Drug Interaction Report

MONITOR: Coadministration with agents that affect renal function or perfusion such as diuretics, ACE inhibitors, angiotensin receptor blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk and/or severity of fluid and electrolyte disturbances associated with the use of bowel cleansing preparations. Fluid and electrolyte disturbances can lead to serious adverse events including cardiac arrhythmias, seizures, and renal impairment.

MANAGEMENT: Caution is advised when bowel cleansing preparations are used in patients treated with agents that affect renal function or perfusion, particularly if they are frail or elderly or have preexisting renal impairment. Baseline and postprocedure labs including serum electrolytes, BUN, and creatinine should be considered. Patients should be advised to drink sufficient quantities of clear fluids before, during, and after bowel cleansing. Hospitalization and intravenous fluid hydration may be appropriate for frail or elderly patients who may be unable to drink an adequate volume of fluid.

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.