Readi-Cat 2 and Readi-Cat 2 SMOOTHIES are indicated for use in computed tomography (CT) of the abdomen to delineate the gastrointestinal (GI) tract in adult and pediatric patients.
2 DOSAGE AND ADMINISTRATION
Base dosing on individual needs and procedure to be performed.
Adult and pediatric patients 12 years and older: 450 mL to 900 mL (9 g to 18 g of barium sulfate)
Patients younger than 12 years of age: adjust dose based on relative GI volume
For oral use only
Shake bottle vigorously for 30 seconds prior to oral administration
Administer undiluted prior to scan
Discard any unused suspension
Advise patients to hydrate following the barium sulfate procedure
3 DOSAGE FORMS AND STRENGTHS
Oral suspension: 9 grams of barium sulfate supplied as a suspension (2% w/v) in a single-dose HDPE plastic bottle.
Readi-Cat 2 products are contraindicated in patients:
with known or suspected perforation of the GI tract
with known obstruction of the GI tract
at high risk of GI perforation such as those with a recent prior GI perforation, acute GI hemorrhage or ischemia, toxic megacolon, severe ileus, post GI surgery or biopsy, acute GI injury or burn, or recent radiotherapy to pelvis
at high risk of aspiration such as those with prior aspiration, tracheo-esophageal fistula, or obtundation
known severe hypersensitivity to barium sulfate or any of the excipients of Readi-Cat 2 or Readi-Cat 2 SMOOTHIES
5 WARNINGS AND PRECAUTIONS
Barium sulfate preparations contain a number of excipients, including natural and artificial flavors and may induce serious hypersensitivity reactions. The manifestations include hypotension, bronchospasm and other respiratory impairments, dermal reactions including rashes, urticaria, and itching. A history of bronchial asthma, atopy, or a previous reaction to a contrast agent may increase the risk for hypersensitivity reactions. Emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction.
Intra-abdominal Barium Leakage
The use of Readi-Cat 2 products is contraindicated in patients at high risk of perforation of the GI tract [see Contraindications (4)]. Administration of Readi-Cat 2 products may result in leakage of barium from the GI tract in the presence of conditions such as carcinomas, GI fistula, inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, or diverticulitis, and in patients with a severe stenosis at any level of the GI tract, especially if it is distal to the stomach. The barium leakage has been associated with peritonitis and granuloma formation.
Delayed Gastrointestinal Transit and Obstruction
Orally administered barium sulfate may accumulate proximal to a constricting lesion of the colon, causing obstruction or impaction with development of baroliths (inspissated barium associated with feces) and may lead to abdominal pain, appendicitis, bowel obstruction, or rarely perforation. Patients with the following conditions are at higher risk for developing obstruction or baroliths: severe stenosis at any level of the GI tract, impaired GI motility, electrolyte imbalance, dehydration, on a low residue diet, taking medications that delay GI motility, and constipation, pediatric patients with cystic fibrosis or Hirschsprung disease, and the elderly [see Use in Specific Populations (8.4, 8.5)]. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration following a barium sulfate procedure.
The use of Readi-Cat 2 products is contraindicated in patients at high risk of aspiration [see Contraindications (4)]. Oral administration of barium is associated with aspiration pneumonitis, especially in patients with a history of food aspiration or with compromised swallowing mechanism. Vomiting following oral administration of barium sulfate may lead to aspiration pneumonitis. In patients at risk for aspiration, begin the procedure with a small ingested volume of Readi-Cat 2 products. Discontinue administration of Readi-Cat 2 products immediately if aspiration is suspected.
Barium sulfate products may occasionally intravasate into the venous drainage of the large bowel and enter the circulation as a "barium embolus" leading to potentially fatal complications which include systemic and pulmonary embolism, disseminated intravascular coagulation, septicemia and prolonged severe hypotension. Although this complication is exceedingly uncommon after oral administration of barium sulfate suspension, monitor patients for potential intravasation when administering barium sulfate.
Risk with Hereditary Fructose Intolerance
Readi-Cat 2 contains sorbitol which may cause severe reactions if ingested by patients with hereditary fructose intolerance, such as: vomiting, hypoglycemia, jaundice, hemorrhage, hepatomegaly, hyperuricemia, and kidney failure. Before administration of Readi-Cat 2 assess patients for a history of hereditary fructose intolerance and avoid use in these patients.
6 ADVERSE REACTIONS
The following adverse reactions have been identified from spontaneous reporting or clinical studies of barium sulfate administered orally. Because the reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or to establish a causal relationship to drug exposure:
Nausea, vomiting, diarrhea and abdominal cramping
Serious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes
8 USES IN SPECIFIC POPULATIONS
Readi-Cat 2 products are not absorbed systemically following oral administration, and maternal use is not expected to result in fetal exposure to the drug.
Readi-Cat 2 products are not absorbed systemically by the mother following oral administration, and breastfeeding is not expected to result in exposure of the infant to Readi-Cat 2.
The efficacy of Readi-Cat 2 in pediatric patients of all groups is based on successful opacification of the GI tract during radiographic procedures [see Clinical Pharmacology (12.1)].
Readi-Cat 2 is contraindicated in pediatric patients with tracheo-esophageal fistula [see Contraindications (4)].
Pediatric patients with a history of asthma or food allergies may be at increased risk for development of hypersensitivity reactions [see Warnings and Precautions (5.1)]. Pediatric patients with cystic fibrosis or Hirschsprung disease should be monitored for bowel obstruction after use [see Warnings and Precautions (5.3)].
Clinical studies of Readi-Cat 2 products do not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Readi-Cat 2 and Readi-Cat 2 SMOOTHIE (barium sulfate) are radiographic contrast agents supplied as a suspension (2% w/v) for oral administration. The active ingredient barium sulfate is designated chemically as BaSO4 with a molecular weight of 233.4 g/mol, a density of 4.5 g/cm3, and the following chemical structure:
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