Interactions between Fleet Prep Kit 3 and Neostigmine
1 drug interaction and 25 additional warnings found for the following 2 drugs:
- Fleet Prep Kit 3 (bisacodyl/sodium biphosphate/sodium phosphate)
- neostigmine
Drug interactions
Moderate drug interactions
Moderate:
neostigmine sodium biphosphate
Applies to: neostigmine and Fleet Prep Kit 3 (bisacodyl / sodium biphosphate / sodium phosphate)
Monitor
The following interaction applies only to products containing sodium biphosphate that are used for bowel cleansing. It does not apply to products containing sodium biphosphate that are used for other, non-laxative related purposes. The risk of seizures induced by the use of bowel cleansing preparations may be increased in patients on concomitant medications that can lower the seizure threshold such as selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. Rare cases of generalized tonic-clonic seizures and/or loss of consciousness in association with low serum osmolality and electrolyte abnormalities (e.g., hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia) have been reported with the use of bowel cleansing products in patients with no prior history of seizures. The condition resolved with correction of fluid and electrolyte abnormalities.
Management
Caution is advised when bowel cleansing preparations are prescribed in patients treated with agents that can lower the seizure threshold. Bowel cleansing preparations should not be used if these patients have impaired renal function or perfusion, dehydration, or uncorrected electrolyte abnormalities. Baseline and postprocedure labs including serum electrolytes, calcium, phosphate, BUN, and creatinine should be considered, particularly in the elderly. Patients should be advised not to exceed the recommended dosage of their bowel cleansing preparation and to drink sufficient quantities of clear fluids before, during, and after the bowel preparation process. Administration of an electrolyte rehydration solution may help attenuate the electrolyte abnormalities and hypovolemia.
References (5)
- Salik JM, Kurtin P (1985) "Severe hyponatremia after colonoscopy preparation in a patient with the acquired immune deficiency syndrome." Am J Gastroenterol, 80, p. 177-9
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2007) "Product Information. Fleet Phospho Soda (sodium acid phosphate-sodium phosphate)." Fleet, CB
- (2007) "Product Information. Visicol (sodium acid phosphate-sodium phosphate)." Salix Pharmaceuticals
- Cerner Multum, Inc. "Australian Product Information."
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
sodium biphosphate Food/Lifestyle
Applies to: Fleet Prep Kit 3 (bisacodyl / sodium biphosphate / sodium phosphate)
Adjust dosing interval
Bowel cleansing products can increase the gastrointestinal transit rate. Oral medications administered within one hour of the start of administration of the bowel cleansing solution may be flushed from the gastrointestinal tract and not properly absorbed.
Management
Patients should be advised that absorption of oral medications may be impaired during bowel cleansing treatment. Oral medications (e.g., anticonvulsants, oral contraceptives, antidiabetic agents, antibiotics) should not be administered during and within one hour of starting bowel cleansing treatment whenever possible. However, if concomitant use cannot be avoided, monitoring for reduced therapeutic effects may be advisable.
References (2)
- "Product Information. Golytely (polyethylene glycol 3350 with electrolytes)." Braintree
- (2022) "Product Information. Prepopik (citric acid/magnesium oxide/sodium picosulfate)." Ferring Pharmaceuticals Inc
Moderate:
bisacodyl multivitamins with minerals
Applies to: Fleet Prep Kit 3 (bisacodyl / sodium biphosphate / sodium phosphate)
Generally avoid
Chronic use of stimulant laxatives may decrease the absorption of fat-soluble vitamins (A, D, E, and K) and minerals such as calcium, potentially leading to deficiencies. This effect is due to accelerated intestinal transit time, which reduces nutrient absorption.
Management
To minimize this risk, limit the use of stimulant laxatives to short-term or occasional use.
References (2)
- (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
- Wakeman M (2021) "A Literature Review of the Potential Impact of Medication on Vitamin D Status" Risk Man Heal Pol, 14, p. 3357-3381
Disease interactions
23 potential interactions Applies to: 21 conditions, including Heart Failure, Arrhythmia, Hyperthyroidism, Inflammatory Bowel Disease, and Hypocalcemia.
Appendicitis
Major:
Fleet Prep Kit 3
The bisacodyl in Fleet Prep Kit 3 has a major potential interaction with Appendicitis.
The use of stimulant laxatives is contraindicated in patients with or who may have acute surgical abdomen or appendicitis. These patients may be candidates for emergency surgery. Stimulant laxatives should also not be administered to patients with abdominal pain, particularly if the cause has not been determined.
Arrhythmia
Major:
neostigmine
Neostigmine has a major potential interaction with Arrhythmia.
Due to their pharmacological action, cholinesterase inhibitors can have a vagotonic effect on the sinoatrial and atrioventricular nodes producing bradycardia or heart block. Therapy with cholinesterase inhibitors should be administered cautiously in patients with preexisting bradycardia or underlying cardiac conduction abnormalities. Syncopal episodes have been reported. Atropine may be used to reverse bradycardia produced by cholinesterase inhibitors.
Bleeding Disorder
Major:
Fleet Prep Kit 3
The bisacodyl in Fleet Prep Kit 3 has a major potential interaction with Bleeding Disorder.
The use of stimulant laxatives is contraindicated in patients with anal or rectal fissures. These preparations may cause irritation, burning sensation, and proctitis.
Dehydration
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Dehydration.
The use of sodium phosphates is contraindicated in patients with congenital megacolon, intestinal obstruction, imperforate anus, active inflammatory disease or congestive heart failure. Serious, potentially life-threatening electrolyte imbalance such as hypocalcemia and hyperphosphatemia can result with prolonged or excessive use of phosphate laxatives. Hypernatremia and dehydration can occur due to improper dilution of hypertonic saline laxatives. Therapy with sodium phosphates should be administered cautiously and frequency of administration limited in patients with renal dysfunction, colostomy, cardiac dysfunction, or electrolyte imbalance. Clinical monitoring of electrolyte concentrations is recommended.
Fluid Retention
Major:
Fleet Prep Kit 3
The sodium phosphate in Fleet Prep Kit 3 has a major potential interaction with Fluid Retention.
Alkalinizing agents containing sodium can induce sodium and water retention and result in hypernatremia, hypokalemia, hyperosmolality, edema and aggravation of congestive heart failure. Therapy with sodium- containing alkalinizing agents should not be used in patients with hypernatremia or fluid retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with alkalinizing agents is recommended.
Gastrointestinal Obstruction
Major:
Fleet Prep Kit 3
The bisacodyl, sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 all have a major potential interaction with Gastrointestinal Obstruction.
The use of laxatives is contraindicated in patients with intestinal obstruction disorders. Patients with intestinal obstruction disorders may need their underlying condition treated to correct the constipation. Some laxatives require reduction in the colon to their active form to be effective which may be a problem in patients with intestinal obstruction.
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Gastrointestinal Obstruction.
The use of sodium phosphates is contraindicated in patients with congenital megacolon, intestinal obstruction, imperforate anus, active inflammatory disease or congestive heart failure. Serious, potentially life-threatening electrolyte imbalance such as hypocalcemia and hyperphosphatemia can result with prolonged or excessive use of phosphate laxatives. Hypernatremia and dehydration can occur due to improper dilution of hypertonic saline laxatives. Therapy with sodium phosphates should be administered cautiously and frequency of administration limited in patients with renal dysfunction, colostomy, cardiac dysfunction, or electrolyte imbalance. Clinical monitoring of electrolyte concentrations is recommended.
Heart Failure
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Heart Failure.
The use of sodium phosphates is contraindicated in patients with congenital megacolon, intestinal obstruction, imperforate anus, active inflammatory disease or congestive heart failure. Serious, potentially life-threatening electrolyte imbalance such as hypocalcemia and hyperphosphatemia can result with prolonged or excessive use of phosphate laxatives. Hypernatremia and dehydration can occur due to improper dilution of hypertonic saline laxatives. Therapy with sodium phosphates should be administered cautiously and frequency of administration limited in patients with renal dysfunction, colostomy, cardiac dysfunction, or electrolyte imbalance. Clinical monitoring of electrolyte concentrations is recommended.
Hyperkalemia
Major:
Fleet Prep Kit 3
The sodium phosphate in Fleet Prep Kit 3 has a major potential interaction with Hyperkalemia.
The use of phosphates is in general contraindicated in conditions where high potassium, high phosphate, or low calcium may be encountered such as hypoparathyroidism, osteomalacia, acute pancreatitis, or chronic renal disease.
Hypernatremia
Major:
Fleet Prep Kit 3
The sodium phosphate in Fleet Prep Kit 3 has a major potential interaction with Hypernatremia.
Alkalinizing agents containing sodium can induce sodium and water retention and result in hypernatremia, hypokalemia, hyperosmolality, edema and aggravation of congestive heart failure. Therapy with sodium- containing alkalinizing agents should not be used in patients with hypernatremia or fluid retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with alkalinizing agents is recommended.
Hyperthyroidism
Moderate:
neostigmine
Neostigmine has a moderate potential interaction with Hyperthyroidism.
Many of the manifestations of hyperthyroidism may be exacerbated by increased levels of acetylcholine produced by cholinesterase inhibitors. Therapy with cholinesterase inhibitors should be administered cautiously to patients with hyperthyroidism. Monitoring of thyroid levels is recommended.
Hypocalcemia
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Hypocalcemia.
The use of phosphates is in general contraindicated in conditions where high potassium, high phosphate, or low calcium may be encountered such as hypoparathyroidism, osteomalacia, acute pancreatitis, or chronic renal disease.
Hypoparathyroidism
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Hypoparathyroidism.
Therapy with phosphates should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Elevated serum concentrations of phosphate and calcium can exceed the solubility level and result in calcium-phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Clinical monitoring of serum calcium and phosphate concentrations is necessary.
Inflammatory Bowel Disease
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Inflammatory Bowel Disease.
The use of sodium phosphates is contraindicated in patients with congenital megacolon, intestinal obstruction, imperforate anus, active inflammatory disease or congestive heart failure. Serious, potentially life-threatening electrolyte imbalance such as hypocalcemia and hyperphosphatemia can result with prolonged or excessive use of phosphate laxatives. Hypernatremia and dehydration can occur due to improper dilution of hypertonic saline laxatives. Therapy with sodium phosphates should be administered cautiously and frequency of administration limited in patients with renal dysfunction, colostomy, cardiac dysfunction, or electrolyte imbalance. Clinical monitoring of electrolyte concentrations is recommended.
Major:
Fleet Prep Kit 3
The bisacodyl, sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 all have a major potential interaction with Inflammatory Bowel Disease.
The use of laxatives is contraindicated in patients with inflammatory bowel disease. Patients with inflammatory bowel disease may experience colonic perforation with use of stimulant laxatives.
Intestinal Obstruction
Major:
neostigmine
Neostigmine has a major potential interaction with Intestinal Obstruction.
Neostigmine is contraindicated in mechanical obstruction of the urinary or intestinal tract and peritonitis.
Ischemic Heart Disease
Major:
neostigmine
Neostigmine has a major potential interaction with Ischemic Heart Disease.
The use of cholinesterase inhibitors has been associated with a constriction of coronary arteries. Therapy with cholinesterase inhibitors should be administered cautiously in patients with coronary artery disease.
Liver Disease
Moderate:
neostigmine
Neostigmine has a moderate potential interaction with Liver Disease.
Neostigmine is metabolized by microsomal enzymes in the liver, and the effect of hepatic impairment on pharmacokinetics has not been evaluated. Patients should be carefully monitored if hepatically cleared neuromuscular blocking agents are used, as their duration of action may be prolonged due to hepatic insufficiency.
Pancreatitis
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Pancreatitis.
The use of phosphates is in general contraindicated in conditions where high potassium, high phosphate, or low calcium may be encountered such as hypoparathyroidism, osteomalacia, acute pancreatitis, or chronic renal disease.
Parkinsonism
Major:
neostigmine
Neostigmine has a major potential interaction with Parkinsonism.
Cholinesterase inhibitors should be used with caution in patients with parkinsonism. Some of these drugs might be contraindicated in these patients (refer to specific prescribing information). Symptoms of Parkinson's disease may be exacerbated with the increase in cholinergic activity. Caregivers and patients should be advised.
Phosphate Imbalance
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Phosphate Imbalance.
The use of sodium phosphates is contraindicated in patients with congenital megacolon, intestinal obstruction, imperforate anus, active inflammatory disease or congestive heart failure. Serious, potentially life-threatening electrolyte imbalance such as hypocalcemia and hyperphosphatemia can result with prolonged or excessive use of phosphate laxatives. Hypernatremia and dehydration can occur due to improper dilution of hypertonic saline laxatives. Therapy with sodium phosphates should be administered cautiously and frequency of administration limited in patients with renal dysfunction, colostomy, cardiac dysfunction, or electrolyte imbalance. Clinical monitoring of electrolyte concentrations is recommended.
Renal Dysfunction
Major:
Fleet Prep Kit 3
The sodium biphosphate and sodium phosphate in Fleet Prep Kit 3 both have a major potential interaction with Renal Dysfunction.
Therapy with phosphates should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Elevated serum concentrations of phosphate and calcium can exceed the solubility level and result in calcium-phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Clinical monitoring of serum calcium and phosphate concentrations is necessary.
Urinary Tract Obstruction
Major:
neostigmine
Neostigmine has a major potential interaction with Urinary Tract Obstruction.
Neostigmine is contraindicated in mechanical obstruction of the urinary or intestinal tract and peritonitis.
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More resources
Fleet Prep Kit 3
A total of 469 drugs are known to interact with Fleet Prep Kit 3.
- Fleet prep kit 3 is in the drug class laxatives.
neostigmine
A total of 139 drugs are known to interact with neostigmine.
- Neostigmine is in the following drug classes: cholinergic muscle stimulants, miscellaneous genitourinary tract agents.
- Neostigmine is used to treat the following conditions:
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
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.