Guidelines differ based on degree of illness, use of TPN, and severity of hypophosphatemia. Marketed under the brand-name Fleet, and as store brands and generic products. Assess serum electrolytes and renal function in patients who may be at higher risk for product-related adverse events, which includes those who have retained a rectal dose for more than 30 minutes, who are vomiting, or who may have signs of dehydration. Selva O'Callaghan A, San Jose A, Simeon CP, Arruche M, Galicia M, Benavente V, et al. How is this medicine (Sodium Phosphates Enema) best taken? In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition/indication and specific institution policy. absorption; electrolyte modifications; phosphatemia; phosphaturia; sodium phosphate enema. Pediatr Surg Int 2012;28:805-14. Call your doctor if you have any unusual problems while you are using this medication. General replacement guidelines (Lentz 1978): Note: The initial dose may be increased by 25% to 50% if the patient is symptomatic secondary to hypophosphatemia and lowered by 25% to 50% if the patient is hypercalcemic. Chesney RW, Haughton PB. Jacobson RM, Peery J, Thompson WO, Kanapka JA, Caswell M. Gastroenterol Nurs. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Eckstein J, Savic S, Eugster T, Pargger H, Grke L, Pechula M, et al. Specifically, the risk of acute phosphate nephropathy may be enhanced. Dehydration, renal impairment, heart failure, electrolyte abnormalities, use for bowel cleansing, bowel obstruction or pseudo, or perforation, gastric bypass or bariatric surgery, toxic megacolon, toxic colitis, or children <5 years, Do not use laxatives when nausea, vomiting, or severe abdominal pain is present, Caution with renal impairment or ascites; increases risk of sodium retention and edema; obtain baseline and postprocedure labs in patients with renal impairment; monitor closely to avoid hyperphosphatemia, Caution in children aged 2-11 years or elderly patients with comorbidities, Caution with pre-existing electrolyte disturbances or patients taking diuretics or other medications that may alter electrolytes, Additional liquids by mouth are recommended to prevent dehydration; inadequate fluid intake may result in hypovolemia due to excessive fluid loss, Exceeding daily dose, no return of enema solution, retention time >10 minutes, or failure to have a bowel movement within 30 minutes of enema use may lead to electrolyte disturbances, including hypernatremia, hyperphosphatemia, hypocalcemia, and hypokalemia, Severe dehydration and electrolyte abnormalities associated with serious complications (eg, acute kidney injury, arrhythmias, and death) have occurred in adults and children who overdosed using oral or rectal over-the-counter (OTC) sodium phosphate solutions to treat constipation, Use caution in unstable angina, cardiomyopathy, history of myocardial infarction arrhythmia, patients with or at risk for arrhythmias, including prolonged QT interval, cardiomyopathy, recent myocardial infarction; caution with other QT-prolonging drugs, consider pre-/postdose ECGs and lab tests in high-risk patients, Correct dehydration prior to using in bowel preparations, Use caution in patients with gastric retention or hypomotility, severe active ulcerative colitis or ileus, severe, chronic constipation, Use caution in history of seizures, those at high risk of seizures or on seizure therapy; obtain baseline and postprocedure labs in high-risk patients, Phosphate absorption may increase in patients with chronic inflammatory bowel disease; phosphate may induce colonic aphthous ulceration; consider this when interpreting colonoscopic findings in patients with inflammatory bowel disease, Use caution in debilitated patients, including elderly patients; evaluate patients ability to hydrate properly if receiving bowel preparation, Purgatives and laxatives can be potentially abused by bulimia nervosa patients, Use caution in patients with impaired gag reflex and those prone to aspiration or regurgitation, When used for bowel evacuation, medications may not be well absorbed due to intestinal peristalsis, Exceeding recommended doses of OTC sodium phosphate preparation to treat constipation may potentially result in serious adverse effects; renal/cardiac adverse effects reported following severe dehydration and alterations in serum electrolytes, including sodium phosphate and calcium, Lactation: Unknown whether distributed in breast milk; caution because of risk for electrolyte disturbances or dehydration, Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs. You may report side effects to Health Canada at 1-866-234-2345. Taking more of this oral product than the recommended dose can be harmful. Use it only as directed by your doctor.Sodium phosphate is a saline laxative that is thought to work by increasing fluid in the small intestine. Do not use vial if crystals are present. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Severe hypocalcemic tetany and respiratory failure in an infant given oral phosphate soda. Caution: With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. This medicine may be harmful if swallowed. Acute hyperphosphatemia caused by sodium phosphate enema in a patient with liver dysfunction and chronic renal failure. Consider therapy modification, Iron Preparations: May decrease the absorption of Phosphate Supplements. If hypokalemia exists, consider phosphate replacement strategy with potassium (eg, potassium phosphates). The use of phosphate enemas in the treatment of constipation. During pregnancy, this medication should be used only when clearly needed. Things to remember when you fill your prescription. This regimen should not be repeated within 7 days of a previous administration. Exercise has many benefits for older adults and can help you to live a longer and healthier life. Refer to adult dosing. The enema usually causes a bowel movement Management: Administer oral phosphate supplements as far apart from the administration of an oral iron preparation as possible to minimize the significance of this interaction. Contact your doctor promptly if you notice any symptoms of dehydration, such as unusual dry mouth/increased thirst, lack of tears, dizziness/lightheadedness, or pale/wrinkled skin. Spinrad S, Sztern M, Grosskopf Y, Graff E, Blum I. For children 5 to <12 years old, use a 2.25-ounce (66 mL) enema (this bottle delivers 59 mL). Alternative method in critically ill patients (Kingston 1985): Low dose: 0.25 mmol/kg over 4 hours; use if serum phosphorus level 0.5 to 1 mg/dL (0.16 to 0.32 mmol/L). Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist for more details. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Tell your doctor if you have or ever had heart failure, ascites (build-up of fluid in the stomach area), a blockage or tear in your stomach or intestine, inflammatory bowel disease (IBD; a group of conditions in which the lining of the lining of the intestines is swollen, irritated, or has sores), paralytic ileus (condition in which food does not move through the intestines), toxic megacolon (a serious or life-threatening widening of the intestine), dehydration, low levels of calcium, sodium, magnesium, or potassium in your blood, or kidney disease. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Extensive calcifications induced by hyperphosphataemia caused by phosphate-based enema in a patient after kidney transplantation. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. Serious - Use Alternative (1)sodium phosphate rectal decreases levels of lithium by Other (see comment). Oral, solution (Monobasic sodium phosphate monohydrate 2.4 g and dibasic sodium phosphate heptahydrate 0.9 g per 5 mL): Note: Must be diluted in a full glass of water: Children 5 to 9 years: 7.5 mL as a single dose. WebForty-five adult participants aged 50 years or older enrolled in the trial. This medicine may be used Consider therapy modification, Nonsteroidal Anti-Inflammatory Agents: Sodium Phosphates may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Electrolyte disturbances: Fluid and electrolyte disturbances may occur. How quickly can acute migraines be treated? Follow all directions on the product package. J Pediatr 1979;94:149-51. WebDosage Forms: Enema: Sodium phosphate 6 g and sodium biphosphate 16 g/100 mL (67.5 mL pediatric enema unit, 135 mL adult enema unit) Injection: Phosphate 3 mmol Nearly two-thirds of the adults and nearly half of the children in whom adverse events were reported had one or more of the following:. Drug Safety and Availability, Recalls, Market Withdrawals and Safety Alerts, Information about Nitrosamine Impurities in Medications, Food and Drug Administration Overdose Prevention Framework, Medication Errors Related to CDER-Regulated Drug Products, Postmarket Drug Safety Information for Patients and Providers, Risk Evaluation and Mitigation Strategies | REMS, Multistate outbreak of fungal meningitis and other infections, FDA Drug Safety Communication: FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation, Comunicado de la FDA sobre la seguridad de los medicamentos: La FDA advierte de posibles efectos adversos por exceder la dosis recomendada de productos de venta libre que contienen fosfato de sodio para el tratamiento del estreimiento. Active ingredients (in each 118mL delivered dose)Purpose - Dibasic Sodium Phosphate 7 gSaline laxative - Monobasic Sodium Phosphate 19 gSaline laxative Use 2022 Medicine.com All rights reserved. Before J Pediatr Surg 1997;32:1244-6. The most reliable method of ordering IV phosphate is by millimoles, then specifying the potassium or sodium salt. Share cases and questions with Physicians on Medscape consult. eCollection 2015. All subjects were randomly assigned in a 1:1 ratio to 1 of 2 study sequences: (1) a single dose of Enema Casen 250 mL in the first period followed by no treatment (control) in the second period, or (2) no treatment in the first period followed by a single dose of the study drug in the second period. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. This medication may be used to relieve occasional constipation. MeSH These include those older than 55 years; patients with hypovolemia; or decreased intravascular volume; those who have baseline kidney disease, decreased bowel transit time, bowel obstruction, or active colitis; and those who are using medications that affect renal perfusion or function, such as diuretics, ACEIs, ARBs, or NSAIDs. If you have any questions, ask your doctor or pharmacist. Using more than one enema in 24 hours can be harmful. Correct dehydration prior to using for bowel preparations. The regimens below have only been studied in adult patients; however, many institutions have used them in children safely and successfully. Separating administer of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, fast heartbeat, increased thirst, seizures, loss of strength and energy, lack of appetite, unable to pass urine or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting. Ismail EA, Al-Mutairi G, Al-Anzy H. A fatal small dose of phosphate enema in a young child with no renal or gastrointestinal abnormality. Oral liquid: 1 tablespoon orally, diluted in 8 ounces of cool water, followed by at least one additional 8 ounce glass of water Domico MB, Huynh V, Anand SK, Mink R. Severe hyperphosphatemia and hypocalcemic tetany after oral laxative administration in a 3-month-old infant. Review our medical disclaimer. Am J Dis Child 1974;127:584-6. Either increases effects of the other by pharmacodynamic synergism. Fatal hypocalcemia from sodium phosphate enemas. Getting enough fiber in your diet is not just essential for maintaining a healthy digestive system, it could also benefit your health in other ways. IV: Administer by intermittent IV infusion; do not administer IV push. 30 mmol potassium phosphate over 4 h or 45 mmol over 6 h) or sodium phosphate (which is more expensive) are as efficacious and should be favored if kalemia is a concern." sharing sensitive information, make sure youre on a federal Comments: Adult Enema: Park JY, Kim KA, Park PW, Lee OJ, Ryu JH, Lee GH, Ha MC, Kim JS, Kang SW, Lee KR. Biebl A, Grillenberger A, Schmitt K. Enema-induced severe hyperphosphatemia in children. Twenty-five participants were given one Enema Casen, whereas 20 participants received one Fleet Enema. Taking more than the recommended dose in 24 hours can be harmful; do not exceed recommended dosage. Concentration and dosing are different from FDA-approved products; use caution when switching between products. Contact a health care professional for advice. Contraindicated (1)sodium phosphate rectal, sodium acid phosphate. Disclaimer, National Library of Medicine Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. IV doses may be incorporated into the patient's maintenance IV fluids; intermittent IV infusion should be reserved for severe depletion situations. Maximum dose: 2 or 3 tablespoons per 24 hours Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Severe dehydration and electrolyte abnormalities associated with serious complications such as acute kidney injury, arrhythmias, and death have occurred in adults and children who overdosed using oral or rectal over-the-counter (OTC) sodium phosphate solutions to treat constipation. Close monitoring required to avoid hyperphosphatemia. Note: If phosphate repletion is required and a phosphate product is not available at your institution, consider the use of sodium glycerophosphate pentahydrate (Glycophos) as a suitable substitute. Phosphorus Ae0-12 was increased after enema administration by 86% (P < 0.001). These individuals include young children; individuals older than 55 years; patients who are dehydrated; patients with kidney disease, bowel obstruction, or inflammation of the bowel; and patients who are using medications that may affect kidney function. The rectal form of these products should never be given to children younger than 2 years. Properly discard this product when it is expired or no longer needed. The recommended dose is a single dose given once a day for not more than 3 days. Next morning (starting 3 to 5 hours before procedure): 4 tablets with 8 ounces of clear liquids every 15 minutes for a total of 12 tablets Enemas are used by individuals with constipation and are often required before certain medical diagnostic procedures and surgical interventions. Avoid concomitant treatment with laxatives containing sodium phosphate. These data raised concerns about the use of phosphate enemas in routine practice. Squeeze the bottle until the recommended amount of the drug is inside the rectum. A typical dose for either lactulose or sorbitol is 1 mL/kg, once or twice daily . Consider therapy modification, Antacids: May decrease the absorption of Phosphate Supplements. Rectal sodium phosphate may cause other side effects. Caution: With orders for IV phosphate, there is considerable confusion associated with the use of millimoles (mmol) versus milliequivalents (mEq) to express the phosphate requirement. Refer to the manufacturer's labeling and/or the medication guide for additional administration instructions. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location one that is up and away and out of their sight and reach. Consult your pharmacist or local waste disposal company. Pediatrics 1974;53:105-6. Laboratory and/or medical tests (such as kidney tests, blood mineral levels) may be performed periodically to monitor your progress or check for side effects. View and print full Drug Safety Communication (PDF - 218KB). Intermediate dose: 0.16 to 0.24 mmol/kg over 4 to 6 hours; use if serum phosphorus level 0.5 to 1 mg/dL (0.16 to 0.32 mmol/L). Obese patients and/or severe renal impairment were excluded from phosphate supplement trials. 12 Medicines That Could Help, List Sodium Phosphates Enema side effects by likelihood and severity. Nephrol Dial Transplant 2006;21:2013-6. Debilitated patients: Use with caution in debilitated patients; consider each patient's ability to hydrate properly. Severe dehydration and alterations in serum electrolytes (eg, calcium, sodium, phosphate) leading to renal/cardiac adverse effects have been reported, mostly when single maximum doses were exceeded or when more than 1 dose was taken per day. Note: Doses listed as mmol of phosphate. American Society of Health-System Pharmacists, Inc. Disclaimer, U.S. Department of Health and Human Services. Selected from data included with permission and copyrighted by First Databank, Inc. J Pediatr 1977;90:484-5. Modify Therapy/Monitor Closely. To prevent laxative dependence, consult your doctor if you need to use this medication or other laxative products for more than 7 days. Am J Dis Child 1977;131:1032. If you have any questions, ask your doctor Other side effects of this drug: Talk with your doctor right away if you have any of these signs of: Note: This is not a comprehensive list of all side effects. Children 2 to 4 years: Administer one half contents of one 2.25 ounce pediatric enema. Costigan AM, Orr S, Alshafei AE, Antao BA. This product is for rectal use only. Drug interactions may change how your medications work or increase your risk for serious side effects. If you do not get any results within 30 minutes after using this medicine, call your doctor before using another Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Swerdlow DB, Labow S, D'Anna J. Tetany and enemas: report of a case. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. Haskell LP. Oral sodium phosphate products may induce colonic aphthous ulceration, which should be considered when interpreting colonoscopic findings in patients with inflammatory bowel disease. GI disorders: Use caution in patients with any of the following: Gastric retention or hypomotility, ileus, severe, chronic constipation, or severe active ulcerative colitis. Fleet Enema: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) [contains Refer to storage information printed on the package. Management: Administer oral phosphate supplements as far apart from the administration of an iron-containing oral multivitamin as possible to minimize the significance of this interaction. 2006 Nov;28(11):1837-47. doi: 10.1016/j.clinthera.2006.11.008. This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. US residents can call their local poison control center at 1-800-222-1222. Talk to your doctor if you have questions. It is also important information to carry with you in case of emergencies. Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Animal reproduction studies have not been conducted. The following weight-based guidelines for adult dosing may be cautiously employed in pediatric patients. 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. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Rectal preparations should never be administered to children younger than 2 years of age (FDA Drug Safety Communication 2014). All material on this website is protected by copyright, Copyright 1994-2022 by WebMD LLC. Bowel cleansing (oral tablets): A clear liquid diet should be used prior to and during tablet administration. Hebbar K, Fortenberry JD, Parks JS. What special dietary instructions should I follow? 2022 Sep 12;22(1):743. doi: 10.1186/s12877-022-03445-1. Administering oral phosphate supplements as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Twenty-four subjects (12 men, 12 women; mean [SD] age, 47.8 [9.6] years [range, 36-68 years]) participated in the study. Use Caution/Monitor. Read all information given to you. Am J Dis Child 1968;115:714-8. Farah R. Fatal acute sodium phosphate enemas intoxication. Talk to your doctor or pharmacist about other treatment options. Ask a doctor before use if you have - a sodium-restricted diet - abdominal pain, nausea or vomiting McCabe M, Sibert JR, Routledge PA. Phosphate enemas in childhood: cause for concern. Oral: Elimination of the large oral phosphate load may be impaired. Consider therapy modification, Tricyclic Antidepressants: May enhance the adverse/toxic effect of Sodium Phosphates. These medications include diuretics or water pills; angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) used to treat high blood pressure; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Adverse events (AEs) were monitored by the investigators throughout the study. While some cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using medicines that affect renal perfusion or function (such as diuretics, angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers, and possibly nonsteroidal anti-inflammatory drugs [NSAIDs]). Symptoms of kidney injury include drowsiness, sluggishness, decreased amount of urine, or swelling of the ankles, feet, and legs. Avoid exceeding the maximum recommended rectal or oral dose of sodium phosphate products for both children and adults. Acute treatment of hypophosphatemia: IV: It is difficult to provide concrete guidelines for the treatment of severe hypophosphatemia because the extent of total body deficits and response to therapy are difficult to predict. It is used to treat or prevent low phosphate levels. Refer to sodium glycerophosphate pentahydrate monograph. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. Symptoms of overdose may include: muscle weakness, fast/slow/irregular heartbeat, mental/mood changes (such as confusion), change in the amount of urine. HHS Vulnerability Disclosure, Help Enter your medication into the WebMD interaction checker, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Fitness vs. Ladenhauf HN, Stundner O, Spreitzhofer F, Deluggi S. Severe hyperphosphatemia after administration of sodium-phosphate containing laxatives in children: case series and systematic review of literature. Helikson MA, Parham WA, Tobias JD. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvZmxlZXQtZW5lbWEtcGVkaWFsYXgtZW5lbWEtc29kaXVtLXBob3NwaGF0ZS1yZWN0YWwtOTk5NzEx. Treating constipation with phosphate enema: an unnecessary risk. Moseley PK, Segar WE. PMC Normal ranges for the electrolytes were as follows: phosphorus, 2.5 to 5 mg/dL; calcium, 8.5 to 10.5 mg/dL; sodium, 135 to 145 mEq/L; and potassium, 3.5 to 5 mEq/L. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002). Generic name: sodium biphosphate/sodium phosphate systemic, Brand names: Fleet Phospho Soda, Fleet Enema, Disposable Enema, Visicol, OsmoPrep, Phosphate Laxative, Fleet Enema EXTRA, Pedia-Lax Enema, Fleet EZ-Prep. May use adjusted body weight for patients weighing >130% of ideal body weight (and BMI <40 kg/m2) by using [IBW + 0.25 (ABW-IBW)]: Low dose, serum phosphorus level 2.3 to 3 mg/dL (0.74 to 0.96 mmol/L): 0.16 to 0.32 mmol/kg over 4 to 6 hours, Intermediate dose, serum phosphorus level 1.6 to 2.2 mg/dL (0.51 to 0.71 mmol/L): 0.32 to 0.64 mmol/kg over 4 to 6 hours, High dose, serum phosphorus <1.5 mg/dL (<0.5 mmol/L): 0.64 to 1 mmol/kg over 8 to 12 hours, Parenteral nutrition: IV: 10 to 15 mmol/1,000 kcal (Hicks 2001) or 20 to 40 mmol/24 hours (Mirtallo 2004 [ASPEN guidelines]), Laxative (Fleet): Rectal: Contents of one 4.5 oz enema as a single dose, Laxative: Oral solution: 15 mL as a single dose; maximum single daily dose: 45 mL. There are many things you can do to ease this common and uncomfortable problem. Some individuals may be at higher risk for potential adverse events when the recommended dose of OTC sodium phosphate is exceeded. High dose: 0.36 mmol/kg over 6 hours; use if serum phosphorus <0.5 mg/dL (<0.16 mmol/L). Flow-through peritoneal dialysis in neonatal enema-induced hyperphosphatemia. Separate dosing of tetracyclines from these products. Ann Emerg Med 1989;18:696-700. All rights reserved. Note: Consider the contribution of sodium when determining the appropriate phosphate replacement. Clin Interv Aging. Clin Chem 2012;58:1515-8. Pediatr Nephrol 2010;25:2183-6. Fleet Company, Inc. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. To maintain normal bowel habits, it is important to drink plenty of fluids (four to six 8-ounce glasses daily), eat foods high in fiber, and exercise regularly. Ann Emerg Med 1990;19:938-40. Medscape Education, Getting Social About Constipation: Enhancing the Patient-Provider Dialogue, encoded search term (sodium phosphate rectal (Fleet Enema%2C Pedia-Lax Enema)) and sodium phosphate rectal (Fleet Enema, Pedia-Lax Enema), Rectal Douching Injury in Men Who Have Sex With Men, Diagnosis, Management and Patient Perspectives of the Spectrum of Constipation Disorders, Review Article: Emerging Drug Therapies in Inflammatory Bowel Disease, Relax With a Great Book: Best Summer Books for Nurses. Follow the directions on the package label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Pediatr Emerg Care 2006;22:118-20. Federal government websites often end in .gov or .mil. Walton DM, Thomas DC, Aly HZ, Short BL. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. Hypokalemia after hypertonic phosphate enemas. The severity of adverse events is similar regardless of the route of sodium phosphate administration. Some products may contain phenylalanine and/or sodium. Drink plenty of clear liquids while you are using this medication. Contains mixture of monobasic sodium phosphate and dibasic sodium phosphate, Indicated as laxative in the relief of occasional constipation and as part of a bowel cleansing regimen in preparing the colon for surgery, x-ray or endoscopic examination, 1 bottle PR; not to exceed 1 administration/24 hr, Remove orange protective shield from enema tip before inserting; with steady pressure, gently insert enema tip into rectum with a slight side-to-side movement, with tip pointing toward navel, Insertion may be easier if person receiving enema bears down, as if having a bowel movement; this helps relax the muscles around the anus, Do not force enema tip into rectum as this can cause injury, Squeeze bottle until nearly all liquid is gone; it is not necessary to empty the bottle completely, as it contains more liquid than needed, Remove enema tip from rectum and maintain position until urge to evacuate is strong (usually 1-5 minutes), Do not retain enema solution for more than 10 minutes, Enema should be at room temperature before use, 2-4 years: Administer one-half bottle PR of pediatric enema (ie, ~30 mL); prepare dose by unscrewing cap from bottle and removing 2 tablespoons of liquid (30 mL) with a measuring spoon, replace cap and administer remaining liquid, 5-11 years: Administer 1 bottle PR of pediatric enema (ie, 59 mL), 12 years or older: Administer as in adults (adult enema). Do not freeze. Laxative doses that may be needed to manage constipation in palliative care. Serum electrolyte shifts following administration of sodium phosphates enema. Arch Dis Child 1993;68:233-4. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. Consider therapy modification, Sucralfate: May decrease the absorption of Phosphate Supplements. Do not use more than 1 enema in any 24-hour period. WebNDC Proprietary Name Non-Proprietary Name Dosage Form Route Name Company Name Status; 0132-0119: Proprietary Name: Fleet Enema: Enema: Rectal: C.b. If someone swallows rectal sodium phosphate or if someone uses too much of this medication, call your local poison control center at 1-800-222-1222. Many people using this product do not have serious side effects. Intermediate dose: 0.64 mmol/kg over 4 to 6 hours; use if serum phosphorus level 1.6 to 2.2 mg/dL (0.51 to 0.72 mmol/L). Obtain baseline and postprocedure labs in patients with renal impairment. sodium phosphate rectal will decrease the level or effect of omadacycline by inhibition of GI absorption. This is only a brief summary of general information about this medicine. QT prolongation: Prolongation of the QT interval has been reported (associated with hypokalemia, hypocalcemia). See manufacturer's labeling. Before using sodium phosphate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Moderate dose: 0.5 mmol/kg over 4 hours; use if serum phosphorus level <0.5 mg/dL (<0.16 mmol/L). 2005 - 2022 WebMD LLC. Ten cases were reported to the FAERS database and 44 were published in the medical literature. Must be diluted prior to parenteral administration. Applies only to oral form of both agents. We identified 54 cases describing serious adverse events in 25 adults and in 29 children. Also tell your doctor if you were born with imperforate anus (a birth defect in which the anus does not form properly and must be repaired with surgery and that may cause ongoing problems with bowel control) and if you have had a colostomy (surgery to create an opening for waste to leave the body). Four subjects (16.7%) had 1 serum phosphorus concentration measurement 7 mg/dL, a value that is considered serious hyperphosphatemia. Separate dosing of tetracyclines from these products. Available for Android and iOS devices. Impaired gag reflex: Use with caution in patients with impaired gag reflex and those prone to regurgitation or aspiration. Oral: Plasma half-life is 2-fold higher in subjects >70 years of age. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. http://www.upandaway.org. Applies to the following strengths: 18%-48%; 7 g-19 g; 3.5 g-9.5 g; 1.5 g. Oral tablets: Clin Pediatr (Phila) 2005;44:93. Otherwise, call a poison control center right away. Use enema rectally. Loughnan P, Mullins GC. Children 12 years and Adolescents: 15 mL as a single dose; maximum single daily dose: 45 mL/day. Do not drink any liquids colored red or purple. It is unknown if this drug passes into breast milk. Bookshelf tell your doctor if you are 55 years of age or older, and if you follow a low salt diet. Clinical Intensive Care 1999;10:21-3. There have been rare but serious reports of acute phosphate nephropathy in patients receiving oral sodium phosphate products for colon cleansing prior to colonoscopy. Specifically, the risk of seizure and/or loss of consciousness may be increased in patients with significant sodium phosphate induced fluid/electrolyte abnormalities. This survey is being conducted by the WebMD marketing sciences department. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). A very serious allergic reaction to this drug is rare. | Nursing Times EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG We use cookies to personalize and improve your experience on our site. Your doctor may also prescribe this product (usually along with other products) to clean stool from the intestines before surgery or certain bowel procedures (such as colonoscopy, radiography). Applies only to oral form of both agents. Avoid combination, Calcium Salts: May decrease the absorption of Phosphate Supplements. Some cases have resulted in permanent renal function impairment and some patients required long-term dialysis. 1-39 The age of the consumers ranged widely from 8 days to 97 years, but most cases involved older adults and children younger than 5 years. Hold the enema contents in place until you feel a strong urge to have a bowel movement. Pediatrics 2000;106:E37. Use caution when recommending these products to patients at potentially higher risk for product-related adverse events. It is usually inserted when a bowel movement is desired. If a sodium phosphate enema is used for severe constipation, it is recommended that no more than one dose be administered per 24 hour period, for no more than 3 days. Table has been converted to the following text. Source: Wolters Kluwer Health. High dose: 1 mmol/kg over 8 to 12 hours; use if serum phosphorus <1.5 mg/dL (<0.5 mmol/L). Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. Blood pressure, pulse, and serum chemistries were evaluated at screening; baseline; and 10, 60, and 120 minutes after receiving the enema. Rectal sodium phosphate should not be given to children younger than 2 years of age. Use rectal sodium phosphate exactly as directed. Enema: 1 bottle, rectally IV: Serum calcium, sodium and phosphorus levels; renal function; after IV phosphate repletion, repeat serum phosphorus level should be checked 2 to 4 hours later. Advise patients of the importance of following the recommended split dosage regimen and the importance of adequate hydration before, during, and after use of oral sodium phosphate products. If the victim has collapsed or is not breathing, call local emergency services at 911. BMC Geriatr. Doing so may increase your risk for serious side effects. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Hypocalcemia and hyperphosphatemia after phosphate enema use in a child. Results: Obese patients and/or severe renal impairment were excluded from phosphate supplement trials. Follow all instructions closely. Critically ill adult trauma patients receiving TPN (Brown 2006): Low dose: 0.32 mmol/kg over 4 to 6 hours; use if serum phosphorus level 2.3 to 3 mg/dL (0.73 to 0.96 mmol/L). Consumers and health care professionals should always read the Drug Facts label for OTC sodium phosphate drugs and use these products as recommended on the label, and not exceed the labeled dose. Then replace the bottle cap. Serum concentrations of phosphorus, sodium, potassium, and calcium were measured in both periods. Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease. WebHow to use Phosphate Enema 19 Gram-7 Gram/118 Ml This product is for rectal use only. sodium phosphate rectal decreases levels of lithium by Other (see comment). Consider therapy modification, Angiotensin-Converting Enzyme Inhibitors: May enhance the nephrotoxic effect of Sodium Phosphates. Monitor therapy, Gastrointestinal: Bloating (31%), nausea (26%), abdominal pain (23%), Endocrine & metabolic: Hyperphosphatemia (96%), hypokalemia (on colonoscopy day; 18% to 22%), 1% to 10%: Gastrointestinal: Vomiting (4%), aphthous stomatitis (3%), Postmarketing and/or case reports: Anaphylaxis, angioedema, bronchospasm, calcium nephrolithiasis, cardiac arrhythmia, dysphagia, dyspnea, facial edema, hypernatremia, hypersensitivity reaction, hypocalcemia, increased blood urea nitrogen, increased serum creatinine, lip edema, paresthesia, pharyngeal edema, pruritus, renal disease (acute phosphate), renal failure syndrome, renal insufficiency, renal tubular necrosis, seizure, skin rash, tongue edema, urticaria. Separate dosing of tetracyclines from these products. In such cases, your bowel may stop working normally and you may have ongoing constipation. Management: Consider avoiding this combination by temporarily suspending treatment with ACEIs, or seeking alternatives to oral sodium phosphate bowel preparation. Young JF, Brooke BN. Avoid or Use Alternate Drug. Discuss the risks and benefits with your doctor. Baloxavir may bind to polyvalent cations resulting in decreased absorption. The Note: 1 mmol phosphate = 31 mg phosphorus; 1 mg phosphorus = 0.032 mmol phosphate. Always read and follow the directions on the Drug Facts labels included on over-the-counter sodium phosphate oral solutions and rectal enemas to find out the correct dose and dosing frequency. Advise patients to adequately hydrate before, during, and after using this drug. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema. A: Generally acceptable. References 1. All doses should be followed by at least one additional 8 ounce glass of water. Use with caution. 2010 May-Jun;33(3):191-201. doi: 10.1097/SGA.0b013e3181e26ec2. Keywords: Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Am J Med 1985;79:645-6. Biberstein M, Parker BA. Intravenous doses listed as mmol of phosphate. An official website of the United States government, : Consult your doctor before breast-feeding. Web45 mL twice daily, each dose must be diluted with half a glass (120 mL) of cold water, followed by one full glass (240 mL) of cold water, timing of doses is dependent on Phosphate enema poisoning in children. Critically ill adult patients receiving concurrent enteral/parenteral nutrition (Brown 2006; Clark 1995): Note: Round doses to the nearest 7.5 mmol for ease of preparation. Use sodium phosphates enema as ordered by your doctor. These serum electrolytes include calcium, sodium, and phosphate. Put enema tip into the rectum with Should I avoid certain foods while taking Sodium Phosphates Enema? Dibasic sodium phosphate 7 g - Monobasic sodium phosphate 19 g Purpose Saline laxative Uses relieves occasional constipation Warnings For rectal use only - Dosage warning: Using more than one enema in 24 hours can be harmful. AHFS Patient Medication Information. Avoid or Use Alternate Drug. If administering with phosphate-containing parenteral nutrition, do not exceed 15 mmol/L within parenteral nutrition. Oral: Bowel cleansing: Baseline and postprocedure labs (electrolytes, calcium, phosphorus, BUN, creatinine) in patients with renal impairment or who are taking medications or with conditions that increase the risk of fluid and electrolyte abnormalities, seizures, arrhythmias, or renal impairment; ECG in patients with risks for prolonged QT or arrhythmias. Aggressive doses of phosphate may result in a transient serum elevation followed by redistribution into intracellular compartments or bone tissue. Use caution if recommending use of an oral OTC sodium phosphate drug product in children 5 years and younger. WebUse it only as directed by your doctor.Sodium phosphate is a saline laxativethat is thought to work by increasing fluid in the small intestine. Left-side position: Lie on left side with knee bent, and arms resting comfortably, Knee-chest position: Kneel, and then lower head and chest forward until left side of face is resting on surface with left arm folded comfortably. The bottle contains extra liquid, so it does not have to be completely empty. Objective: Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. 12 years and older: 1 bottle, rectally, once daily, Fleet Enema, OsmoPrep, Fleet Phospho Soda, Visicol, Disposable Enema. Remove the protective shield from the tip of the enema. Clear liquids may include water, flavored water, pulp-free lemonade, ginger ale, or apple juice; avoid alcohol, milk, purple or red colored liquids, and pulp-containing foods/liquids. tell your doctor and pharmacist if you are allergic to sodium phosphate, any other medications, or any of the ingredients in the enema. Phosphorus - Recommended Daily Allowance (RDA) and Estimated Average Requirement (EAR): Hypophosphatemia, acute: Hypophosphatemia does not necessarily equate with phosphate depletion. However, when treating constipation, you should use milder products (such as stool softeners, bulk-forming laxatives) whenever possible. Advise patients to ensure they are adequately hydrated during product use. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Kidney problems like unable to pass urine, blood in the urine, change in amount of urine passed, or weight gain. Since the inorganic form of phosphate is excreted almost entirely by the kidneys, patients with renal disease may have difficulty excreting a large phosphate load. Diarrhea that doesn't stop may result in dehydration. Before using this medication, tell your doctor or pharmacist your medical history, especially of: dehydration, high/low levels of certain minerals in the blood (such as potassium, calcium, sodium, phosphate), kidney disease, current stomach/abdominal symptoms (such as nausea/vomiting that doesn't stop, pain, cramping), bowel problems (such as blockage, ulcerative colitis, hemorrhoids), laxative use for constipation in the past week, heart disease (such as heart failure, irregular heartbeat), liver disease, sodium-restricted diet. If any of these effects last or get worse, tell your doctor or pharmacist promptly. 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