Basic Information
ID DDInter1443 and DDInter1487
Interaction Concomitant use of stimulant laxatives (e.g., bisacodyl, sodium picosulfate) may increase the risk of serious gastrointestinal adverse effects associated with certain osmotic laxatives (e.g., polyethylene glycol (PEG), oral sulfate solution), such as colonic mucosal ulcerations or ischemic colitis. When administered in conjunction with an osmotic laxative such as PEG, increased intramural pressure secondary to increased peristalsis may lead to ischemic colitis and perforation.
Management The manufacturers for some osmotic bowel cleansing products recommend avoiding the concurrent use of stimulant laxatives. However, stimulant laxatives, in particular bisacodyl and sodium picosulfate, are sometimes used with PEG in certain bowel cleansing regimens to help reduce dose volume and improve patient tolerability and acceptance. Please consult individual product labeling for specific recommendations and guidance. Patients using osmotic bowel cleansing products and stimulant laxatives who present with sudden abdominal pain, rectal bleeding, or other symptoms of ischemic colitis should be evaluated promptly.
References [1] Vaizman K, Li J, Iswara K, Tenner S "Ischemic colitis induced by the combination of Bisacodyl and polyethylene glycol in preparation for colonoscopy." Am J Gastroenterol 102 (2007): S267 [2] "Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates)." Braintree Laboratories, Braintree, MA. [3] "Product Information. MoviPrep (polyethylene glycol 3350 with electrolytes)." Physicians Total Care, Tulsa, OK. [4] Adamcewicz M, Bearelly D, Porat G, Friedenberg FK "Mechanism of action and toxicities of purgatives used for colonoscopy preparation." Expert Opin Drug Metab Toxicol 7 (2011): 89-101 [5] Cerner Multum, Inc. "Australian Product Information." O 0 [6] Baudet JS, Castro V, Redondo I "Recurrent ischemic colitis induced by colonoscopy bowel lavage." Am J Gastroenterol 105 (2010): 700-1 [7] "Product Information. GaviLyte-H and Bisacodyl with Flavor Packs (bisacodyl-PEG 3350 with electrolytes)." Gavis Pharmaceuticals, Somerset, NJ. [8] Anastassopoulos K, Farraye FA, Knight T, Colman S, Cleveland MvB, Pelham RW "A comparative study of treatment-emergent adverse events following use of common bowel preparations among a colonoscopy screening population: results from a post-marketing observational study." Dig Dis Sci 61 (2016): 2993-3006 [9] Belsey J, Epstein O, heresbach D "Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol." Aliment Pharmacol Ther 29 (2009): 15-28 [10] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [11] "Product Information. Bi-Peglyte (bisacodyl-PEG 3350 with electrolytes)." Pendopharm, Montreal, QC. [12] Hung SY, Chen HC, Chen WT "A randomized trial comparing the bowel cleansing efficacy of sodium picosulfate/magnesium citrate and polyethylene glycol/Bisacodyl (The Bowklean Study)" Sci Rep 10 (2020): 5604 [13] Barbeau P, Wolfe D, Yazdi F, et.al "Comparative safety of bowel cleansers: protocol for a systematic review and network meta-analysis." BMJ Open 8 (2018): e021892 [14] "Product Information. Plenvu (polyethylene glycol 3350 with electrolytes)." Bausch Health US (formerly Valeant Pharmaceuticals), Bridgewater, NJ. [15] Ajani S, Hurt RT, Teeters DA, Bellmore LR "Ischaemic colitis associated with oral contraceptive and bisacodyl use." BMJ Case Rep 2012 (2012):
Alternative for Phenolphthalein A06A
Alvimopan Prucalopride Magnesium sulfate Sodium phosphate, monobasic Glycerin Sorbitol
Naloxegol Sodium sulfate Naloxone Naldemedine Magnesium citrate
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Alternative for Polyethylene glycol (3350 with electrolytes) -
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.