Adult Dosing
Cleansing colon as a colonoscopy preparation
Day prior to colonoscopy (early evening)
- Pour the contents of 1 bottle into the mixing container provided and fill the container with water to the 16 oz fill line and drink the entire amount x 1 dose, then drink 32 oz water over the next hour
Day of colonoscopy:
- Repeat the same procedure in the morning on the day of colonoscopy, 10 to 12 hours after the evening dose
Notes:- Should be taken as a split-dose (two-day) regimen
- Consume a light breakfast or have only clear liquids on the day before colonoscopy or until after the colonoscopy
- Avoid red and purple liquids, milk, and alcoholic beverages
- Do not directly ingest the undiluted solution as it may increase the risk of nausea, vomiting, dehydration, and electrolyte disturbances
- Complete all of the prepared mixture and required water at least one hour prior to colonoscopy
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Advise patients to be well hydrated before, during, and after the use of this preparation. If significant vomiting or signs of dehydration is observed after taking this preparation, consider monitoring electrolytes, creatinine, and BUN after colonoscopy
- Marked fluid and electrolyte disturbances may lead to serious adverse events such as seizures, cardiac arrhythmias, and renal impairment
- Advise patients with electrolyte abnormalities to have them corrected before treatment with this preparation. Exercise caution in patients with conditions or who are using medications which increase the risk for fluid and electrolyte disturbances
- Temporary elevation in uric acid has been associated with this product. Uric acid fluctuations in gout patients may precipitate an acute flare
- Rare events of serious arrhythmias have been reported with the use of ionic osmotic laxatives used for bowel prep. Use cautiously and consider pre-dose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias
- Cases of generalized tonic-clonic seizures and/or loss of consciousness have been reported with the use of bowel preparation products in patients with no prior history of seizures. The seizures were associated with electrolyte abnormalities (e.g., hypokalemia, hyponatremia, hypomagnesemia, and hypocalcemia) and low serum osmolality. Correction of fluid and electrolyte abnormalities resolves neurologic abnormalities
- Osmotic laxative products may produce colonic mucosal aphthous ulcerations; cases of serious ischemic colitis requiring hospitalization have been reported. Concomitant administration of stimulant laxatives may increase these risks
- Use cautiously in patients with renal impairment or those taking concomitant medications that may affect renal function. Consider monitoring baseline and post-colonoscopy electrolytes, creatinine, and BUN in these patients
- Before administering ionic osmotic laxatives, perform appropriate diagnostic studies to rule out gastrointestinal obstruction or perforation
- Recommended dilution of each bottle with water to a final volume of 16 oz and ingestion of additional water, as direct ingestion of the undiluted solution may increase the risk of nausea, vomiting, dehydration, and electrolyte disturbances
Cautions: Use cautiously in
- Renal impairment
- Renal impairment risk
- Uric acid metabolic disorders
- Risk of arrhythmias
- History of seizure
- Risk of seizure
- Concurrent nephrotoxic agents
- Severe active ulcerative colitis
- Inflammatory bowel disease
- Impaired gag reflex
- Risk of aspiration or regurgitation
Supplemental Patient Information
- Advise patients to be well hydrated before, during, and after the use of this preparation
- Instruct patients to inform if they have trouble swallowing or if they are prone to aspiration or regurgitation
- Inform patients that oral medications taken within one hour of starting each dose of ionic laxative bowel preparations may not be absorbed properly
- Instruct patients not to take other laxatives while receiving this product
Pregnancy Category:C
Breastfeeding: Oral absorption of magnesium by the infant is poor; hence, breastfed infant's serum magnesium is unchanged following maternal magnesium therapy. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). Magnesium is compatible and considered safe during breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 12 August 2011). As per manufacturer's data, it is unknown whether this combination drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised while administering this drug to nursing women.
Magnesium sulfate/potassium sulfate/sodium sulfate
- Saline laxatives; sulfate anions provided by sulfate salts are poorly absorbed which with associated cations cause excess water retention within the GI tract by their osmotic effect. The osmotic effect of the unabsorbed ions with large volume of water produces copious watery diarrhea
- Metabolism: Unknown
- Excretion: Feces (primary route)
- Half-life: 8.5 hrs
US Trade Name(s)
US Availability
SUPREP Bowel Prep Kit (magnesium sulfate/potassium sulfate/sodium sulfate)
- SOLN: [1.6 g/3.13 g/17.5 g]/bottle
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]