Polycarbophil is a synthetic, oral, bulk-forming insoluble fiber laxative. It is a polyacrylic resin with a marked capacity for binding water. Bulk-forming fiber laxatives are among the agents of choice as initial therapy for most forms of occasional or idiopathic constipation and are also considered to be some of the safest laxative agents. Calcium polycarbophil products are available in nonprescription dosage forms and may be used in adult and pediatric patients 12 years of age and older; the chewable products may be used in patients 2 years of age and older. The ingestion of these products with an adequate amount of liquid is essential to avoid choking or obstruction and ensure safe use, particularly in young patients. However, fiber supplements are not routinely recommended in the treatment of childhood functional constipation due to a lack of evidence that supports their use over a healthy diet. Patients of all ages with chronic constipation may need other strategies besides fiber supplementation to treat their condition. Guidelines strongly recommend soluble fiber products (e.g., psyllium), but not insoluble fiber (e.g., calcium polycarbophil) products, to treat global symptoms of irritable bowel syndrome.
General Administration Information
For storage information, see specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
Oral Solid Formulations
Regular (non-chewable) tablets, capsules, or caplets:
-Patient should drink at least 8 ounces (240 mL) of water or other liquid with each dose. Taking the tablets without enough liquid may cause choking.
-Generally not recommended for children less than 12 years due to potential choking hazard; use chewable tablets instead.
Chewable tablets:
-Chew the tablets thoroughly before swallowing. Do NOT swallow whole.
-Patient should drink at least 8 ounces (240 mL) of water or other liquid with each dose.
The most common side effects associated with polycarbophil use are gastrointestinal and include abdominal cramps, severe abdominal pain, bloating, diarrhea, increased flatulence, nausea/vomiting, and perianal irritation. The drug should be discontinued if abdominal pain or vomiting occurs. In addition, rarely, accumulation of polycarbophil can lead to esophageal or GI obstruction. If patients experience rectal/GI bleeding, the product should be discontinued and their healthcare provider contacted. Polycarbophil should be taken with adequate amounts of fluid (e.g., 8 ounces of water or other liquid for the non-chewable tablets or liquid). If polycarbophil is not taken with adequate fluid, it can swell and block the patient's throat or esophagus leading to choking and/or asphyxia. Patients should be aware of the signs of esophageal obstruction and should notify their physician immediately if they experience chest pain (unspecified), regurgitation, vomiting, or difficulty swallowing or breathing.
Adverse reactions are rare because polycarbophil is not absorbed; however, weakness, dizziness, and syncope have been reported.
Polycarbophil contains substantial amounts of calcium. Although rare, hypercalcemia, which may manifest as anorexia, confusion, constipation, drowsiness, hypertension, nausea/vomiting, premature ventricular contractions (PVCs), or polyuria, may occur in patients at risk for hypercalcemia (e.g., those taking other drugs with calcium or those with renal insufficiency or renal failure. Another serious side effect of hypercalcemia is calcific nephrolithiasis.
Polycarbophil is contraindicated in patients with hypersensitivity to polycarbophil or any of the ingredients found in formulations containing polycarbophil.
Bulk-forming laxatives should not be used in patients with symptoms of acute abdomen or appendicitis, esophageal stricture or perforation, or GI obstruction or ileus. Patients should be advised to consult with their healthcare professional before using calcium polycarbophil products if unexplained/undiagnosed abdominal pain or nausea or vomiting are present or if they have noticed a sudden change in bowel habits that persists for 2 weeks. Patients should be advised to discontinue this product and to consult their health care professional if they experience rectal GI bleeding or a failure to produce a bowel movement after use. Patients should not use this product for a period more than 1 week for constipation without first consulting their provider.
The use of non-chewable polycarbophil tablets/caplets is contraindicated in patients that have difficulty in swallowing or dysphagia. The use of non-chewable tablets without adequate fluid intake (e.g., 8 ounces) may cause the dosage form to swell and block the throat or esophagus, which may cause choking. Advise patients to discontinue use of this product and seek immediate medical attention if they experience chest pain, vomiting, dysphagia, or difficulty breathing after taking this product.
Each 625 mg of calcium polycarbophil contains approximately 125 mg of calcium, therefore polycarbophil should not be used in patients with preexisting hypercalcemia. Calcium polycarbophil should be used with caution in patients with preexisting hypercalciuria or nephrolithiasis, especially if renal calculi are present.
Calcium polycarbophil, as a fiber laxative, is not absorbed systemically and is generally considered safe and effective by the American Gastroenterological Association (AGA) for use as directed during pregnancy for the purpose of treating occasional constipation; fiber supplements along with adequate water intake are first line therapies. To avoid impaction, polycarbophil should be taken with plenty of fluids. The AGA also recommends PEG 3350 as a first-choice laxative in pregnancy when non-pharmacologic methods (e.g., fluids, dietary fiber such as polycarbophil) are ineffective or inadequate for preventing or treating constipation. A stool softener such as docusate sodium is also considered low risk.
Polycarbophil use during breast-feeding is considered compatible. Because the drug is not absorbed systemically by the mother, there is a lack of worry about excretion in breast milk. Adequate fluid intake and adequate fiber supplementation in the diet are first-line therapies for constipation during lactation. Adequate fluid intake is especially important to avoid impaction and straining following childbirth. Alternative fiber choices often recommended include psyllium.
The safe and effective use of calcium polycarbophil has been established in children 2 years of age and older; use chewable products in children less than 12 years due to the potential choking hazard presented by non-chewable dosage forms of calcium polycarbophil. Use of polycarbophil in neonates, infants, and children less than 2 years is not recommended.
The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of medications in residents (e.g., geriatric adults) of long-term care facilities. The OBRA guidelines caution that bulk forming laxatives, such as polycarbophil, may cause accumulation of stool and possible bowel obstruction if not used with a sufficient amount of fluid or in patients with other causes of impaired bowel motility.
For the treatment and prevention of constipation:
Oral dosage (tablets or caplets with 625 mg calcium polycarbophil):
Adults: 2 tablets (1,250 mg calcium polycarbophil) PO 1 to 4 times daily as needed is the usual dosage for treatment of constipation. Titrate dosage individually. Max: 8 tablets/day.
Children and Adolescents 12 years and older: 2 tablets (1,250 mg calcium polycarbophil) PO 1 to 4 times daily as needed is the usual dosage for treatment of constipation. Titrate dosage individually. Max: 8 tablets/day.
Oral dosage (chewable tablets with 625 mg calcium polycarbophil):
Adults: 2 tablets (1,250 mg calcium polycarbophil) PO 1 to 4 times daily as needed is the usual dosage for treatment of constipation. Titrate dosage individually. Max: 8 tablets/day.
Children and Adolescents 12 years and older: 2 tablets (1,250 mg calcium polycarbophil) PO 1 to 4 times daily as needed is the usual dosage for treatment of constipation. Titrate dosage individually. Max: 8 tablets/day.
Children 6 to 11 years: 1 chewable tablet (625 mg calcium polycarbophil) PO 1 to 4 times daily as needed is the usual dosage for treatment of constipation. Titrate dosage individually. Max: 4 tablets/day.
Children 2 to 5 years: 1 chewable tablet (625 mg calcium polycarbophil) PO once or twice daily as needed is the usual dosage for treatment of constipation. Max: 2 tablets/day PO.
Maximum Dosage Limits:
-Adults
8 tablets/day PO (5,000 mg of calcium polycarbophil).
-Geriatric
8 tablets/day PO (5,000 mg of calcium polycarbophil).
-Adolescents
8 tablets/day PO (5,000 mg of calcium polycarbophil).
-Children
12 years: 8 tablets/day PO (5,000 mg of calcium polycarbophil).
6 to 11 years: 4 chewable tablets/day PO (2,500 mg of calcium polycarbophil). Use of chewable tablets is recommended.
2 to 5 years: 2 chewable tablets/day PO (1,250 mg of calcium polycarbophil). Use chewable tablets only due to choking hazards.
Less than 2 years: Safety and efficacy have not been established.
-Infants
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
It appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
It appears that no dosage adjustments are needed.
*non-FDA-approved indication
Alendronate: (Moderate) Coadministration of alendronate with calcium polycarbophil can interfere with the oral absorption of alendronate; do not administer calcium polycarbophil within 30 minutes of alendronate. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Alendronate; Cholecalciferol: (Moderate) Coadministration of alendronate with calcium polycarbophil can interfere with the oral absorption of alendronate; do not administer calcium polycarbophil within 30 minutes of alendronate. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Atenolol; Chlorthalidone: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Azilsartan; Chlorthalidone: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Bumetanide: (Moderate) Loop diuretics may increase the risk of hypokalemia, especially in patients receiving prolonged therapy with laxatives such as calcium polycarbophil. Monitor serum potassium to determine the need for potassium supplementation and/or alteration in drug therapy.
Calcifediol: (Moderate) The concurrent use of vitamin D analogs, like calcifediol with calcium polycarbophil may contribute to vitamin D-induced hypercalcemia. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Calcipotriene: (Moderate) Use calcipotriene cautiously with other agents that can produce hypercalcemia, including calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). There is evidence that calcipotriene can be absorbed in amounts that are sufficient to produce systemic effects, including elevated serum calcium; hypercalcemia has been observed in normal prescription use.
Calcipotriene; Betamethasone: (Moderate) Use calcipotriene cautiously with other agents that can produce hypercalcemia, including calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). There is evidence that calcipotriene can be absorbed in amounts that are sufficient to produce systemic effects, including elevated serum calcium; hypercalcemia has been observed in normal prescription use.
Calcitriol: (Major) The concurrent use of vitamin D analogs, like calcitriol with calcium polycarbophil may contribute to vitamin D-induced hypercalcemia. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Calcium Phosphate, Supersaturated: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Cardiac glycosides: (Major) Since electrolyte disorders modify the actions of cardiac glycosides (e.g., digoxin and digitoxin), drugs that can affect electrolyte balance can potentially affect the response to digoxin. Hypercalcemia increases digoxin's effect, and each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). It is recommended that serum calcium be monitored regularly in patients receiving digoxin.
Chlorothiazide: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Chlorthalidone: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Ciprofloxacin: (Major) Administer oral ciprofloxacin at least 2 hours before or 6 hours after calcium polycarbophil. Ciprofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations.
Delafloxacin: (Major) Administer oral delafloxacin at least 2 hours before or 6 hours after calcium polycarbophil. Delafloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations.
Demeclocycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Digoxin: (Major) Since electrolyte disorders modify the actions of cardiac glycosides (e.g., digoxin and digitoxin), drugs that can affect electrolyte balance can potentially affect the response to digoxin. Hypercalcemia increases digoxin's effect, and each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). It is recommended that serum calcium be monitored regularly in patients receiving digoxin.
Doxercalciferol: (Moderate) The concurrent use of vitamin D analogs, like doxercalciferol with calcium polycarbophil may contribute to vitamin D-induced hypercalcemia. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Doxycycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Droperidol: (Moderate) Caution is advised when using droperidol in combination with laxatives, such as calcium polycarbophil, which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia; such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Estramustine: (Major) Administration of estramustine with calcium polycarbophil can impair the oral absorption of estramustine significantly, due to formation of a calcium-phosphate complex. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg) and must not be taken simultaneously with estramustine. Patients should be instructed to take estramustine with water at least 1 hour before or 2 hours after meals.
Ethacrynic Acid: (Moderate) Loop diuretics may increase the risk of hypokalemia, especially in patients receiving prolonged therapy with laxatives such as calcium polycarbophil. Monitor serum potassium to determine the need for potassium supplementation and/or alteration in drug therapy.
Etidronate: (Moderate) Coadministration of etidronate with calcium polycarbophil can interfere with the oral absorption of etidronate; do not administer calcium polycarbophil within 2 hours of etidronate. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Furosemide: (Moderate) Loop diuretics may increase the risk of hypokalemia, especially in patients receiving prolonged therapy with laxatives such as calcium polycarbophil. Monitor serum potassium to determine the need for potassium supplementation and/or alteration in drug therapy.
Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Ibandronate: (Moderate) Coadministration of ibandronate with calcium polycarbophil can interfere with the oral absorption of ibandronate; do not administer calcium polycarbophil within 60 minutes of ibandronate. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Lactulose: (Major) In general, other laxatives, such as calcium polycarbophil, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved.
Levofloxacin: (Major) Administer calcium polycarbophil at least 2 hours before or 2 hours after orally administered levofloxacin. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Chelation of divalent cations with levofloxacin is less than with other quinolones.
Levothyroxine: (Moderate) Administer thyroid hormones at least 2 hours before or after the ingestion of calcium polycarbophil. Thyroid hormones are best taken on an empty stomach, and, administration should be separated from medications that might interfere with absorption. Monitor the patient's thyroid function and clinical status if the patient is on calcium polycarbophil treatment. Dietary fiber may bind and decrease the absorption of thyroid hormones from the gastrointestinal tract. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Calcium salts can chelate oral thyroid hormones within the GI tract when administered simultaneously, also leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from calcium supplements and thyroid hormone interactions. In a study of 8 volunteers, the absorption of levothyroxine decreased from 89% when administered alone to only 86% when administered concomitantly with 1,000 mg of calcium polycarbophil.
Levothyroxine; Liothyronine (Porcine): (Moderate) Administer thyroid hormones at least 2 hours before or after the ingestion of calcium polycarbophil. Thyroid hormones are best taken on an empty stomach, and, administration should be separated from medications that might interfere with absorption. Monitor the patient's thyroid function and clinical status if the patient is on calcium polycarbophil treatment. Dietary fiber may bind and decrease the absorption of thyroid hormones from the gastrointestinal tract. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Calcium salts can chelate oral thyroid hormones within the GI tract when administered simultaneously, also leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from calcium supplements and thyroid hormone interactions. In a study of 8 volunteers, the absorption of levothyroxine decreased from 89% when administered alone to only 86% when administered concomitantly with 1,000 mg of calcium polycarbophil.
Levothyroxine; Liothyronine (Synthetic): (Moderate) Administer thyroid hormones at least 2 hours before or after the ingestion of calcium polycarbophil. Thyroid hormones are best taken on an empty stomach, and, administration should be separated from medications that might interfere with absorption. Monitor the patient's thyroid function and clinical status if the patient is on calcium polycarbophil treatment. Dietary fiber may bind and decrease the absorption of thyroid hormones from the gastrointestinal tract. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Calcium salts can chelate oral thyroid hormones within the GI tract when administered simultaneously, also leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from calcium supplements and thyroid hormone interactions. In a study of 8 volunteers, the absorption of levothyroxine decreased from 89% when administered alone to only 86% when administered concomitantly with 1,000 mg of calcium polycarbophil.
Liothyronine: (Moderate) Administer thyroid hormones at least 2 hours before or after the ingestion of calcium polycarbophil. Thyroid hormones are best taken on an empty stomach, and, administration should be separated from medications that might interfere with absorption. Monitor the patient's thyroid function and clinical status if the patient is on calcium polycarbophil treatment. Dietary fiber may bind and decrease the absorption of thyroid hormones from the gastrointestinal tract. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Calcium salts can chelate oral thyroid hormones within the GI tract when administered simultaneously, also leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from calcium supplements and thyroid hormone interactions. In a study of 8 volunteers, the absorption of levothyroxine decreased from 89% when administered alone to only 86% when administered concomitantly with 1,000 mg of calcium polycarbophil.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Loop diuretics: (Moderate) Loop diuretics may increase the risk of hypokalemia, especially in patients receiving prolonged therapy with laxatives such as calcium polycarbophil. Monitor serum potassium to determine the need for potassium supplementation and/or alteration in drug therapy.
Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Magnesium Salts: (Moderate) Oral calcium-containing medications, such as calcium polycarbophil, may increase serum calcium or magnesium concentrations in susceptible patients, primarily in patients with renal insufficiency. Calcium and magnesium salts are often combined together in nutritional supplements and vitamin products. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Magnesium: (Moderate) Oral calcium-containing medications, such as calcium polycarbophil, may increase serum calcium or magnesium concentrations in susceptible patients, primarily in patients with renal insufficiency. Calcium and magnesium salts are often combined together in nutritional supplements and vitamin products. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Metolazone: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Minocycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Moxifloxacin: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after calcium polycarbophil. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations.
Ofloxacin: (Major) Administer calcium polycarbophil at least 2 hours before or 2 hours after ofloxacin. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Omadacycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Paricalcitol: (Moderate) The concurrent use of vitamin D analogs, like paricalcitol with calcium polycarbophil may contribute to vitamin D-induced hypercalcemia. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Phenytoin: (Major) The oral absorption of phenytoin may be reduced by calcium salts, and each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Calcium products may form complexes with phenytoin that are nonabsorbable. Although the magnitude of these interactions is not great, an occasional patient may be affected and the interaction may lead to subtherapeutic anticonvulsant concentrations. Separating the administration of calcium polycarbophil and either phenytoin by at least 2 hours will help minimize the possibility of such an interaction.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Risedronate: (Moderate) Coadministration of risedronate with calcium polycarbophil can interfere with the oral absorption of risedronate; do not administer calcium polycarbophil within 30 minutes of risedronate. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Sarecycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery.
Sodium Sulfate; Magnesium Sulfate; Potassium Chloride: (Moderate) Oral calcium-containing medications, such as calcium polycarbophil, may increase serum calcium or magnesium concentrations in susceptible patients, primarily in patients with renal insufficiency. Calcium and magnesium salts are often combined together in nutritional supplements and vitamin products. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg).
Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Tetracycline: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Tetracyclines: (Major) Coadministration of calcium polycarbophil with orally administered tetracyclines can decrease the absorption of tetracyclines; oral doses of tetracyclines should be given 2 hours before or after the administration of calcium polycarbophil. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). This effect is presumably due to the chelation of the antibiotic by the calcium.
Thiazide diuretics: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Thyroid hormones: (Moderate) Administer thyroid hormones at least 2 hours before or after the ingestion of calcium polycarbophil. Thyroid hormones are best taken on an empty stomach, and, administration should be separated from medications that might interfere with absorption. Monitor the patient's thyroid function and clinical status if the patient is on calcium polycarbophil treatment. Dietary fiber may bind and decrease the absorption of thyroid hormones from the gastrointestinal tract. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Calcium salts can chelate oral thyroid hormones within the GI tract when administered simultaneously, also leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from calcium supplements and thyroid hormone interactions. In a study of 8 volunteers, the absorption of levothyroxine decreased from 89% when administered alone to only 86% when administered concomitantly with 1,000 mg of calcium polycarbophil.
Torsemide: (Moderate) Loop diuretics may increase the risk of hypokalemia, especially in patients receiving prolonged therapy with laxatives such as calcium polycarbophil. Monitor serum potassium to determine the need for potassium supplementation and/or alteration in drug therapy.
Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Coadministration may lead to hypercalcemia because thiazides cause a decrease in renal tubular excretion of calcium as well as increase in distal tubular reabsorption. Each 625 mg of calcium polycarbophil contains a substantial amount of calcium (approximately 125 mg). Moderate increases in serum calcium have been seen during the treatment with thiazides; if calcium polycarbophil is used concomitantly, monitoring of serum calcium may be prudent.
Polycarbophil is an oral synthetic, polyacrylic resin bulk-forming laxative. Polycarbophil absorbs water and forms a gel that expands to provide increased bulk and moisture content to the stool. The increased stool bulk encourages normal peristalsis and bowel motility. When polycarbophil is used to treat constipation, intestinal transit time increases and results in more frequent and softer bowel movements. The onset of fiber laxative action of polycarbophil is usually 12 to 72 hours. Polycarbophil is physiologically inert and does not affect the absorption of nutrients. The drug is most often available as calcium polycarbophil, which is more palatable than polycarbophil. After oral ingestion, the calcium is exchanged for hydrogen in the stomach, and polycarbophil acid then exerts its pharmacological effects in the small intestine and colon. The ionized calcium is available for absorption after dissociation. Each 625 mg of calcium polycarbophil contains 125 mg of calcium.
Polycarbophil is administered orally. Polycarbophil is not absorbed from the gastrointestinal tract and is not metabolized. Each 625 mg of calcium polycarbophil provides approximately 125 mg of calcium, which can be absorbed systemically. The onset of action of polycarbophil is usually within 12 to 72 hours of starting administration.
Affected Cytochrome P450 (CYP450) isoenzymes and drug transporters: None