sodium sulfate/​magnesium sulfate/potassium chloride (Rx)

Brand and Other Names:Sutab
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

sodium sulfate/magnesium sulfate/potassium chloride

tablet

  • 1.479g/0.225g/0.188g
  • Each carton contains

    • 2 bottles; each bottle contains 12 tablets.
    • 1 container with a 16-ounce fill line

Bowel Preparation

Indicated for cleansing of the colon in preparation for colonoscopy

Administer as a split dose (2-dose) regimen

Split-dose regimen consists of 2 doses: First dose during the evening prior to colonoscopy and second dose the next day, during the morning of the colonoscopy

Dose 1 (evening before colonoscopy)

  • A low-residue breakfast (eg, eggs, white bread, cottage cheese, yogurt, coffee, tea) may be consumed
  • After breakfast, consume only clear liquids until after the colonoscopy
  • Early in the evening prior to colonoscopy, open one bottle of 12 tablets
  • Fill provided container with 16 ounces of water (up to the fill line); swallow each tablet with a sip of water and drink entire amount over 15-20 min
  • ~1 hr after the last tablet is ingested, drink 16 ounces of water over 30 minutes
  • Wait ~30 min after finishing the second container of water; drink another 16 ounces of water over 30 minutes
  • If patients experience preparation-related symptoms (eg, nausea, bloating, cramping), pause or slow the rate of drinking the additional water until symptoms diminish

Dose 2 (morning of colonoscopy)

  • Continue to consume only clear liquids until after colonoscopy
  • Morning of colonoscopy (5-8 hr before colonoscopy and no sooner than 4 hr from starting Dose 1), open second bottle of 12 tablets
  • ~1 hr after the last tablet is ingested, drink 16 ounces of water over 30 minutes
  • Wait ~30 min after finishing the second container of water; drink another 16 ounces of water over 30 minutes
  • If patients experience preparation-related symptoms (eg, nausea, bloating, cramping), pause or slow the rate of drinking the additional water until symptoms diminish
  • Complete all tablets and water at least 2 hr prior to colonoscopy

Dosage Modifications

Renal impairment

  • Use with caution in patients with renal impairment or patients taking concomitant medications that may affect renal function; these patients may be at risk for renal injury

Safety and efficacy not established

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Interactions

Interaction Checker

and sodium sulfate/​magnesium sulfate/potassium chloride

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Mild upper abdominal pain (65-82%)

            Mild nausea (71-74%)

            Mild abdominal distension (68-73%)

            Mild vomiting (48-53%)

            Moderate vomiting (47-52%)

            Moderate upper abdominal pain (16-35%)

            Moderate abdominal distension (27-30%)

            Moderate nausea (20-27%)

            1-10%

            Severe nausea (2-6%)

            Severe abdominal pain (2%)

            Severe abdominal distension (1%)

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            Warnings

            Contraindications

            Gastrointestinal obstruction or ileus

            Bowel perforation

            Toxic colitis or toxic megacolon

            Gastric retention

            Cautions

            Encourage adequate hydration, assess concurrent medications, and consider laboratory assessments (electrolytes, creatinine, BUN) before and after each use

            There have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation; use with caution in patients at increased risk of arrhythmias (eg, patients with a history of prolonged QT, uncontrolled arrhythmias, recent myocardial infarction, unstable angina, congestive heart failure, cardiomyopathy); consider predose and postcolonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias

            Use with caution in patients with impaired renal function or patients taking concomitant medications that may affect renal function (eg, diuretics, ACE inhibitors, angiotensin receptor blockers, NSAIDs); advise these patients of the importance of adequate hydration and consider performing baseline and postcolonoscopy laboratory testing

            Rare reports of serious arrhythmias associated with ionic osmotic laxative products

            Osmotic laxative products may produce colonic mucosal aphthous ulcerations; reports of serious cases of ischemic colitis requiring hospitalization; coadministration with stimulant laxatives may increase risk

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

            Seizures

            • Reports of generalized tonic-clonic seizures and/or loss of consciousness have been associated with use of bowel preparation products in patients with no prior history of seizures
            • Use caution in patients with a history of seizures and in patients at increased risk of seizure, such as patients taking medications that lower the seizure threshold (eg, tricyclic antidepressants), patients withdrawing from alcohol or benzodiazepines, or patients with known or suspected hyponatremia

            Drug interaction overview

            • Caution with coadministration of drugs that increase risk of fluid and electrolyte disturbances or that may increase risk of seizure, arrhythmias, or prolonged QT
            • Avoid coadministration with stimulant laxatives owing to increased risk of mucosal ulceration or ischemic colitis
            • Caution if coadministered with medications that may affect renal function (eg, diuretics, ACE inhibitors, angiotensin receptor blockers, NSAIDs)
            • Potential for reduced drug absorption
              • Oral medication administered within 1 hr before bowel preparation may not be absorbed properly
              • Administer tetracycline or fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, or penicillamine at least 2 hr before and not less than 6 hr after administration of bowel preparation to avoid chelation
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            Pregnancy & Lactation

            Pregnancy

            No data available data on use in pregnant females to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

            No reproduction or developmental studies in animals have been conducted with sodium sulfate, magnesium sulfate, and potassium chloride

            Lactation

            There are no available data on drug presence in human or animal milk, effects on the breastfed child, 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

            Osmotic action of sodium sulfate and magnesium sulfate induces a laxative effect

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

            Absorption

            Median serum sulfate concentration increased by about 2.5-fold at 5-8 hr post Dose 2 (0.61 mmol/L) compared with baseline (0.25 mmol/L) and returned to baseline by 24-48 hr after colonoscopy

            Elimination

            Excretion: Fecal

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            Administration

            Oral Administration

            Correct fluid and electrolyte abnormalities before treatment

            Administration of 2 doses (each dose is 12 tablets) is required for a complete preparation for colonoscopy

            Consume water with each dose and additional water must be consumed after each dose

            Consume a low-residue breakfast on the day before colonoscopy, followed by clear liquids up to 2 hr prior to colonoscopy.

            Do not drink alcohol or milk, and do not eat or drink anything colored red or purple

            Do not take other laxatives during treatment

            Do not take oral medications within 1 hour of starting each dose

            If taking tetracycline or fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, or penicillamine, take these medications at least 2 hr before and not less than 6 hr after administration of each dose

            Stop consumption of all fluids at least 2 hr before the colonoscopy

            Storage

            Tablets: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

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            Formulary

            FormularyPatient Discounts

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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.
            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.
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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.