sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol (Rx)

Brand and Other Names:Suflave
Sections

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for oral solution

  • Each package contains 2 bottles of powder for reconstitution and 2 flavor enhancing packets
  • Each bottle contains 178.7g PEG 3350, 7.3g sodium sulfate, 1.12g potassium chloride, 0.9g magnesium sulfate, and 0.5g sodium chloride

Bowel Preparation

Indicated for cleansing of the colon in preparation for colonoscopy

Administer as either a split dose (2-day) regimen

If nausea, bloating, or abdominal cramping occurs, pause or slow rate of drinking solution and additional water until symptoms diminish

Day before colonoscopy

  • Low residue breakfast may be consumed (eg, white bread, biscuits, muffins [no wheat], cornflakes, eggs, cream of wheat, grits, yogurt, cottage cheese, coffee, tea, juice without pulp, fruit [no skin or seeds])
  • After breakfast, only consume clear liquids until after colonoscopy (eg, water, fruit juice [without pulp], lemonade, plain coffee, tea [no cream or nondairy creamer], chicken broth, gelatin dessert [no fruit or topping])
  • No red or purple liquids, no milk, or alcoholic beverages

Day 1, Dose 1 – early evening before colonoscopy

  • Open 1 flavor enhancing packet and pour contents into 1 bottle
  • Fill provided bottle with lukewarm water up to the fill line; after capping bottle, gently shake until all powder has dissolved
  • For best taste, refrigerate solution for an hour before drinking
  • Do not freeze; use within 24 hr
  • Drink 8 oz of solution every 15 minutes until the bottle is empty
  • Drink an additional 16 oz of water during the evening

Day 2, Dose 2 – morning of colonoscopy

  • Continue to consume only clear liquids until after the colonoscopy 5-8 hr before colonoscopy and no sooner than 4 hr from starting Dose 1, consume 2nd bottle mixed with flavor enhancing packet and water (as prepared the previous evening)
  • Repeat instructions of drinking 8 oz of solution every 15 minutes until bottle is empty
  • Drink an additional 16 oz of water during the morning
  • Stop drinking liquids at least 2 hr before colonoscopy

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

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    Contraindicated

      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (3)

              • bisacodyl

                bisacodyl, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Stimulant laxatives may increase the risk of mucosal ulceration or ischemic colitis when coadministered with bowel preps.

              • senna

                senna, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Stimulant laxatives may increase the risk of mucosal ulceration or ischemic colitis when coadministered with bowel preps.

              • sodium picosulfate

                sodium picosulfate, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Stimulant laxatives may increase the risk of mucosal ulceration or ischemic colitis when coadministered with bowel preps.

              Monitor Closely (97)

              • albuterol

                albuterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • amitriptyline

                amitriptyline, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • amoxapine

                amoxapine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • amphotericin B cholesteryl sulfate

                amphotericin B cholesteryl sulfate and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • amphotericin B deoxycholate

                amphotericin B deoxycholate and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • amphotericin B liposomal

                amphotericin B liposomal and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • amphotericin B phospholipid complex

                amphotericin B phospholipid complex and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • ampicillin

                ampicillin and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • arformoterol

                arformoterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • betamethasone

                betamethasone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • budesonide

                budesonide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • bumetanide

                bumetanide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • carbamazepine

                carbamazepine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • caspofungin

                caspofungin and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • celecoxib

                celecoxib, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • chlorothiazide

                chlorothiazide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • chlorthalidone

                chlorthalidone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • cisplatin

                cisplatin and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • citalopram

                citalopram, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • clomipramine

                clomipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • deflazacort

                sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol and deflazacort both decrease serum potassium. Use Caution/Monitor.

              • desipramine

                desipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • desvenlafaxine

                desvenlafaxine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • dexamethasone

                dexamethasone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • diclofenac

                diclofenac, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • diflunisal

                diflunisal, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • dobutamine

                dobutamine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • dopamine

                dopamine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • doxepin

                doxepin, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • duloxetine

                duloxetine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • ephedrine

                ephedrine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • epinephrine

                epinephrine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • epinephrine racemic

                epinephrine racemic and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • escitalopram

                escitalopram, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • ethacrynic acid

                ethacrynic acid and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • etodolac

                etodolac, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • fenoprofen

                fenoprofen, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • fluconazole

                fluconazole and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • fludrocortisone

                fludrocortisone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • fluoxetine

                fluoxetine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • flurbiprofen

                flurbiprofen, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • fluvoxamine

                fluvoxamine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Increased risk for water retention or electrolyte imbalance.

              • formoterol

                formoterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • furosemide

                furosemide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • gentamicin

                gentamicin and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • hydrochlorothiazide

                hydrochlorothiazide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • hydrocortisone

                hydrocortisone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • ibuprofen

                ibuprofen, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • ibuprofen IV

                ibuprofen IV, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • imipramine

                imipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • indapamide

                indapamide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • indomethacin

                indomethacin, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • insulin aspart

                insulin aspart and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • insulin glargine

                insulin glargine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • insulin glulisine

                insulin glulisine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • insulin lispro

                insulin lispro and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • insulin NPH

                insulin NPH and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • insulin regular human

                insulin regular human and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • isoproterenol

                isoproterenol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • ketoconazole

                ketoconazole and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • ketoprofen

                ketoprofen, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • ketorolac

                ketorolac, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • levalbuterol

                levalbuterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • levoketoconazole

                levoketoconazole and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • levomilnacipran

                levomilnacipran, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • meclofenamate

                meclofenamate, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • mefenamic acid

                mefenamic acid, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • meloxicam

                meloxicam, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • metaproterenol

                metaproterenol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • methyclothiazide

                methyclothiazide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • methylprednisolone

                methylprednisolone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • metolazone

                metolazone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • milnacipran

                milnacipran, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • nabumetone

                nabumetone, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • naproxen

                naproxen, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • norepinephrine

                norepinephrine and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • nortriptyline

                nortriptyline, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • paroxetine

                paroxetine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • pegvaliase

                pegvaliase, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: The majority of patients treated with pegvaliase develop anti-polyethylene glycol (PEG) IgM and IgG antibodies. Risk of coadministration with different PEGylated products is unknown. There is a case report of anaphylaxis following a medroxyprogesterone acetate injectable suspension that contained PEG 3350. Carefully read all drug labels, including OTC drugs to check contents for PEG. Note: Unable to include an exhaustive product list for this interaction.

              • pirbuterol

                pirbuterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • piroxicam

                piroxicam, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • posaconazole

                posaconazole and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • prednisolone

                prednisolone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • prednisone

                prednisone and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • protriptyline

                protriptyline, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • salmeterol

                salmeterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • sertraline

                sertraline, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • sodium bicarbonate

                sodium bicarbonate and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • sodium polystyrene sulfonate

                sodium polystyrene sulfonate and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • sulindac

                sulindac, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • terbutaline

                terbutaline and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • tolmetin

                tolmetin, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • torsemide

                torsemide and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • triamcinolone acetonide injectable suspension

                triamcinolone acetonide injectable suspension and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • trimipramine

                trimipramine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • venlafaxine

                venlafaxine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

              • voriconazole

                voriconazole and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              Minor (0)

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                Adverse Effects

                >10%

                Nausea (7-13%)

                1-10%

                Abdominal distension (1-6%)

                Vomiting (4-6%)

                Abdominal pain (3%)

                Headache (2-3%)

                Postmarketing Reports

                Cardiovascular: Arrhythmia, atrial fibrillation, peripheral edema, asystole, acute pulmonary edema

                Gastrointestinal: Upper gastrointestinal bleeding from a Mallory-Weiss tear; esophageal perforation, usually with gastroesophageal reflux disease

                Hypersensitivity reactions: Rash, urticaria, pruritus, dermatitis, dyspnea, chest tightness and throat tightness, fever, angioedema, anaphylaxis, and anaphylactic shock

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                Warnings

                Contraindications

                Hypersensitivity

                GI obstruction or ileus

                Bowel perforation

                Gastric retention

                Toxic colitis or toxic megacolon

                Cautions

                Serious fluid and electrolyte abnormalities

                • Bowel preparation products can cause fluid and electrolyte disturbances, which can lead to serious adverse reactions including cardiac arrhythmias, seizures, and renal impairment
                • Correct fluid and electrolyte abnormalities before use
                • Caution in patients with conditions or medications (eg, diuretics, ACE inhibitors, ARBs) that may increase risk
                • Advise all patients to hydrate adequately before, during, and after the use
                • If significant vomiting or signs of dehydration develops after ingestion, consider performing post-colonoscopy lab tests (electrolytes, creatinine, and BUN)

                Cardiac arrhythmias

                • Rare reports of serious arrhythmias associated with ionic osmotic laxative products
                • Occurred predominantly in patients with underlying cardiac risk factors and electrolyte disturbances
                • Use caution when prescribing for patients at increased risk of arrhythmias (eg, history of prolonged QT interval, uncontrolled arrhythmias, recent MI, unstable angina, CHF, or cardiomyopathy)

                Seizures

                • Reports of generalized tonic-clonic seizures and/or loss of consciousness associated with use of bowel preparation products in patients with no prior history of seizures
                • Seizure cases were associated with electrolyte abnormalities (eg, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia) and low serum osmolality
                • Caution when prescribing for patients with history of seizures and or those at increased risk of seizure, such as patients taking medications that lower the seizure threshold (eg, tricyclic antidepressants), those withdrawing from alcohol or benzodiazepines, or with known or suspected hyponatremia

                Risk of renal injury

                • Patients with impaired renal function or taking concomitant medications that may affect renal function may be at risk for renal injury
                • Emphasize importance of adequate hydration and consider performing baseline and postcolonoscopy laboratory tests (electrolytes, creatinine, and BUN)

                Colonic mucosal ulcerations and ischemic colitis

                • Osmotic laxative products may produce colonic mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization
                • Concurrent use of stimulant laxatives may increase these risks
                • Consider potential for mucosal ulcerations resulting from the bowel preparation when interpreting colonoscopy findings in patients with known or suspect inflammatory bowel disease

                Significant gastrointestinal disease

                • If gastrointestinal obstruction or perforation suspected, perform appropriate diagnostic studies to rule out these conditions before administering
                • Use with caution in patients with severe active ulcerative colitis

                Aspiration

                • Patients with impaired gag reflex or other swallowing abnormalities are at risk for regurgitation or aspiration
                • Observe these patients during administration
                • Do not combine with starch-based thickeners
                • When mixed with starch-thickened liquids, polyethylene glycol (PEG) reduces viscosity of starch-thickened liquid
                • When a PEG-based product used for another indication was mixed in starch-based pre-thickened liquids used in patients with dysphagia, thinning of the liquid occurred and cases of choking and potential aspiration were reported

                Hypersensitivity

                • PEG and other ingredients may cause serious hypersensitivity reactions including anaphylaxis, angioedema, rash, urticaria, and pruritus
                • Inform patients of signs and symptoms of anaphylaxis, and instruct them to seek immediate medical care should signs and symptoms occur
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                Pregnancy & Lactation

                Pregnancy

                Data are unavailable regarding use during pregnancy to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

                Animal reproduction studies have not been conducted

                Lactation

                There are no available data on presence of drug in human or animal milk, effects on breastfed children, or effects on milk production

                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

                Primary mode of action is the osmotic effects of polyethylene glycol (PEG) 3350, sodium sulfate, and magnesium sulfate, which induce a laxative effect

                The physiological consequence is increased water retention in the lumen of the colon, resulting in loose stools

                Absorption

                Peak plasma time

                • 4 hr (PEG)
                • 3 hr (sulfate)

                Peak plasma concentration

                • 3.4 mcg/mL (PEG dose 1); 2.9 mcg/mL (PEG dose 2)
                • 29.2 mcg/mL (sulfate)

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                Administration

                Oral Administration

                Prepare each bottle as directed and administer as split dose regimen (ie, evening before colonoscopy and morning of colonoscopy)

                Storage

                Unopened package

                • Store at room temperature between 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

                Reconstituted solution

                • Refrigerate at 2-8ºC (36-46ºF)
                • Do not freeze
                • Use within 24 hr, discard unused solution
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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

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                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                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
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
                Additional Offers
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.