sodium sulfate/potassium sulfate/magnesium sulfate (Rx)

Brand and Other Names:Suprep, ColPrep
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Dosing & Uses

AdultPediatricGeriatric

Dosage Form & Strengths

sodium sulfate/potassium sulfate/magnesium sulfate

oral solution

  • (17.5g/3.13g/1.6g)/6 oz bottle
  • Each kit contains 2 bottles of concentrated oral solution (6 oz each) for further dilution and a mixing bottle

Bowel Prep

Indicated for cleansing of the colon in preparation for colonoscopy

Administer in a split dose (2-day regimen) for a total volume of 96 oz (2880 mL)

Day prior to colonoscopy

  • Light breakfast may be consumed, or have only clear liquids on day before
  • Avoid red and purple liquids, milk, and alcoholic beverages
  • Early evening before colonoscopy: Dilute 1 bottle to 16 oz (480 mL) with water in provided mixing container and drink entire amount
  • Drink additional 32 oz (960 mL) of water over the next hour

Day of colonoscopy

  • Have only clear liquids until after colonoscopy
  • Avoid red and purple liquids, milk, and alcoholic beverages
  • Morning of colonoscopy (10-12 hr after evening dose and at least 3.5 hr before colonoscopy): Prepare 2nd bottle by diluting contents to 16 oz (480 mL) in provided mixing container and drink entire amount
  • Drink additional 32 oz (960 mL) of water over the next hour
  • Complete all of the bowel kit and required water at least 2 hr before colonoscopy

Safety and efficacy not established

In clinical trials, 25% of participants were aged 65 yr or older; no overall differences were noted with the split-dose (2-day) regimen; however, geriatric patients tended to have more vomiting when administered as a 1-day regimen

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Interactions

Interaction Checker

and sodium sulfate/potassium sulfate/magnesium sulfate

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            Adverse Effects

            >10%

            Abdominal distension (40%)

            Abdominal pain (36%)

            Nausea (36%)

            Discomfort (54%)

            Decreased bicarbonate (13%)

            Hyperuricemia (23.5%)

            Metabolic acidosis (12.7%)

            Hypercalcemia (10.4%)

            1-10%

            Elevated anion gap (8.9%)

            Hyperbilirubinemia (8.5%)

            Vomiting (8%)

            Hyperosmolality (5.8%)

            Hyponatremia (3.1%)

            Hyperchloremia (2.4%)

            Elevated serum creatinine (1.9%)

            Hyperkalemia (1.8%)

            Elevated BUN (1.6%)

            Headache (1.1%)

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            Warnings

            Contraindications

            Hypersensitivity

            Gastrointestinal obstruction

            Bowel perforation

            Gastric retention

            Ileus

            Toxic colitis or toxic megacolon

            Cautions

            Administration in an evening-only (1-day) doing regiment not recommended; elevated levels of total bilirubin, BUN, serum creatinine, osmolality, potassium, and uric acid observed; also, increased risk of vomiting (particularly in elderly)

            Caution with conditions/medications that increase risk for fluid and electrolyte disturbances, or may increase risk of adverse events of seizure, arrhythmias, and prolonged QT in the setting of fluid and electrolyte abnormalities

            Adequate hydration before, during, and after use is essential to prevent consequences of fluid/electrolyte disturbances

            Oral medication administered within 1 hr before Suprep may not be absorbed properly

            Not for direct ingestion, each bottle must be diluted with water to final volume (16 oz) and ingested with additional water

            Rule out GI obstruction/perforation before administration

            Caution with severe active ulcerative colitis

            Osmotic laxatives may cause colonic mucosal aphthous ulceration; concurrent use with stimulant laxatives increases this risk

            Caution with impaired gag reflex

            Caution with impaired renal function; increased incidence of elevated serum electrolytes, serum creatinine, and BUN

            Seizures: Reports of generalized tonic-clinic seizures with use of bowel preparations products; associated with electrolyte abnormalities (eg, hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia); caution in patients at risk of seizures (alcohol withdrawal, drugs lowering seizure threshold, suspected/known hyponatremia)

            Cardiac arrhythmias: Rare reports of serious arrhythmias associated with ionic osmotic laxative products

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown whether distributed in breast milk

            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

            Osmotic laxative; sulfate salts provide sulfate anions and associated cations causing water retention within bowel; osmotic effect of unabsorbed ions and large volume of water ingested produces copious watery diarrhea

            Pharmacokinetics

            Half-Life: 8.5 hr

            Peak Plasma Time (serum sulfate): 17 hr (1st dose); 5 hr (2nd dose); renal impairment increases Tmax by 44% and AUC by 54%

            Excretion (sulfate): predominantly in feces

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            Formulary

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            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.
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