Diagnostic aid: Neonates: Dosing and administration vary based upon product used. Refer to individual product labeling for approved ages and dosage information.
Diagnostic aid: Infants, Children, and Adolescents: Dosing and administration vary based upon product used. Refer to individual product labeling for approved ages and dosage information.
(For additional information see "Barium: Drug information")
Diagnostic aid: Refer to individual product labeling for dosage information.
The following adverse drug reactions are derived from product labeling unless otherwise specified. Adverse reactions are for the oral dosage form unless otherwise indicated.
Postmarketing:
Cardiovascular: ECG abnormality (rectal), syncope, vasodepressor syncope
Gastrointestinal: Abdominal cramps, diarrhea, fecal impaction, intestinal perforation, nausea, vomiting
Hypersensitivity: Hypersensitivity reaction (including severe hypersensitivity reaction), nonimmune anaphylaxis
Respiratory: Pneumonitis (aspiration)
Hypersensitivity to barium or any component of the formulation; gastric or intestinal perforation (known or suspected).
Additional contraindications may vary (refer to specific product labeling):
Oral formulations: Known obstruction of the GI tract; patients at high risk of GI perforation (eg, recent prior GI perforation, acute GI hemorrhage or ischemia, toxic megacolon, severe ileus, post GI surgery or biopsy, acute GI injury or burn, recent radiotherapy to the pelvis); patients at high risk of aspiration (eg, patients with prior aspiration, tracheoesophageal fistula, obtundation).
Concerns related to adverse effects:
• Aspiration: Oral administration of barium is associated with aspiration pneumonitis, especially in patients with a history of food aspiration or with compromised swallowing mechanism. In patients at risk for aspiration, use with caution and begin the procedure with a small volume; some product labeling contraindicates use of oral formulations in patients at high risk of aspiration (refer to specific product labeling). Some oral formulations are not recommended in patients with a history of food aspiration. Monitor patient closely for aspiration; discontinue immediately if aspiration is suspected, and monitor for development of aspiration pneumonitis.
• Hypersensitivity: Severe hypersensitivity reactions have been reported; manifestations include hypotension, bronchospasm and other respiratory impairments, and dermal reactions including rashes, urticaria, and itching. A history of bronchial asthma, atopy (as evidenced by hay fever and eczema), food allergies, or a previous reaction to a contrast agent may increase this risk. Emergency equipment and trained personnel should be immediately available and should remain available for at least 30 to 60 minutes following administration (delayed reactions may occur).
• Intra-abdominal leakage: Administration may result in leakage of barium at any level of the GI tract in the presence of conditions that increase the risk of perforation 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. Use is contraindicated in patients at high risk of perforation of the GI tract.
• Intravasation: Barium 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, monitor patients for potential intravasation during administration.
• Obstruction/baroliths: Oral administration of barium 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, constipation, pediatric patients with cystic fibrosis or Hirschsprung disease, and the elderly. To reduce the risk of delayed GI transit and obstruction, maintain adequate hydration during and in the days following procedure and consider the administration of laxatives.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with marked hypertension or advanced cardiac disease.
Special populations:
• Debilitated patients: Use with caution in debilitated patients.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP 1997; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007). See manufacturer's labeling.
• Rectal formulations: Use rectal formulations with caution when obstructive lesions of the colon are suspected; minimize the amount of barium allowed to flow proximal to obstructive lesions of the colon.
• Sodium: Some formulations may contain sodium.
• Sorbitol: Some formulations may contain sorbitol, which may cause severe reactions (eg, vomiting, hypoglycemia, jaundice, hemorrhage, hepatomegaly, hyperuricemia, kidney failure) in patients with hereditary fructose intolerance; avoid formulations containing sorbitol in patients with hereditary fructose intolerance.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, Oral, as sulfate:
E-Z-Paste: 60% (454 g) [contains methylparaben, propylparaben, saccharin sodium; vanilla flavor]
Paste, Oral, as sulfate:
Varibar Pudding: 40% (230 mL [DSC]) [contains polysorbate 80, saccharin sodium, sodium benzoate]
Suspension, Combination, as sulfate:
Liquid Polibar Plus: 105% (750 mL, 1900 mL [DSC]) [contains carrageenan, polysorbate 80, saccharin sodium, sodium benzoate]
Vanilla SilQ: 2.1% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate]
Suspension, Oral, as sulfate:
Entero VU: 24% (600 mL [DSC]) [contains carrageenan, polysorbate 80, saccharin sodium, sodium benzoate; blueberry flavor]
Liquid E-Z-Paque: 60% (355 mL) [contains polysorbate 80, saccharin sodium, sodium benzoate]
Liquid E-Z-Paque: 60% (355 mL [DSC]) [contains saccharin sodium, sodium benzoate]
NeuLumEX: 0.1% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate]
Readi-Cat 2: 2% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate; banana smoothie flavor]
Readi-Cat 2: 2% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate; berry flavor]
Readi-Cat 2: 2% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate; creamy vanilla flavor]
Readi-Cat 2: 2% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate; mochaccino flavor]
Readi-Cat 2: 2% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate; orange flavor]
Readi-Cat 2: 2% (450 mL [DSC]) [contains benzoic acid, saccharin sodium, sodium benzoate, sorbitol; banana flavor]
Readi-Cat 2: 2% (450 mL [DSC]) [contains benzoic acid, saccharin sodium, sodium benzoate, sorbitol; berry flavor]
Readi-Cat 2: 2% (450 mL [DSC]) [contains benzoic acid, saccharin sodium, sodium benzoate, sorbitol; mochaccino flavor]
Readi-Cat 2: 2% (450 mL [DSC]) [contains benzoic acid, saccharin sodium, sodium benzoate, sorbitol; vanilla flavor]
Readi-Cat 2: 2% (450 mL [DSC]) [contains saccharin sodium, sodium benzoate, sorbitol; orange flavor]
Tagitol V: 40% (60 mL [DSC]) [contains saccharin sodium, sodium benzoate]
Tagitol V: 40% (20 mL) [contains saccharin sodium, sodium benzoate; apple flavor]
Varibar Honey: 40% (250 mL [DSC]) [contains polysorbate 80, saccharin sodium, sodium benzoate]
Varibar Nectar: 40% (240 mL) [contains polysorbate 80, saccharin sodium, sodium benzoate]
Varibar Thin Honey: 40% (250 mL [DSC]) [contains polysorbate 80, saccharin sodium, sodium benzoate]
VoLumen: 0.1% (450 mL [DSC]) [contains benzoic acid, saccharin sodium, sodium benzoate]
Suspension Reconstituted, Oral, as sulfate:
E-Z-HD: 98% (1 ea) [contains saccharin sodium]
E-Z-Paque: 96% (176 g) [contains carrageenan, polysorbate 80, propylene glycol, saccharin sodium]
Varibar Thin Liquid: 40% (148 g) [contains polysorbate 80, saccharin sodium]
Tablet, Oral, as sulfate:
E-Z-Disk: 700 mg [contains corn starch]
No
Cream (E-Z-Paste Oral)
60% (per gram): $0.14
Suspension (Liquid E-Z-Paque Oral)
60% (per mL): $0.02
Suspension (Liquid Polibar Plus Combination)
105% (per mL): $0.03
Suspension (NeuLumEX Oral)
0.1% (per mL): $0.02
Suspension (Readi-Cat 2 Oral)
2% (per mL): $0.01
Suspension (Tagitol V Oral)
40% (per mL): $0.47
Suspension (Vanilla SilQ Combination)
2.1% (per mL): $0.01
Suspension (Varibar Nectar Oral)
40% (per mL): $0.08
Suspension (reconstituted) (E-Z-HD Oral)
98% (per each): $7.94
Suspension (reconstituted) (E-Z-Paque Oral)
96% (per gram): $0.03
Suspension (reconstituted) (Varibar Thin Liquid Oral)
40% (per gram): $0.05
Tablets (E-Z-Disk Oral)
700 mg (per each): $3.27
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral, rectal: Administration varies based upon product used. Refer to individual product labeling for administration information.
Oral, rectal: Refer to individual product labeling for dosage and administration information.
Store at 20°C to 25°C (68°F to 77°F). Protect suspension from freezing; protect tablets from moisture. Once Varibar pudding, nectar, and honey have been opened, use within 21 days.
Diagnostic aid for computed tomography or x-ray examinations of the GI tract (FDA approved in all ages). Note: Approved ages in pediatric patients may vary; refer to product-specific labeling.
VoLumen may be confused with Voluven
Barium is not systemically absorbed; use is not expected to result in exposure to the fetus. Information related to barium exposure in pregnancy is limited (Han 2010; Han 2011).
Barium is an insoluble material that is opaque to x-rays and therefore provides a positive contrast for radiographic studies.
Absorption: None
Metabolism: Not metabolized
Excretion: Feces
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