Clearly, a patient with a shortened ileum is at risk for mal- absorption of any poorly absorbed drug. The dosage form, too, is a major factor in bio-availability. As a general rule, the smaller the particle size provided to the GI tract, the easier it is absorbed. True solutions have the best bio-availability by the oral route and suspensions are almost as good. Chewable tablets have a pretty good record if they are chewed well; in most cases they are better than capsules or compressed tablets.
Ostomates who have had a significant portion of their intestine removed may achieve better absorption by emptying the contents of a capsule into applesauce, or crushing a compressed tablet and adding the powder to food. A word of caution though - not all tablets can safely be crushed, and not all capsules should be emptied. Generally speaking, timed release tablets should not be crushed, nor should time released capsules be emptied. The result could be 12 to 24 hours worth of medication being released all at once. Certain drugs can react chemically with foods.
Tetracycline is notorious for combining with heavy metals and with ions such as calcium, which is present in milk, yogurt, ice cream and other dairy products. Enterec-coated tablets should never be crushed. The reason those tablets are coated is to prevent acid degration in the stomach or to protect the mucosa from irritation. Enteric-coated tablets are a poor choice for ostomates. Entire tablets have been recovered intact in an ostomy bag. A patient's diet can affect the drug absorption too, either by absorption of the medication onto the food, chemical interaction, or by delaying gastric emptying time. Since many drugs are affected by acid, prolonged exposure to stomach acid may decompose the medication. Physicians, pharmacists and especially enterostomal therapists have an important role in educating ostomy patients so they'll know what to expect and avoid in drug therapy. Ostomates owe it to themselves to be informed and alert, to minimize risks and to ask when there remains but the slightest doubt.
