Drug Interaction Report

GENERALLY AVOID: Theoretically, use of sodium picosulfate during or following antibiotic treatment may result in a reduced laxative effect of sodium picosulfate. The proposed mechanism involves antibiotic-induced reduction of colonic bacteria that hydrolyze sodium picosulfate, a prodrug, to its active metabolite bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM), a compound that stimulates colonic peristalsis. The clinical significance of this effect remains unknown.

MANAGEMENT: Consider use of an alternate laxative in patients who have recently taken or are currently taking an antibiotic. If concomitant use is required, additional bowel cleansing and colonoscopy may be required.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete 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.

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.