Drug Interactions between HalfLytely and Bisacodyl and sotorasib

GENERALLY AVOID: Coadministration with drugs that increase gastric pH may significantly decrease the oral bioavailability of sotorasib and reduce its concentrations in plasma. According to the product labeling, the aqueous solubility of sotorasib decreases from 1.3 mg/mL at pH 1.2 to 0.03 mg/mL at pH 6.8. When a single 960 mg dose of sotorasib was coadministered with multiple doses of the proton pump inhibitor omeprazole, sotorasib peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 65% and 57%, respectively, under fed conditions, and by 57% and 42%, respectively, under fasted conditions. Coadministration of a single dose of the H2-receptor antagonist famotidine given 10 hours before and 2 hours after a single 960 mg dose of sotorasib under fed conditions decreased sotorasib Cmax by 35% and AUC by 38%. The interaction may similarly occur with other acid reducing or neutralizing agents, which may reduce the efficacy of sotorasib.

MANAGEMENT: Concomitant use of sotorasib with proton pump inhibitors, H2-receptor antagonists, or other acid reducing agents should generally be avoided. If acid suppression therapy is required, locally acting antacids may be considered. The manufacturer recommends taking sotorasib 4 hours before or 10 hours after administration of a locally acting antacid.

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ADJUST DOSING INTERVAL: By increasing gastric pH, antacids may reduce the resistance of the enteric coating of bisacodyl tablets, resulting in earlier release of bisacodyl and gastric irritation and dyspepsia.

MANAGEMENT: The administration of antacids and bisacodyl should be separated by at least one hour.

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GENERALLY AVOID: Concomitant use of stimulant laxatives (e.g., bisacodyl, sodium picosulfate) may increase the risk of serious gastrointestinal adverse effects associated with certain osmotic laxatives (e.g., polyethylene glycol (PEG), oral sulfate solution), such as colonic mucosal ulcerations or ischemic colitis. There have been isolated case reports of ischemic colitis occurring with the use of PEG-based bowel cleansing products in combination with higher dosages of bisacodyl (usually greater than 10 mg). Bisacodyl can cause colonic ischemia due to transient reduction in splanchnic blood flow. When administered in conjunction with an osmotic laxative such as PEG, increased intramural pressure secondary to increased peristalsis may lead to ischemic colitis and perforation.

MANAGEMENT: The manufacturers for some osmotic bowel cleansing products recommend avoiding the concurrent use of stimulant laxatives. However, stimulant laxatives, in particular bisacodyl and sodium picosulfate, are sometimes used with PEG in certain bowel cleansing regimens to help reduce dose volume and improve patient tolerability and acceptance. Please consult individual product labeling for specific recommendations and guidance. Patients using osmotic bowel cleansing products and stimulant laxatives who present with sudden abdominal pain, rectal bleeding, or other symptoms of ischemic colitis should be evaluated promptly.

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