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Sodium, potassium, and magnesium sulfates bowel preparation kit: Drug information

Sodium, potassium, and magnesium sulfates bowel preparation kit: Drug information
(For additional information see "Sodium, potassium, and magnesium sulfates bowel preparation kit: Patient drug information" and see "Sodium, potassium, and magnesium sulfates bowel preparation kit: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Suprep Bowel Prep Kit
Pharmacologic Category
  • Laxative, Osmotic
Dosing: Adult
Colon cleansing prior to colonoscopy

Colon cleansing prior to colonoscopy: Oral:

2-day regimen: Total volume of liquid consumed over the course of treatment: 2,880 mL (96 oz).

Evening before colonoscopy: Drink the entire contents of one 6 oz bottle, diluted to a final volume of 480 mL (16 oz). Then drink 2 additional containers of water each (filled to the 16-ounce line) over the next hour, for an additional volume of 960 mL (32 oz).

Morning of the colonoscopy (10 to 12 hours after the evening dose): Repeat entire process with the second 6 oz bottle: Drink entire contents of second bottle diluted to a final volume of 480 mL (16 oz); then drink 2 additional containers of water (each filled to the 16-ounce line) over the next hour, for an additional volume of 960 mL (32 oz). Complete at least 2 hours before the procedure.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no adjustments provided in the manufacturer's labeling. Use with caution, ensure adequate hydration, and consider baseline and post-colonoscopy renal assessment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, no adjustment expected due to similar disposition to healthy patients in pharmacokinetic studies.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Sodium, potassium, and magnesium sulfates bowel preparation kit: Pediatric drug information")

Note: Product is available in multiple sizes (4.5 oz for pediatric patients and 6 oz for adults); use extra precaution.

Colon cleansing prior to colonoscopy

Colon cleansing prior to colonoscopy: Children ≥12 years and Adolescents: Oral: Oral solution: 13.13 g sodium sulfate/2.35 g potassium sulfate/1.2 g magnesium sulfate per 4.5 oz bottle:

2-day regimen: Total volume of liquid consumed over the course of treatment: 2,128 mL (72 oz).

Evening before colonoscopy: Drink the entire contents of one 4.5 oz bottle, diluted to a final volume of 354 mL (12 oz). Then drink 2 additional containers of water each (filled to the 12-ounce line) over the next hour, for an additional volume of 710 mL (24 oz).

Morning of the colonoscopy (10 to 12 hours after the evening dose): Repeat entire process with the second 4.5 oz bottle: Drink entire contents of second bottle diluted to a final volume of 354 mL (12 oz). Then drink 2 additional containers of water (each filled to the 12-ounce line) over the next hour, for an additional volume of 710 mL (24 oz). Complete at least 2 hours before the procedure.

Dosing: Kidney Impairment: Pediatric

There are no adjustments provided in the manufacturer's labeling. Use with caution, ensure adequate hydration, and consider baseline and post-colonoscopy renal assessment.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. However, no adjustment expected due to similar disposition to healthy patients in pharmacokinetic studies.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions are reported for adults unless otherwise indicated.

>10%:

Endocrine & metabolic: Decreased serum bicarbonate (13%), increased uric acid (24%)

Gastrointestinal: Abdominal distention (40%), abdominal pain (36%), bloating (adolescents), nausea (36%)

Nervous system: Malaise (54%)

1% to 10%:

Endocrine & metabolic: Hyperchloremia (2%), increased serum calcium (10%), serum hyperosmolarity (6%)

Gastrointestinal: Vomiting (8%)

Hepatic: Increased serum bilirubin (9%)

Renal: Increased blood urea nitrogen (2%)

<1%: Cardiovascular: Atrioventricular block

Frequency not defined: Neuromuscular & skeletal: Increased creatine phosphokinase in blood specimen

Contraindications

Hypersensitivity to sodium sulfate, potassium sulfate, magnesium sulfate, or any component of the formulation; GI obstruction, bowel perforation, gastric retention, ileus, toxic colitis, toxic megacolon

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmias: Serious arrhythmias have occurred rarely with the use of ionic osmotic laxative products; use caution in patients at increased risk for arrhythmias (eg, recent MI, unstable angina, cardiomyopathy, history of prolonged QT, uncontrolled arrhythmias, heart failure); consider baseline and post-colonoscopy ECGs in patients at increased risk for serious arrhythmias.

• Fluid and electrolyte abnormalities: May cause fluid and electrolyte disturbances, particularly in patients at increased risk (eg, renal impairment, concomitant mediations that alter electrolyte balance). Any preexisting electrolyte abnormalities should be corrected prior to use and patients should be adequately hydrated before, during, and after use.

• GI effects: Osmotic laxatives may produce colonic mucosal aphthous ulcerations, including cases of ischemic colitis. Use caution when interpreting colonoscopy results in patients with inflammatory bowel disease.

• Seizures: Seizures associated with electrolyte abnormalities (eg, hyponatremia, hypokalemia hypocalcemia, hypomagnesemia) and low serum osmolality have occurred. Use with caution in patients with a history of seizures, underlying electrolyte disturbances, in patients at increased risk for seizures (eg, concomitant medications that lower seizure threshold, withdrawal from alcohol or benzodiazepines), or patients with hyponatremia (known or suspected).

Disease-related concerns:

• Gout: May cause transient increases in uric acid and may precipitate an acute flare; use caution in patients with gout.

• Impaired gag reflex: Use with caution in patients with impaired gag reflex and patients prone to regurgitation or aspiration; observe these patients during administration.

• Renal impairment: Use caution in patients with renal impairment or using concomitant medications that may affect renal function; may increase risk of renal injury. Adequate hydration is particularly important in these patients. Consider baseline and post-colonoscopy electrolyte, creatinine, and BUN levels.

• Ulcerative colitis: Use with caution in patients with severe, active ulcerative colitis.

Other warnings/precautions:

• Appropriate use: Evaluate patients with symptoms of bowel obstruction/perforation (nausea, vomiting, abdominal pain or distension) prior to use. Each bottle must be diluted with water prior to use; inadvertent administration of undiluted solution may increase the risk of nausea, vomiting, and fluid/electrolyte abnormalities.

Product Availability

Suprep Bowel Prep Kit (for pediatric patients ≥12 years of age): FDA approved July 2020; anticipated availability currently unknown.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, oral:

Suprep Bowel Prep Kit: Sodium sulfate 17.5 g, potassium sulfate 3.13 g, and magnesuim sulfate 1.6 g per 177 mL (2 x 177 mL) [contains sodium benzoate]

Generic Equivalent Available: US

No

Pricing: US

Solution (Na Sulfate-K Sulfate-Mg Sulf Oral)

17.5-3.13-1.6GM/177ML (per mL): $0.30 - $0.33

Solution (Suprep Bowel Prep Kit Oral)

17.5-3.13-1.6GM/177ML (per mL): $0.39

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.

Administration: Adult

Oral: Each bottle of oral solution must be diluted prior to use. The entire contents of each bottle should be consumed, followed by each postdose hydration amount. Patients should avoid laxatives, solid food, red and purple liquids, milk, and alcoholic beverages on the day prior and the day of the colonoscopy. Oral medications should not be administered within 1 hour of start of therapy; tetracyclines, fluoroquinolones, iron, digoxin, chlorpromazine, or penicillamine should not be administered within 2 hours prior to start of therapy or ≤6 hours after administration of therapy.

Day prior to colonoscopy: Patients may have a light breakfast or clear liquids (eg, water, strained fruit juice without pulp, lemonade, plain coffee or tea, chicken broth, gelatin dessert without fruit).

Day of the colonoscopy: Only clear liquids may be consumed; stop drinking clear liquids at least 2 hours before colonoscopy.

Administration: Pediatric

Oral: 4.5 oz bottle: Each 4.5 oz bottle of oral solution must be diluted prior to use. The entire contents of the 4.5 oz bottle should be consumed, followed by postdose hydration. Patients should avoid laxatives, solid food, red and purple liquids, milk, and alcoholic beverages on the day prior and the day of the colonoscopy.

Day prior to colonoscopy: Patients may have a light breakfast or clear liquids (eg, water, strained fruit juice without pulp, lemonade, plain coffee or tea, chicken broth, gelatin dessert without fruit).

Day of the colonoscopy: Only clear liquids may be consumed; stop drinking clear liquids at least 2 hours before colonoscopy.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Suprep: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/022372s013lbl.pdf#page=13

Use: Labeled Indications

Colon cleansing prior to colonoscopy: Cleansing of the colon as a preparation for colonoscopy in adults and pediatric patients ≥12 years of age.

Medication Safety Issues
Sound-alike/look-alike issues:

Suprep Bowel Prep Kit may be confused with Suclear

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfacalcidol: May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving alfacalcidol. If magnesium-containing products must be used with alfacalcidol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification

Alpha-Lipoic Acid: Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Magnesium Salts. Management: Separate administration of alpha-lipoic acid from that of any magnesium-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral magnesium-containing products at lunch or dinner. Risk D: Consider therapy modification

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination

Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification

Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification

Calcitriol (Systemic): May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification

Calcium Channel Blockers (Dihydropyridine): Magnesium Sulfate may enhance the adverse/toxic effect of Calcium Channel Blockers (Dihydropyridine). Specifically, the risk of hypotension or muscle weakness may be increased. Risk C: Monitor therapy

Calcium Polystyrene Sulfonate: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of calcium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of calcium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination

CNS Depressants: Magnesium Sulfate may enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification

Dolutegravir: Magnesium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Risk D: Consider therapy modification

Doxercalciferol: May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. Risk D: Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification

Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification

Gabapentin: Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Risk D: Consider therapy modification

Laxatives (Stimulant): May enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased. Risk X: Avoid combination

Levonadifloxacin: Magnesium Salts may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination

Levothyroxine: Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours. Risk D: Consider therapy modification

Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour. Risk D: Consider therapy modification

Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification

Phosphate Supplements: Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Risk D: Consider therapy modification

Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Risk D: Consider therapy modification

Raltegravir: Magnesium Salts may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Risk X: Avoid combination

Ritodrine: May enhance the adverse/toxic effect of Magnesium Sulfate. Risk C: Monitor therapy

Roxadustat: Polyvalent Cation Containing Products may decrease the serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider therapy modification

Sodium Polystyrene Sulfonate: Laxatives (Magnesium Containing) may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of sodium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of sodium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination

Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Risk D: Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider therapy modification

Unithiol: May diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination

Pregnancy Considerations

Colonoscopy in pregnant women is generally reserved for strong indications; elective procedures should be delayed until after delivery. Although data are insufficient to recommend a specific bowel preparation, use of other agents may be preferred (ESGE [Hassan 2019]; Gomes 2018).

Breastfeeding Considerations

It is not known if significant amounts of sodium, potassium, or magnesium are present in breast milk following use as a bowel preparation.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

Dietary Considerations

Avoid solid food, red and purple liquids, milk, and alcoholic beverages.

Monitoring Parameters

Consider baseline and postprocedure electrolytes, BUN, and creatinine in patients at risk for renal impairment, seizure, or who have a history of electrolyte abnormality; ECG (prior to therapy and post-colonoscopy) in patients with risks for prolonged QT or arrhythmias.

Mechanism of Action

Induces catharsis by the osmotic effects of the unabsorbed ions in the GI tract

Pharmacokinetics (Adult Data Unless Noted)

Note: Pharmacokinetics measured in terms of serum sulfate unless otherwise specified.

Absorption: Sulfate anions poorly absorbed in the GI tract

Half-life, elimination: 8.5 hours

Time to peak: ~17 hours after first dose; ~5 hours after second dose

Excretion: Feces (primarily)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: In patients with moderate renal impairment, mean AUC and Cmax were 54% and 44% higher than those in healthy subjects, respectively; urinary excretion of sulfate over 30 hours, starting after the first half dose, was ~16% lower.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (KR) Korea, Republic of: S free
  1. Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol. 2018;31(4):385-394. doi:10.20524/aog.2018.0264 [PubMed 29991883]
  2. Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2019. Endoscopy. 2019;51(8):775-794. doi:10.1055/a-0959-0505 [PubMed 31295746]
  3. Suprep (sodium sulfate/potassium sulfate/magnesium sulfate) [prescribing information]. Braintree, MA: Braintree Laboratories; July 2020.
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