Constipation and bowel cleansers:
Indications for OSMOPREP:
Bowel cleansing prior to colonoscopy.
≥18yrs: Evening before colonoscopy: 4 tabs with 8oz of clear liq every 15 mins for a total of 20 tabs; repeat on day of colonoscopy 3–5 hrs before procedure for a total of 12 tabs. Wait 7 days before retreating.
<18yrs: not recommended.
Biopsy-proven acute phosphate nephropathy.
Renal disease and acute phosphate nephropathy.
Elderly, hypovolemia, increased bowel transit time, active colitis, baseline kidney disease: increased risk of acute phosphate nephropathy. Severe renal insufficiency (CrCl<30mL/min). Impaired renal function. History of acute phosphate nephropathy. CHF. Unstable angina. Arrhythmias (consider pre-dose and post-colonoscopy ECGs). History of cardiomyopathy. Prolonged QT. Recent MI. Ascites. Gastric retention. Ileus or acute obstruction or pseudo-obstruction. Gastric bypass or stapling surgery. Severe chronic constipation. Bowel perforation. Toxic megacolon. Hypomotility syndrome. Inflammatory bowel disease. Correct electrolyte abnormalities before use. Consider doing baseline and post-colonoscopy labs in patients at increased risk. History or risk of seizures. Maintain adequate hydration. Pregnancy (Cat.C).
Avoid concomitant purgative agents (esp. sodium phosphate). Caution with drugs that prolong QT interval, affect electrolytes or renal function (eg, diuretics, ACEIs, ARBs, NSAIDs), or lower seizure threshold. May reduce drug absorption.
Abdominal bloating/pain, nausea, vomiting, electrolyte imbalances, dizziness, headache; rare: renal failure, acute phosphate nephropathy, nephrocalcinosis.