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sodium acid phosphate (Rx)Brand and Other Names:OsmoPrep, Phospho Soda, more...sodium biphosphate, sodium phosphate, Visicol

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

aqueous solution

  • Na2HPO4/NaH2PO4
  • (48g/18g)/100mL

tablet

  • Na2HPO4/NaH2PO4
  • 0.398g/1.102g

enema

  • Na2HPO4/NaH2PO4
  • (7g/19g)/118mL
more...

Bowel Preparation for Colonoscopy

OsmoPrep: 4 tablets with 8 oz of water PO q15min (total 20 tablets) evening before procedure, & repeat regimen (12 tablets) next day 3-5 hours before procedure

Visicol: 3 tablets with 8 oz of water PO q15min (last dose 2 tablets, total 20 tablets) evening before procedure, & repeat same regimen next day 3-5 hours before procedure

Aqueous: 30-45 mL (of 48 g Na2HPO4-18 g NaH2PO4/100 mL) PO x2 10-12 hours apart; each dose with at least 8 oz liquid; each dose followed by additional minimum 16 oz liquid; 2nd dose at least 3 hours before procedure

Laxative

PR: Administer contents of 4.5 oz enema rectally as single dose

PO: Administer 15 mL as single dose qDay; not to exceed 45 mL/day

Dosage Forms & Strengths

aqueous solution

  • Na2HPO4/NaH2PO4
  • (48g/18g)/100mL

tablet

  • Na2HPO4/NaH2PO4
  • 0.398g/1.102g

enema

  • Na2HPO4/NaH2PO4
  • (7g/19g)/118mL

pediatric enema

  • Na2HPO4/NaH2PO4
  • (3.5g/9.5g)/59mL
more...

Bowel Preparation for Colonoscopy (No Standard Regimen; One Recommended)

<15 kg: 22.5 mL aqueous PO afternoon & evening before colonoscopy

≥15 kg: 45 mL aqueous PO afternoon & evening before colonoscopy

Laxative (Rectal)

<2 years: Safety & efficacy not established

2-4 years: Administer one half content of 2.25 oz pediatric enema as single dose

4-12 years: Administer contents of 2.25 oz pediatric enema as single dose

≥12 years: Administer contents of 4.5 oz enema rectally as single dose

Laxative (Oral)

<5 years: Safety and efficacy not established

5-10 years: 7.5 mL as single dose; not to exceed 7.5 mL/day

10-12 years: 15 mL as single dose; not to exceed 15 mL/day

≥12 years: 15 mL as single dose qDay; not to exceed 45 mL/day

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Interactions

Interaction Checker

sodium acid phosphate and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Possible QT interval prolongation due to electrolyte imbalance

            Aspiration

            Dizziness

            Headache

            Abdominal pain

            Vomiting

            Mucosal bleeding

            Bloating

            Colonic mucosal ulceration

            Nausea

            Electrolyte imbalance: hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia

            Metabolic acidosis, dehydration

            Acute phosphate nephropathy

            Cardiac arrythmia

            Facial edema

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            Warnings

            Black Box Warnings

            Rare reports of acute phosphate nephropathy with oral sodium phosphate products used for colon cleansing before colonoscopy

            Some cases have resulted in permanent renal function impairment requiring long-term hemodialysis

            Risk factors for acute phosphate nephropathy include age >55 yr, hypovolemia, baseline kidney disease, bowel obstruction, active colitis, and those using medicines that affect renal perfusion or function (eg, diuretics, ACE inhibitors, ARBs, NSAIDs)

            Carefully follow dosing regimen as recommended (pm/am split dose) with adequate hydration

            Contraindications

            Enema: Renal failure, CHF, ascites, obstruction, megacolon, perforated bowel, ulcerative colitis, fecal impaction

            IV: Hyperphosphatemia, hypocalcemia, hypernatremia

            Oral: Bowel obstruction, bowel perforation, gastric bypass, toxic colitis, toxic megacolon, acute phosphate nephropathy

            Cautions

            Should not be readministered for at least 7 days

            Risk of acute phosphate nephropathy

            Osmotic laxative products may produce colonic mucosal ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization

            QT interval prolongation reported

            Use caution in heart failure, unstable angina, cardiomyopathy, patients at risk for arrhythmias, patients with pre-existing electrolyte disturbances, gastric retention or hypomotility, severe chronic constipation, colitis, or ileus, chronic inflammatory bowel disease, or history of seizures

            Severe dehydration and electrolyte abnormalities associated with serious complications (eg, acute kidney injury, arrhythmias, and death) have occurred in adults and children who overdosed using oral or rectal over-the-counter (OTC) sodium phosphate solutions to treat constipation

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Draws water into the lumen of the gut where it causes osmotic effect; causes abdominal distention and promotes peristalsis and evacuation of the bowel

            Pharmacokinetics

            Onset: 2-5 min (rectal); 3-6 hr (cathartic)

            Absorption: 1-20%

            Excretion: Urine: 90%

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
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            ST Step Therapy
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