colon is removed or rerouted
•urostomy – a portion of the urinary tract is removed or rerouted

Generally, individuals with an ileostomy must be much more cautious when it comes to their medications compared to individuals with a colostomy or urostomy. As a result this article will focus mainly on medications and how they affect and are affected by an ileostomy.

In an ileostomy an ostomate has had a portion of their small intestine removed or rerouted. The small intestine is responsible for the greatest absorption of nutrients and medications. You can imagine that by removing this important organ it will have a huge effect on the absorption and therefore effectiveness of certain medications. In particular many coated or delayed/ controlled release drugs may pass through the shortened small intestine without actually being absorbed. Individuals with an ileostomy may notice that these controlled release drugs will actually pass through their digestive system and appear unchanged in their ostomy pouch.

In order for a medication to be absorbed it must first be broken down into a liquid/ gel form. If this does not happen before passing out of the body it will not be absorbed and will not produce its desired effects on the body. There are certain instances where this process can be sped up in an ostomate by crushing the medication and preparing it in a liquid suspension. This compounded suspension is ready for absorption immediately once it hits the digestive tract improving the likelihood that the medication will be absorbed and do its job. However, it is extremely important that you do not crush, split or alter any medication without first checking with your pharmacist or doctor. There 3 reasons why certain medications must not be crushed or split:

•Certain medications come in higher doses that are intended to be released very slowly over a long period. If these medications are crushed that large dose is released all at once resulting in potential toxicity/ overdose.
•Other medications have a coating on them that help prevent the medication from irritating the stomach. When this coating is removed the medication inside comes into contact with the stomach lining causing unnecessary irritation and stomach upset.
•Lastly, Some medications have a coating that protect the medication from being destroyed by the stomach acid. If this coating is broken the medication will be easily broken down in the stomach and will not work.

Laxatives and other medications that can cause diarrhea are usually avoided in individuals with an ostomy unless otherwise directed by your physician. Laxatives can speed the rate at which the medication is cleared from the digestive system, therefore reducing its absorption. Laxatives may also cause fluctuations in an ostomates vital fluids and electrolytes.

In general immediate release formulations of medications such as suspensions, liquids, gel capsules and uncoated tablets are the best route of administration for any ostomate. As a general rule of thumb, if a tablet is placed into a glass of water and begins to dissolve within 30mins there is a good chance that this medication will be absorbed and produce its desired effects even in an individual with an ileostomy.

If you or a loved one is living with an ostomy always make sure that your physician and pharmacist are aware. If they are aware of your situation they will be able to select a better medication regimen specifically for you. Talk to a Boggio Family of Pharmacies pharmacist today to make sure your medications are safe and effective for your unique situation.

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