Generally, people with descending or sigmoid colostomies absorb medications as well as people who do not have an ostomy. However, some medications (eg, enteric-coated tablets, time-release products, or large tablets) are designed for gradual absorption along the full length of the intestine (the ileum and the colon). If transit time is reduced/increased and/or portions of the bowel have been removed, these medications can be incompletely and erratically absorbed, especially in persons with an ileostomy. Erwin-Toth and Doughty1 recommend teaching patients to evaluate tablets at home by placing the tablet in a glass of water and recording the amount of time it takes for the tablet to begin to dissolve. If the tablet begins to dissolve in 30 minutes, most likely it can be adequately absorbed in the body. Patients should be instructed not to crush tablets without first checking with the pharmacist because the practice may expose the medication to gastric fluids, which could cause gastric upset or inactivate the drug.1 Medication forms more suitable to people with an ileostomy include prompt-acting formulations such as solutions, suspensions, gelatin capsules, and uncoated tablets.2 Patients should be taught to look for remnants of unabsorbed medications when they empty their pouch and report what they observe to their physician who, if necessary, can prescribe the drug in an alternate, more suitable form. Most antidiarrheal and antibiotic medications are available as liquids and may be recommended initially to ensure the full intended effect of the drug2 rather than waiting to discover the tablet form is not being absorbed.
