Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate

Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate is a prescription medication used for cleansing the colon for colonoscopy preparation.

• Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate is available under the following different brand names: Suprep.

Common side effects of Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate include:

• overall discomfort
• abdominal fullness
• nausea
• abdominal cramping
• vomiting
• headache

Serious side effects of Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate include:

• cardiac arrhythmias
• seizures

Rare side effects of Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors.
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Oral solution for dilution

• (17.5 g/3.13 g/1.6 g)/6 oz bottle for adults
  • Each kit contains 2 bottles of concentrated oral solution (6 oz each) for further dilution and a mixing bottle
• (13.13 g/2.35 g/1.2 g)/4.5 oz bottle for children aged 12 years and older
  • Each kit contains 2 bottles of concentrated oral solution (4.5 oz each) for further dilution and a mixing bottle

Bowel Prep

Adult dosage

• Administer in a split dose (2-day regimen) for a total volume of 96 oz (2880 mL)
• Day before colonoscopy
  • May consume light breakfast or only clear liquids on the day before (no solid foods)
  • Avoid red and purple liquids, milk, and alcoholic beverages
• Early evening before colonoscopy: Dilute 1st 6-oz bottle to 16 oz (480 mL) with water in the provided mixing container and drink the entire amount
  • Drink an additional 32 oz (960 mL) of water over the next hour
• Day of colonoscopy
  • Have only clear liquids until after colonoscopy
  • Avoid red and purple liquids, milk, and alcoholic beverages
  • Morning of colonoscopy (10-12 hours after evening dose and at least 3.5 hours before colonoscopy): Prepare 2nd 6-oz bottle by diluting contents to 16 oz (480 mL) in the provided mixing container and drink the entire amount
  • Drink an additional 32 oz (960 mL) of water over the next hour
  • Complete all of the bowel kit and required water at least 2 hours before the colonoscopy

Pediatric dosage

• Children aged 12 years and older: Administer in a split dose (2-day regimen) for a total volume of liquid using 2 bottles is 72 oz (~2130 mL)
• Day before colonoscopy
  • May consume light breakfast or only clear liquids on the day before (no solid food)
  • Avoid red and purple liquids, milk, and alcoholic beverages
• Early evening before colonoscopy: Dilute 1st 4.5-oz bottle to 12 oz (360 mL) with cool water in the provided mixing container and drink the entire amount
  • Drink an additional 24 oz (720 mL) of water over the next hour
• Day of colonoscopy
  • Have only clear liquids until after colonoscopy
  • Avoid red and purple liquids, milk, and alcoholic beverages
  • Morning of colonoscopy (10-12 hours after evening dose and at least 3.5 hours before colonoscopy): Prepare 2nd 4.5-oz bottle by diluting contents to 12 oz (360 mL) in the provided mixing container and drink the entire amount
  • Drink an additional 24 oz (720 mL) of water over the next hour
  • Complete all of the bowel kit and required water at least 2 hours before the colonoscopy

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, healthcare provider, or pharmacist first.

• Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate has severe interactions with no other drugs
• Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate has serious interactions with the following drugs:
  • baloxavir marboxil
  • bisacodyl
  • bisacodyl rectal
  • demeclocycline
  • doxycycline
  • eravacycline
  • minocycline
  • omadacycline
  • penicillamine
  • polyethylene glycol/electrolytes and bisacodyl
  • raltegravir
  • sarecycline
  • senna
  • tetracycline
• Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate has moderate interactions with at least 251 other drugs
• Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate has minor interactions with no other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

• Hypersensitivity
• Gastrointestinal obstruction or ileus
• Bowel perforation
• Gastric retention
• Toxic colitis or toxic megacolon

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Sodium Sulfate-Potassium Sulfate-Magnesium Sulfate?”

Cautions

• Caution with increased incidence of elevated serum electrolytes, serum creatinine, and BUN
• Caution in patients with renal impairment or patients taking concomitant medications that may affect renal function; patients may be at risk for renal injury; advise patients of the importance of adequate hydration before, during and after use of the product and consider performing baseline and post-colonoscopy laboratory tests
• Reports of generalized tonic-clonic seizures with the use of bowel preparations products; associated with electrolyte abnormalities (eg, hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia) and low serum osmolality; caution in patients at risk of seizures (alcohol or benzodiazepine withdrawal, drugs lowering seizure threshold, suspected/known hyponatremia)
• Rare reports of serious arrhythmias associated with ionic osmotic laxative products; use caution when prescribing for patients at increased risk of arrhythmias (eg, patients with a history of prolonged QT, uncontrolled arrhythmias, recent myocardial infarction, unstable angina, congestive heart failure, or cardiomyopathy); consider pre-dose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias
• Osmotic laxative products may produce colonic mucosal aphthous ulcerations; reports of serious cases of ischemic colitis requiring hospitalization; coadministration with stimulant laxatives may increase risk
• If GI obstruction or perforation is suspected, perform appropriate diagnostic studies to rule out these conditions before administering; caution with severe active ulcerative colitis
• Patients with impaired gag reflex or other swallowing abnormalities are at risk for regurgitation or aspiration of bowel prep solution
• Fluid and serum chemistry abnormalities
  • Advise patients to hydrate adequately before, during, and after use
  • Correct fluid and electrolyte abnormalities before treatment to avoid serious adverse effects (eg, arrhythmias, seizures, renal impairment)
  • Caution in patients with conditions or medications that increase the risk for fluid and electrolyte disturbances or may increase the risk of adverse events of seizure, arrhythmias, and renal impairment
  • If significant vomiting or signs of dehydration develop consider performing post-colonoscopy laboratory tests (eg, electrolytes, creatinine, BUN)
• Can cause temporary elevations in uric acid; monitor patients with gout for acute flare; consider the potential for uric acid elevation before administering the product to patients with gout or other disorders of uric acid metabolism
• Drug interaction overview
• Oral medication administered within 1 hour before bowel prep may not be absorbed properly
  • Caution if coadministration with drugs that increase the risk of fluid and electrolyte disturbances or may increase the risk of seizure, arrhythmias, or prolonged QT
  • Avoid coadministration with stimulant laxatives owing to the increased risk of mucosal ulceration or ischemic colitis
  • Caution if coadministered with medications that may affect renal function (eg, diuretics, ACE inhibitors, ARBs, NSAIDs)
• Chelation with magnesium
  • Take tetracycline or fluoroquinolone antibiotics, iron, digoxin, chlorpromazine, or penicillamine at least 2 hours before and not less than 6 hours after administration of bowel prep to avoid chelation

Pregnancy and Lactation

• Data are unavailable data on use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
• Animal reproductive studies have not been conducted
• Lactation
  • There are no data available on the presence of drug combination in human or animal milk, its effects on the breastfed child, or milk production; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for a prep kit and any potential adverse effects on the breastfed child from the product or from an underlying maternal condition