Sodium Biphosphate / Sodium Phosphate Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Bowel Preparation

For colon cleansing prior to colonoscopy procedure:
Visicol(R):
The evening before the procedure: Take 3 Visicol(R) tablets (the last dose will be 2 tablets) with 240 mL of clear liquids every 15 minutes for a total of 20 tablets.

On the day of the procedure: Starting 3 to 5 hours before the procedure, take 3 Visicol(R) tablets (the last dose will be 2 tablets) with 240 mL of clear liquids every 15 minutes for a total of 20 tablets.

OsmoPrep(R):
The evening before the procedure: Take 4 OsmoPrep(R) tablets with 240 mL of clear liquids every 15 minutes for a total of 20 tablets.

On the day of the procedure: Starting 3 to 5 hours before the procedure, take 4 OsmoPrep(R) tablets with 240 mL of clear liquids every 15 minutes for a total of 12 tablets.

For bowel cleansing prior to surgery, X-rays, or other intestinal procedures, and for general care after surgery:
Enema: Sodium biphosphate-sodium phosphate 7 g-19 g (118 mL or 197 mL depending upon the size enema used) rectally once

Usual Adult Dose for Constipation

Enema: Sodium biphosphate-sodium phosphate 7 g-19 g (118 mL or 197 mL depending upon the size enema used) rectally once

Oral solution: 15 mL (diluted in 240 mL of cool water) orally as a single dose; dose should be followed with at least an additional 240 mL of cool water
Maximum single daily dose: 30 or 45 mL

Usual Pediatric Dose for Bowel Preparation

For bowel cleansing prior to surgery, X-rays, or other intestinal procedures, and for general care after surgery:
Enema:
2 to less than 5 years: Sodium biphosphate-sodium phosphate 1.75 g-4.75 g (29 mL or one-half enema) rectally once

5 to 11 years: Sodium biphosphate-sodium phosphate 3.5 g-9.5 g (59 mL or one enema) rectally once

12 years or older: Sodium biphosphate-sodium phosphate 7 g-19 g (118 mL or 197 mL depending upon the size enema used) rectally once

Usual Pediatric Dose for Constipation

Enema:
2 to less than 5 years: Sodium biphosphate-sodium phosphate 1.75 g-4.75 g (29 mL or one-half enema) rectally once

5 to 11 years: Sodium biphosphate-sodium phosphate 3.5 g-9.5 g (59 mL or one enema) rectally once

12 years or older: Sodium biphosphate-sodium phosphate 7 g-19 g (118 mL or 197 mL depending upon the size enema used) rectally once

Oral solution:
5 to 9 years: 7.5 mL (diluted in 240 mL of cool water) orally as a single dose
Maximum single daily dose: 7.5 mL

10 to 11 years: 15 mL (diluted in 240 mL of cool water) orally as a single dose
Maximum single daily dose: 15 mL

12 years or older: 15 mL (diluted in 240 mL of cool water) orally as a single dose
Maximum single daily dose: 30 or 45 mL

The oral dose should be followed with at least an additional 240 mL of cool water.

Renal Dose Adjustments

Caution is recommended when administering sodium biphosphate-sodium phosphate to patients with renal dysfunction.

Considerable caution is advised before sodium biphosphate-sodium phosphate tablets are used in patients with CrCl less than 30 mL/minute.

Sodium biphosphate-sodium phosphate enemas should not be used in patients with clinically significant renal function impairment.

Sodium biphosphate-sodium phosphate oral solution should not be used in patients with impaired renal functions.

Liver Dose Adjustments

Data not available

Precautions

Sodium biphosphate-sodium phosphate oral tablets are contraindicated in patients with biopsy-proven acute phosphate nephropathy.

Sodium biphosphate-sodium phosphate oral solution should not be used for bowel cleansing. Patients with previous kidney problem, congestive heart failure, decreased intravascular volume, dehydration, or uncorrected electrolyte abnormalities should not use sodium biphosphate-sodium phosphate oral solution.

Sodium biphosphate-sodium phosphate enemas should not be used in patients with congestive heart failure, known or suspected gastrointestinal obstruction, megacolon (congenital or acquired), paralytic ileus, perforation, active inflammatory bowel disease, imperforate anus, and dehydration. In general, sodium biphosphate-sodium phosphate enemas should not be used in any case where absorption capacity is increased or elimination capacity is decreased.

Considerable caution is advised before sodium biphosphate-sodium phosphate tablets are used in patients with the following illnesses: congestive heart failure, ascites, unstable angina, gastric retention, ileus, acute bowel obstruction, pseudo-obstruction of the bowel, severe chronic constipation, bowel perforation, acute colitis, toxic megacolon, gastric bypass or stapling surgery, or hypomotility syndrome. Sodium biphosphate-sodium phosphate tablets should be used with caution in patients with a history of acute phosphate nephropathy, known or suspected electrolyte disturbances (such as dehydration), or taking medications that may affect electrolyte levels (such as diuretics). Electrolyte abnormalities (such as hypernatremia, hyperphosphatemia, hypokalemia, or hypocalcemia) should be corrected prior to sodium biphosphate-sodium phosphate therapy.

Sodium biphosphate-sodium phosphate enemas should be used with caution in patients taking agents known to affect renal perfusion, renal function, or hydration status; with preexisting electrolyte disturbances or who are taking diuretics or other agents which may affect electrolyte levels; who are taking agents known to prolong the QT interval; with ascites; and/or with a colostomy. Sodium biphosphate-sodium phosphate enemas should be used with caution in children 2 to 11 years of age, in patients 65 years or older who are under a physician's care for any medical condition, and in pregnant or nursing women.

Baseline and postcolonoscopy labs (phosphate, calcium, potassium, sodium, creatinine, and BUN) are recommended in patients with history of renal insufficiency, history of (or at greater risk of) acute phosphate nephropathy, known or suspected electrolyte disorders, seizures, arrhythmias, cardiomyopathy, prolonged QT, recent history of myocardial infarction, and in patients with known or suspected hyperphosphatemia, hypocalcemia, hypokalemia, and hypernatremia. Postcolonoscopy labs (phosphate, calcium, potassium, sodium, creatinine, and BUN) should also be measured in patients who develop vomiting and/or signs of dehydration.

Extreme caution is recommended when using sodium phosphate products in patients with a history of seizures and in patients at higher risk of seizure.

Sodium biphosphate-sodium phosphate should be used with caution in patients with higher risk of arrhythmias (patients with history of cardiomyopathy, prolonged QT, history of uncontrolled arrhythmias, or recent myocardial infarction). Baseline and postcolonoscopy electrocardiograms should be considered in patients with high risk of serious cardiac arrhythmias.

Sodium biphosphate-sodium phosphate should be used with caution in patients experiencing an acute exacerbation of chronic inflammatory bowel disease because data suggest that sodium phosphate absorption may be enhanced in such patients.

Patients receiving sodium biphosphate-sodium phosphate tablets should be instructed to drink the exact amount of clear liquids recommended by the individual product.

Patients should not use more than one enema in 24 hours or more than one enema per indicated use unless instructed by the health care provider.

Pediatric patients less than 12 years of age should only use the enema labeled for use in children (e.g., Pedia-Lax(R) Enema). Safety and effectiveness of sodium biphosphate-sodium phosphate enemas have not been established and should not be used in pediatric patients less than 2 years of age.

Safety and effectiveness of sodium biphosphate-sodium phosphate tablets have not been established in pediatric patients (less than 18 years of age).

Safety and effectiveness of sodium biphosphate-sodium phosphate oral solution have not been established and should not be used in pediatric patients less than 5 years of age.

Dialysis

Data not available

Other Comments

Patients undergoing a colonoscopy procedure should adequately hydrate before, during, and after the use of colon cleansing products. Patients should not take a colon cleansing product within 7 days of previous administration. No additional enema or laxative is required, and patients should be advised not to take additional products, particularly those containing sodium phosphate. Timing of all doses should be determined by the individual product manufacturer or a health care provider.

Health care providers should instruct patients whether or not to eat or drink anything before their medical test, and what to eat or drink for up to 24 hours after their test.

It is not necessary to empty the enema bottle completely, as it contains more liquid than needed.

Each administration of sodium biphosphate-sodium phosphate in tablet form has a purgative effect for approximately 1 to 3 hours.

Sodium biphosphate-sodium phosphate enemas should produce a bowel movement within 1 to 5 minutes. The enema solution should not be retained for more than 10 minutes.

Sodium biphosphate-sodium phosphate oral solution generally produces a bowel movement in 30 minutes to 6 hours.

Medications administered in close proximity to sodium biphosphate-sodium phosphate may not be absorbed from the gastrointestinal tract due to the rapid intestinal peristalsis and watery diarrhea induced by the purgative agent.

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