Dosing considerations in the use of sodium phosphate bowel preparations for colonoscopy.
OBJECTIVE
To review dosing considerations and other treatment recommendations to maximize the efficacy, tolerability, and safety of sodium phosphate (NaP) preparations.


METHODS
Literature was accessed through PubMed (1990-May 2007) and abstracts from scientific meetings.


METHODS
English-language publications including clinical trials and case reports were evaluated. Recent reports assessing newer bowel preparations containing reduced doses of NaP were reviewed to evaluate efficacy, tolerability, and safety.


RESULTS
Among commonly administered bowel preparations for colonoscopy, NaP preparations are generally more effective and better tolerated compared with polyethylene glycol electrolyte lavage solution regimens. However, NaP preparations are contraindicated in specific patient populations, and clinicians must use effective screening mechanisms to select proper patients to receive NaP preparation for colonoscopy. Recently, cases of renal failure in patients with previously normal renal function have been reported after NaP preparation for colonoscopy, heightening concerns about the safety of these agents. Newer products contain reduced doses of NaP and may improve the safety and tolerability of NaP purgatives without compromising efficacy of colon cleansing. In addition, accumulating clinical data and/or rationale support split dosing of NaP products, wide intervals between doses, and aggressive hydration before and during bowel preparation and after the colonoscopy procedure.


CONCLUSIONS
Safe administration of NaP products requires rigorous attention to dosing considerations and other treatment recommendations, including administration of minimally effective doses of NaP, split-dosing schedules, and aggressive hydration.
Rex
Douglas K
DK
Indiana University Hospital, Indiana University Medical Center, #4100, 550 North University Blvd., Indianapolis, IN 46202, USA. drex@iupui.edu
D058186:Acute Kidney Injury / Q000139:chemically induced; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D003113:Colonoscopy; D004573:Electrolytes / Q000097:blood; D006801:Humans; D010710:Phosphates / Q000008:administration & dosage* / Q000009:adverse effects; D014882:Water-Electrolyte Balance
D002400:Cathartics; D004573:Electrolytes; D010710:Phosphates; C018279:sodium phosphate