What should be considered when choosing the dose of an enterally administered drug?

When selecting the dose of an enterally administered drug, it is crucial to consider the first-pass effect on drug metabolism. The first-pass effect refers to the phenomenon where a drug is metabolized at a specific site, typically the liver, before it reaches systemic circulation. This can significantly reduce the bioavailability of the drug when it is delivered via the enteral route.

For drugs that undergo extensive first-pass metabolism, a higher dose might be required to ensure that an adequate amount of the drug reaches the bloodstream and exerts its therapeutic effect. Understanding the extent to which a drug is metabolized by the liver helps healthcare providers adjust the dosing appropriately to achieve the desired plasma concentration. This aspect is especially important in neonatal and pediatric populations, where metabolic rates can differ considerably from older populations.

Considering the first-pass effect is particularly relevant for drugs that are highly lipophilic or have significant first-pass metabolism, influencing how much of the administered dose will ultimately be available to the patient. Therefore, encompassing the first-pass effect is vital when determining the effective dose of an enterally administered medication.