Constipation and bowel cleansers:
Indications for SUPREP:
Bowel cleansing before colonoscopy.
Split-dose regimen (1st dose start the evening before colonoscopy): use 1 bottle of 6oz and dilute to 16oz with water and drink entire amount. Drink 32oz of water over the next hour; (2nd dose start next morning): repeat using the 2nd bottle. Complete prep at least 2hrs before colonoscopy.
<12yrs: not established. 12–16yrs: Split-dose regimen (1st dose start the evening before colonoscopy): use 1 bottle of 4.5oz and dilute to 12oz with water and drink entire amount. Drink 24oz of water over the next hour; (2nd dose start next morning): repeat using the 2nd bottle. Complete prep at least 2hrs before colonoscopy.
GI obstruction or ileus. Bowel perforation. Toxic colitis. Toxic megacolon. Gastric retention.
Maintain adequate hydration. Correct fluid and electrolyte abnormalities before therapy. Renal impairment; monitor baseline and post-colonoscopy electrolytes, creatinine, BUN. History of QT prolongation, uncontrolled arrhythmias, recent MI, unstable angina, CHF, or cardiomyopathy: increased risk of arrhythmias; consider ECGs at pre-dose and post-colonoscopy. Gout. History of seizures. Hyponatremia. Inflammatory bowel disease. Colonic mucosal ulcerations. Ischemic colitis. Severe ulcerative colitis. Risk of regurgitation or aspiration in gag reflex impairment or other swallowing abnormalities. Elderly. Pregnancy. Nursing mothers.
Caution with concomitant diuretics, ACE inhibitors, ARBs, NSAIDs; may affect renal function. Drugs that may lower the seizure threshold (eg, tricyclic antidepressants), alcohol or benzodiazepine withdrawal: may increase risk of seizures. Caution with drugs that may increase risk for fluid or electrolyte disturbances, arrhythmias or QT prolongation. Administer oral medications at least 1hr before starting each dose of Suprep. Administer tetracycline and fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, and penicillamine at least 2hrs before and not less than 6hrs after Suprep to avoid chelation with magnesium. Avoid concomitant stimulant laxatives (eg, bisacodyl, sodium picosulfate).
Overall discomfort, abdominal distention/pain, nausea, vomiting; transient elevated uric acid, renal injury.
Generic Drug Availability:
Bowel prep kit (adults)—1 (2 x 6oz bottles + mixing container); Bowel prep kit (pediatrics)—1 (2 x 4.5oz bottles + mixing container)