Phospho-soda, OsmoPrep
Generic Name
Sodium Phosphates (Monobasic and Dibasic)
Manufacturer
Various Pharmaceutical Companies
Country
Various
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Description
Overview of the medicine
Phosphoprep is a saline laxative used for bowel cleansing before colonoscopy, radiological examination, or surgery. It works by drawing water into the colon, which helps to evacuate its contents.
Uses & Indications
Dosage
Adults
Typically administered as a split dose regimen: one 45 mL bottle taken with 8 oz of clear liquids, followed by another 45 mL bottle taken 10-12 hours later with 8 oz of clear liquids, along with additional clear liquids throughout the preparation.
Elderly
Use with extreme caution; elderly patients are at higher risk of acute phosphate nephropathy, electrolyte disturbances, and dehydration. Lower doses or alternative preparations may be considered based on renal function and comorbidities.
Renal_impairment
Contraindicated in patients with severe renal impairment (CrCl < 30 mL/min). Use with extreme caution in moderate renal impairment, and consider alternative bowel preparations.
How to Take
Oral solution should be mixed with water or other clear liquids as directed by a healthcare professional. It is crucial to consume additional clear liquids as per instructions to prevent dehydration and electrolyte imbalances.
Mechanism of Action
As a saline laxative, sodium phosphates exert an osmotic effect in the gastrointestinal tract, drawing water into the colon. This increase in fluid distends the bowel, stimulates peristalsis, and results in bowel evacuation.
Pharmacokinetics
Onset
Bowel evacuation typically begins within 0.5 to 6 hours after the first dose.
Excretion
Primarily via feces for the unabsorbed drug. Any systemically absorbed phosphate is excreted renally.
Half life
Not clinically significant for unabsorbed drug due to limited systemic absorption. Absorbed phosphate is renally excreted.
Absorption
Poorly absorbed systemically; however, some absorption of phosphate and sodium can occur, particularly in individuals with impaired gastrointestinal integrity or certain medical conditions.
Metabolism
Minimal to none for the unabsorbed drug. Systemically absorbed phosphate is not metabolized.
Side Effects
Contraindications
- Known hypersensitivity to sodium phosphate
- Patients with impaired renal function (CrCl < 30 mL/min)
- Congestive heart failure, severe cardiac impairment
- Gastric retention, bowel obstruction, ileus, or bowel perforation
- Acute phosphate nephropathy, severe dehydration, or active inflammatory bowel disease
Drug Interactions
NSAIDs, ACE Inhibitors, ARBs, Diuretics
Increased risk of acute phosphate nephropathy and electrolyte disturbances. Use with extreme caution or avoid.
Calcium Supplements, Antacids, Iron Supplements
May bind phosphate and reduce its effectiveness, or lead to further electrolyte imbalances.
Oral Medications (within 1 hour of preparation)
May be flushed out of the gastrointestinal tract and not absorbed. Consider delaying or rescheduling essential oral medications.
Medications affecting electrolytes (e.g., lithium)
Increased risk of severe electrolyte imbalances.
Storage
Store at room temperature (20°C to 25°C or 68°F to 77°F), away from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Overdose can lead to severe electrolyte disturbances, including hyperphosphatemia, hypocalcemia, hypernatremia, and metabolic acidosis, potentially resulting in cardiac arrhythmias, acute renal failure, and seizures. Management involves immediate discontinuation, supportive care, intravenous fluids, and correction of electrolyte imbalances. Hemodialysis may be required in severe cases.
Pregnancy & Lactation
Pregnancy Category C. Use with caution during pregnancy only if the potential benefit justifies the potential risk to the fetus. It can cause electrolyte imbalances in the mother which may affect the fetus. Excretion into breast milk is unknown; exercise caution when administering to a nursing mother. Consult a healthcare professional.
Side Effects
Contraindications
- Known hypersensitivity to sodium phosphate
- Patients with impaired renal function (CrCl < 30 mL/min)
- Congestive heart failure, severe cardiac impairment
- Gastric retention, bowel obstruction, ileus, or bowel perforation
- Acute phosphate nephropathy, severe dehydration, or active inflammatory bowel disease
Drug Interactions
NSAIDs, ACE Inhibitors, ARBs, Diuretics
Increased risk of acute phosphate nephropathy and electrolyte disturbances. Use with extreme caution or avoid.
Calcium Supplements, Antacids, Iron Supplements
May bind phosphate and reduce its effectiveness, or lead to further electrolyte imbalances.
Oral Medications (within 1 hour of preparation)
May be flushed out of the gastrointestinal tract and not absorbed. Consider delaying or rescheduling essential oral medications.
Medications affecting electrolytes (e.g., lithium)
Increased risk of severe electrolyte imbalances.
Storage
Store at room temperature (20°C to 25°C or 68°F to 77°F), away from light and moisture. Do not freeze. Keep out of reach of children.
Overdose
Overdose can lead to severe electrolyte disturbances, including hyperphosphatemia, hypocalcemia, hypernatremia, and metabolic acidosis, potentially resulting in cardiac arrhythmias, acute renal failure, and seizures. Management involves immediate discontinuation, supportive care, intravenous fluids, and correction of electrolyte imbalances. Hemodialysis may be required in severe cases.
Pregnancy & Lactation
Pregnancy Category C. Use with caution during pregnancy only if the potential benefit justifies the potential risk to the fetus. It can cause electrolyte imbalances in the mother which may affect the fetus. Excretion into breast milk is unknown; exercise caution when administering to a nursing mother. Consult a healthcare professional.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Varies by specific product, usually 2 to 3 years from the date of manufacture.
Availability
Pharmacies, Hospitals
Approval Status
FDA Approved
Patent Status
Generic available
Clinical Trials
Numerous clinical trials have established the efficacy and safety of sodium phosphate preparations for bowel cleansing. Ongoing research focuses on optimizing regimens to improve patient tolerability and reduce the risk of adverse events, particularly acute phosphate nephropathy, by comparing with other bowel preparations like PEG-based solutions.
Lab Monitoring
- Baseline and post-procedure serum electrolytes (phosphate, calcium, sodium, potassium) in at-risk patients
- Renal function tests (serum creatinine, BUN) before and after administration, especially in elderly and those with pre-existing renal impairment
Doctor Notes
- Crucially assess patient risk factors (age, renal function, cardiac status, concurrent medications) for acute phosphate nephropathy and electrolyte disturbances before prescribing.
- Emphasize the importance of adequate hydration with clear liquids and strict adherence to the administration schedule.
- Consider alternative bowel preparations (e.g., PEG-based) for high-risk patients or those with contraindications.
- Advise patients to contact a healthcare professional immediately if they experience severe symptoms.
Patient Guidelines
- Follow all instructions from your healthcare provider precisely, including dosage, timing, and clear liquid intake.
- Stay well-hydrated by drinking plenty of recommended clear liquids during the preparation period.
- Report any severe abdominal pain, excessive vomiting, dizziness, or decreased urination immediately.
- Do not use if you have kidney disease, heart failure, or inflammatory bowel disease without consulting your doctor.
Missed Dose Advice
If a dose is missed, especially as part of a bowel preparation regimen, consult your doctor or pharmacist immediately. Incomplete bowel preparation may necessitate rescheduling the procedure.
Driving Precautions
Phosphoprep can cause dizziness, lightheadedness, or weakness due to dehydration or electrolyte imbalances. It is advisable to avoid driving or operating heavy machinery until you know how the medication affects you and your symptoms have resolved.
Lifestyle Advice
- Avoid solid foods on the day before and day of the procedure, adhering strictly to a clear liquid diet.
- Plan to stay at home or near a toilet during the bowel preparation to manage frequent bowel movements.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.