Basic Information
ID DDInter468 and DDInter1464
Interaction The risk of seizures induced by the use of bowel cleansing preparations may be increased in patients on concomitant medications that can lower the seizure threshold such as selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. Rare cases of generalized tonic-clonic seizures and/or loss of consciousness in association with low serum osmolality and electrolyte abnormalities (e.g., hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia) have been reported with the use of bowel cleansing products in patients with no prior history of seizures. The condition resolved with correction of fluid and electrolyte abnormalities.
Management Caution is advised when bowel cleansing preparations are prescribed in patients treated with agents that can lower the seizure threshold. Bowel cleansing preparations should not be used if these patients have impaired renal function or perfusion, dehydration, or uncorrected electrolyte abnormalities. Baseline and postprocedure labs including serum electrolytes, calcium, phosphate, BUN, and creatinine should be considered, particularly in the elderly. Patients should be advised not to exceed the recommended dosage of their bowel cleansing preparation and to drink sufficient quantities of clear fluids before, during, and after the bowel preparation process. Administration of an electrolyte rehydration solution may help attenuate the electrolyte abnormalities and hypovolemia.
References [1] Salik JM, Kurtin P "Severe hyponatremia after colonoscopy preparation in a patient with the acquired immune deficiency syndrome." Am J Gastroenterol 80 (1985): 177-9 [2] "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories, Braintree, MA. [3] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [4] "Product Information. Fleet Phospho Soda (sodium biphosphate-sodium phosphate)." Fleet, CB, Lynchburg, VA. [5] Cerner Multum, Inc. "Australian Product Information." O 0 [6] "Product Information. Suclear (polyethylene glycol 3350 with electrolytes)." Braintree Laboratories, Braintree, MA. [7] "Product Information. Visicol (sodium biphosphate-sodium phosphate)." Salix Pharmaceuticals, Raleigh, NC. [8] "Product Information. Golytely (polyethylene glycol electrolyte solution)." Braintree, Braintree, MA. [9] "Product Information. Prepopik (citric acid/Mg oxide/Na picosulfate)." Ferring Pharmaceuticals Inc, Tarrytown, NY.
Alternative for Dalfampridine N07X
Dextromethorphan Sodium oxybate Riluzole Inotersen Tafamidis
Alternative for Picosulfuric acid A06A
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.