Drug Interactions between bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride and Hydrotropine
This report displays the potential drug interactions for the following 2 drugs:
- bisacodyl/polyethylene glycol 3350/potassium chloride/sodium bicarbonate/sodium chloride
- Hydrotropine (homatropine/hydrocodone)
Interactions between your drugs
potassium chloride homatropine
Applies to: bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride and Hydrotropine (homatropine / hydrocodone)
CONTRAINDICATED: The following interaction does not apply to all products containing potassium chloride, including split dose products used for colon preparation prior to colonoscopy. It is applicable to certain oral solid formulations of potassium chloride used primarily for potassium supplementation, and the prescriber should consult the individual product labeling for more specific information and guidance.
Concomitant use of agents with anticholinergic properties (e.g., antihistamines, antispasmodics, neuroleptics, phenothiazines, skeletal muscle relaxants, tricyclic antidepressants, the class IA antiarrhythmic disopyramide) may potentiate the risk of upper gastrointestinal injury associated with oral solid formulations of potassium chloride. The proposed mechanism involves increased gastrointestinal transit time due to reduction of stomach and intestinal motility by anticholinergic agents, thereby creating a high localized concentration of potassium ions in the region of a dissolving tablet or capsule and increasing the contact time with GI mucosa. Solid formulations of potassium chloride have been associated with upper GI bleeding and small bowel ulceration, stenosis, perforation, and obstruction. Deaths have been reported rarely. In clinical studies, short-term coadministration of wax-matrix or microencapsulated formulations of potassium chloride at high dosages in combination with an anticholinergic agent such as glycopyrrolate resulted in more frequent and more serious endoscopic lesions than potassium therapy alone. However, the lesions were not accompanied by bleeding or epigastric symptoms. Some investigators have suggested a higher risk of upper GI lesions with wax-matrix than microencapsulated formulations, although existing data are limited and conflicting.
MANAGEMENT: The use of certain oral solid formulations of potassium chloride is considered contraindicated in patients receiving agents with anticholinergic properties at sufficient doses to exert anticholinergic effects. A liquid formulation of potassium chloride should be considered. Patients prescribed a solid oral formulation should be advised to discontinue potassium therapy and contact their physician if they experience potential symptoms of upper GI injury such as severe vomiting, abdominal pain, distention, and gastrointestinal bleeding.
References
- Lambert JR, Newman A (1980) "Ulceration and stricture of the esophagus due to oral potassium chloride (slow release tablet) therapy." Am J Gastroenterol, 73, p. 508-11
- Farquharson-Roberts MA, Giddings AE, Nunn AJ (1975) "Perforation of small bowel due to slow release potassium chloride (slow-K)." Br Med J, 3, p. 206
- Wynn V (1965) "Potassium chloride and bowel ulceration." Br Med J, 5477, p. 1546
- McMahon FG, Ryan JR, Akdamar K, Ertan A (1984) "Effect of potassium chloride supplements on upper gastrointestinal mucosa." Clin Pharmacol Ther, 35, p. 852-5
- McMahon FG, Ryan JR, Akdamar K, Ertan A (1982) "Upper gastrointestinal lesions after potassium chloride supplements: a controlled clinical trial." Lancet, 2, p. 1059-61
- Leijonmarck CE, Raf L (1985) "Gastrointestinal lesions and potassium chloride supplements." Lancet, 1, p. 56-7
- Lofgren RP, Rothe PR, Carlson GJ (1982) "Jejunal perforation associated with slow-release potassium chloride therapy." South Med J, 75, p. 1154-5
- Leijonmarck CE, Raf L (1985) "Ulceration of the small intestine due to slow-release potassium chloride tablets." Acta Chir Scand, 151, p. 273-8
- Weiss SM, Rutenberg HL, Paskin DL, Zaren HA (1977) "Gut lesions due to slow-release KCI tablets." N Engl J Med, 296, p. 111-2
- (2001) "Product Information. K-Dur (potassium chloride)." Schering Corporation
- Heffernan SJ, Murphy JJ (1975) "Ulceration of small intestine and slow-release potassium tablets." Br Med J, 2, p. 746
sodium bicarbonate bisacodyl
Applies to: bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride and bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride
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.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
HYDROcodone homatropine
Applies to: Hydrotropine (homatropine / hydrocodone) and Hydrotropine (homatropine / hydrocodone)
MONITOR: Coadministration of opioids with anticholinergic agents may result in additive central nervous system (CNS), gastrointestinal, and genitourinary effects. The risk and/or severity of adverse effects such as sedation, dizziness, confusion, cognitive and psychomotor impairment, dry mouth, constipation, and urinary retention may increase. Severe constipation may lead to paralytic ileus in some cases.
MANAGEMENT: Caution and close monitoring of central nervous system, gastrointestinal, and genitourinary adverse effects are recommended when opioids are used with anticholinergic agents. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References
- (2002) "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals
- (2002) "Product Information. Dolophine (methadone)." Lilly, Eli and Company
- (2001) "Product Information. Tylenol with Codeine (acetaminophen-codeine)." Janssen Pharmaceuticals
- "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
- (2001) "Product Information. Ultram (tramadol)." McNeil Pharmaceutical
- (2001) "Product Information. OxyContin (oxycodone)." Purdue Frederick Company
- (2001) "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals
- (2004) "Product Information. DepoDur (morphine liposomal)." Endo Laboratories LLC
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2006) "Product Information. Opana (oxymorphone)." Endo Laboratories LLC
- (2009) "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals
- (2010) "Product Information. Exalgo (hydromorphone)." Covidien
- (2016) "Product Information. Belbuca (buprenorphine)." Endo Pharmaceuticals Solutions Inc
- (2017) "Product Information. Alfentanil Hydrochloride (alfentanil)." Akorn Inc
- (2017) "Product Information. SUFentanil Citrate (sufentanil)." Akorn Inc
- (2017) "Product Information. Lortab (acetaminophen-hydrocodone)." Akorn Inc
- (2017) "Product Information. Levorphanol Tartrate (levorphanol)." Sentynl Therapeutics
- (2018) "Product Information. Naloxone HCl-Pentazocine HCl (naloxone-pentazocine)." Actavis U.S. (Amide Pharmaceutical Inc)
- (2018) "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc
bisacodyl polyethylene glycol 3350
Applies to: bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride and bisacodyl / polyethylene glycol 3350 / potassium chloride / sodium bicarbonate / sodium chloride
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.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
- Baudet JS, Castro V, Redondo I (2010) "Recurrent ischemic colitis induced by colonoscopy bowel lavage." Am J Gastroenterol, 105, p. 700-1
- (2010) "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories
- Ajani S, Hurt RT, Teeters DA, Bellmore LR (2012) "Ischaemic colitis associated with oral contraceptive and bisacodyl use." BMJ Case Rep, 2012
- (2016) "Product Information. MoviPrep (polyethylene glycol 3350 with electrolytes)." Physicians Total Care
- (2020) "Product Information. Plenvu (polyethylene glycol 3350 with electrolytes)." Bausch Health US (formerly Valeant Pharmaceuticals)
- (2022) "Product Information. GaviLyte-H and Bisacodyl with Flavor Packs (bisacodyl-PEG 3350 with electrolytes)." Gavis Pharmaceuticals
- "Product Information. Bi-Peglyte (bisacodyl-PEG 3350 with electrolytes)." Pendopharm
- Vaizman K, Li J, Iswara K, Tenner S (2007) "Ischemic colitis induced by the combination of Bisacodyl and polyethylene glycol in preparation for colonoscopy." Am J Gastroenterol, 102, S267
- Belsey J, Epstein O, heresbach D (2009) "Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol." Aliment Pharmacol Ther, 29, p. 15-28
- Hung SY, Chen HC, Chen WT (2020) "A randomized trial comparing the bowel cleansing efficacy of sodium picosulfate/magnesium citrate and polyethylene glycol/Bisacodyl (The Bowklean Study)" Sci Rep, 10, p. 5604
- Adamcewicz M, Bearelly D, Porat G, Friedenberg FK (2011) "Mechanism of action and toxicities of purgatives used for colonoscopy preparation." Expert Opin Drug Metab Toxicol, 7, p. 89-101
- Anastassopoulos K, Farraye FA, Knight T, Colman S, Cleveland MvB, Pelham RW (2016) "A comparative study of treatment-emergent adverse events following use of common bowel preparations among a colonoscopy screening population: results from a post-marketing observational study." Dig Dis Sci, 61, p. 2993-3006
- Barbeau P, Wolfe D, Yazdi F, et al. (2018) "Comparative safety of bowel cleansers: protocol for a systematic review and network meta-analysis." BMJ Open, 8, e021892
Drug and food interactions
HYDROcodone food
Applies to: Hydrotropine (homatropine / hydrocodone)
GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.
GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).
GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.
MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.
References
- (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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