General

Pronunciation:
soe-dee-um sul-fate/poe-tass-ee-um sul-fate/mag-nee-zhum sul-fate

Trade Name(s)

• Suprep Bowel Prep Kit

Ther. Class.

laxatives

Pharm. Class.

osmotics

Indications

Cleansing of the colon in preparation for colonoscopy.

Action

Unabsorbed cations and anions in the GI tract cause osmotic laxative effect by causing water retention in the GI tract.

Therapeutic Effect(s):

With concurrent fluid ingestion, produces watery diarrhea and colonic purging in preparation for colonoscopy.

Pharmacokinetics

Absorption: Minimal systemic absorption.

Distribution: Action is primarily local.

Metabolism and Excretion: Not metabolized; primarily eliminated via fecal excretion.

Half-life: 8.5 hr.

TIME/ACTION PROFILE (onset of watery diarrhea)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• GI obstruction/ileus/bowel perforation/toxic colitis or megacolon/gastric retention.

Use Cautiously in:

• Renal impairment/concurrent medications affecting renal function (↑ risk of renal impairment);
• Known risk factors for arrhythmias including prolonged QT interval, recent MI, unstable angina pectoris, HF, or cardiomyopathy;
• Known/suspected inflammatory bowel disease (may cause mucosal ulcerations);
• Electrolyte abnormalities (correct prior to administration);
• History of seizures or concurrent use of medications that ↓ seizure threshold (may ↑ risk of seizures);
• Gout (may ↑ uric acid levels);
• At risk for aspiration;
• OB:  Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Pedi:   Children <12 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

CV: ARRHYTHMIAS

F and E: hypercalcemia, dehydration

GI: abdominal distention, abdominal pain, nausea, hyperbilirubinemia, vomiting

GU: RENAL IMPAIRMENT

Metabolic: hyperuricemia

Neuro: headache, SEIZURES

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Concurrent use of drugs affecting fluid and electrolyte status/renal function, including  ACE inhibitors,  angiotensin receptor blockers,  corticosteroids,  NSAIDs,  diuretics, and other  laxatives  may ↑ risk of dehydration, renal impairment, seizures, hypotension, and fluid/electrolyte abnormalities.
• Concurrent use of medications that ↓ seizure threshold, including  tricyclic antidepressants  or concurrent  alcohol / benzodiazepine  withdrawal (may ↑ risk of seizures).
•  Oral medications  taken within 1 hr of start may not be properly absorbed.
• Concurrent use of other  laxatives  may ↑ risk of mucosal ulcerations.
• May ↑ risk of  digoxin  toxicity in the presence of electrolyte abnormalities.

Route/Dosage

PO (Adults): One 6-oz bottle during evening before colonoscopy, repeated during the morning prior to the colonoscopy (10–12 hr after evening dose). Additional clear liquids are required after each dose.

PO (Children ≥12 yr): One 4.5-oz bottle during evening before colonoscopy, repeated during the morning prior to the colonoscopy (10–12 hr after evening dose). Additional clear liquids are required after each dose.

Availability (generic available)

Oral solution (for adults) (lemon): 17.5 g sodium sulfate/3.13 g potassium sulfate/1.6 g magnesium sulfate/6 oz.

Oral solution (for children ≥12 yr) (lemon): 13.13 g sodium sulfate/2.35 g potassium sulfate/1.2 g magnesium sulfate/4.5 oz

Assessment

• Assess for significant vomiting and signs of dehydration after administration of prep kit.

Lab Test Considerations:

Monitor electrolytes, serum creatinine, and BUN if signs of dehydration occur.

Implementation

• PO Dilute each of two 6-oz doses for adults and two 4.5-oz doses for pediatric patients of solution with an additional 16 oz of water. 3 quarts (approximately 2.8 L) taken orally prior to the colonoscopy is required for colon cleansing.  Day prior to colonoscopy:  Eat a light breakfast or only clear liquids. Avoid red and purple liquids, milk, and alcoholic beverages.  Early in evening prior to colonoscopy:  Pour contents of one bottle into mixing container provided. Fill the container to 16-oz fill line, or for pediatric patients to the 12-oz fill line, with cool drinking water; drink the entire amount. Drink 2 additional containers filled to 16-oz or 12-oz line with water over next hr.  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 the evening dose):  Pour contents of second bottle into mixing container provided. Fill to 16-oz fill line, or the 12-oz fill line for pediatric patients with water, and drink entire amount. Drink two additional containers filled to 16-oz line with water over next hr. Complete all bowel prep kit and required water at least 2 hr prior to colonoscopy.

Patient/Family Teaching

• Instruct patient in correct technique for preparing and taking prep kit. Solution must be diluted as directed; ingestion of undiluted solution may increase risk of nausea, vomiting, and dehydration.
• Advise patient to hydrate adequately before, during, and after prep. Advise patient to expect watery diarrhea after ingesting prep kit.
• Inform patients to avoid taking other oral medications within 1 hr of each dose of prep kit; they may not be absorbed.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Instruct patient to avoid taking other laxatives while taking prep kit.
• Rep:  Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Watery diarrhea and cleansing of colon prior to colonoscopy.