Barium sulfate is an orally or rectally administered inert radiopaque agent. It is used as a contrast medium for radiographic examination of the gastrointestinal (GI) tract to detect or evaluate abnormalities. Whether administered orally or rectally, examination using barium sulfate may be done as a single-contrast or double-contrast examination. The single-contrast examination uses barium alone as the contrast medium. The double-contrast examination combines barium with the insufflation of air or gas, a technique that increases the sensitivity in evaluating mucosal lesions. To achieve double-contrast examination, a thin coating of barium is administered, followed by the introduction of air or gas (e.g., carbon dioxide) via a tube, or via the use of effervescent tablets (sodium bicarbonate 35 mg, tartaric acid 35 mg, calcium carbonate 500 mg) to react with the gastric contents to produce carbon dioxide. The purpose of the double-contrast technique is to allow better visualization of the surface in question. The use of a double-contrast technique requires the selection of a barium sulfate product labeled for this purpose; many available commercial preparations are suitable. Barium sulfate suspensions designed for double-contrast studies usually have heterogeneous particle sizes for mucosal coating compared to homogeneous particles found in products for use in single-contrast study products only.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
-Follow the instructions of the specific barium product utilized; timing, volume, and technique of administration are determined by the specific radiologic procedure to be performed.
-Advise the patient to drink plenty of liquids after the test to help avoid constipation.
Route-Specific Administration
Oral Administration
Oral Solid Formulations
-Swallow tablet whole with 1 or 2 swallows of water just before fluoroscopic examination.
Oral Liquid Formulations
-The specific type of testing procedure will dictate when the patient will begin drinking the barium sulfate and when the first radiograph should be taken or when the computed tomography (CT) scan will begin.
-Discard any unused product in the normal trash after the examination. Do not discard down the drain.
Entero VU Oral Suspension
-This product does not require reconstitution.
-Shake bottle vigorously before oral administration.
-Administer undiluted before the scan.
E-Z-CAT DRY Powder for Oral Suspension
-Product may be provided to the patient for self-administration. However, children younger than 12 years of age must receive the product under the direct supervision of a physician.
-To reconstitute, add 450 mL of water to the mixing container. Pour the contents of the foil pouch into the container. Twist lid onto the container tightly. Invert the container and shake vigorously for 20 seconds. Let mixture stand for 5 minutes, then re-shake container for 15 additional seconds before use.
-Administration may begin the night before to allow adequate time for transit of the barium suspension to the distal gastrointestinal tract.
E-Z-HD Powder for Oral Suspension
-To reconstitute, add 65 mL of water to the bottle containing barium sulfate powder. Replace cap and shake vigorously for 30 seconds. Wait 5 minutes, then re-shake the bottle thoroughly.
-The total reconstituted volume is approximately 140 mL, with a concentration of 2.38 g of barium sulfate per mL.
-Administer immediately after reconstitution.
-To administer via a straw, remove the adhesive label from the top of the cap. Remove cap and use a straw to push out cap liner. Replace the cap.
E-Z-PAQUE Powder for Oral Suspension
-To reconstitute, tap the bottle on a hard surface (right side up) to compact the product in the bottle.
-Add water to blue line marked "Initial Fill-Line". Replace cap, invert the bottle, and tap with fingers to mix contrast into the water.
-Shake vigorously for 30 seconds; wait 5 minutes.
-Add more water as needed to achieve the desired % w/v concentration using the fill-lines marked on the bottle. Use suspension concentrations up to 115% w/v for examinations of the esophagus and upper GI tract. For small bowel examinations, use a 60% w/v suspension.
-Re-shake vigorously for 30 seconds.
-Ensure patients have nothing by mouth (NPO) for the following time periods before examination:-Adults and pediatric patients older than 12 months: 4 hours.
-Infants 3 to 12 months: 3 hours.
-Neonates and infants younger than 3 months: 2 hours.
-To administer via a straw, remove the adhesive label from the top of the cap. Remove cap and use a straw to push out cap liner. Replace the cap.
-Use immediately after reconstitution and dilution.
Liquid E-Z-PAQUE Oral Suspension
-This product does not require reconstitution.
-Ensure patients have nothing by mouth (NPO) for the following time periods before examination:-Adults and pediatric patients older than 12 months: 4 hours.
-Infants 3 to 12 months: 3 hours.
-Neonates and infants younger than 3 months: 2 hours.
-Shake bottle vigorously for 30 seconds before oral administration.
-Administer undiluted before the scan.
Liquid Polibar Plus Suspension
-Shake bottle vigorously before oral administration.
-For esophageal exam: Administer undiluted, with films taken during rapid swallowing.
-For stomach or small bowel exam: Administer undiluted or diluted 1:1 with water to produce a 52.5% w/v.
READI-CAT 2 and READI-CAT 2 SMOOTHIES
-This product does not require reconstitution.
-Shake bottle vigorously for 30 seconds before oral administration.
-Administer undiluted before the scan.
Tagitol V Oral Suspension
-Shake the bottle for 15 seconds before oral administration.
-Discard any unused suspension.
Varibar Honey and Thin Honey
-These products do not require reconstitution.
-Administer undiluted via oral syringe, spoon, or cup.
-Storage: Document date opened and use by date on the label; discard any unused product after 21 days.
Varibar Pudding
-This product does not require reconstitution.
-After administration of large doses (i.e., more than 120 mL), the use of mild laxatives may be necessary to prevent bowel impaction.
Varibar Nectar
-This product does not require reconstitution.
-Administer undiluted via oral syringe, spoon, cup, or infant bottle.
Varibar Thin Liquid
-To reconstitute, add water to the 40% w/v line on the bottle. Replace cap, invert bottle, and tap with fingers to mix the powder into the water.
-Shake vigorously for 30 seconds; wait 5 minutes.
-Refill with water to the 40% w/v line. Re-shake vigorously.
-Reconstitution yields approximately 300 mL of oral suspension containing 0.4 g/mL of barium sulfate.
-Storage: Write the discard after date on the immediate container label after reconstitution. Reconstituted suspension may be stored under refrigeration at 2 to 8 degrees C (36 to 46 degrees F) for up to 72 hours.
VoLumen Oral Suspension
-Shake bottle vigorously before oral administration.
-Administer undiluted.
-Instruct the patient to begin drinking suspension approximately 20 to 30 minutes before procedure. For improved gastric marking, have patient consume the final 200 mL immediately before scan.
-Bowel lumen marking can be improved by increasing the volume of suspension consumed.
Rectal Administration
-Barium sulfate is given rectally by an enema administration system.
-The specific type of testing procedure will dictate when the barium sulfate will be given. Usually rectal administration of barium sulfate is 1 to 2 hours before the test to allow bowel transit to opacify the colon.
-Suspension should be at room temperature prior to rectal administration.
-Prior to test, the colon must be cleansed, which is usually accomplished by placing the patient on a low fat, low residue diet combined with the use of laxatives and/or cathartics. A cleansing enema may also be used unless contraindicated.
Liquid Polibar Plus Suspension
-Shake well prior to administration.
-For single contrast colon exam: Dilute 1 part suspension with 5 parts water to yield a 17.5% w/v and 15% w/w suspension; or dilute as required.
-For double contrast colon exam: Administer suspension undiluted.
-To ensure rapid colonic filling and drainage, administer suspension using an enema kit with a large (0.5 inch) lumen (e.g., Super XL Enema Bag System or equivalent).
Polibar ACB Powder for Suspension
-Reconstitution:-Remove the white seal, and then add the required amount of lukewarm water to achieve the desired suspension density (% w/w, % w/v).
-Close cap and hold bag by the finger holes. Shake vigorously until powder is completely suspended (approximately 20 to 30 seconds). Wait 10 minutes, then re-shake for an additional 30 seconds.
-When adding more than 800 mL of water, add the water in 2 equal portions; shake vigorously each time.
-Close tubing clamp. Then, with thumb and forefinger, pop red ball from tubing into the bag.
-Administration:-Administer immediately after mixing.
-Use vinyl or non-latex gloves during the procedure.
-For double contrast studies, use an enema tip for air contrast (not included).
-Connect enema tip to tubing of enema bag.
-Lubricate enema tip and carefully insert into the patient's anus. Do not exert undue pressure to the neuromuscular plexus, which can result in syncope or a vasovagal reaction. Avoid forceful or deep insertion as this may cause tearing or perforation of the rectum.
-Release clamp on enema tubing and administer desired volume of the barium suspension.
-Discard the entire single-use enema kit and tubing. Do not reuse or leave any plastic or rubber accessories in the body cavity for an extended period of time.
Gastrointestinal (GI) adverse events are associated with barium sulfate administration and include constipation, diarrhea, abdominal pain (cramping), nausea, and vomiting. In addition, orally administered barium sulfate may accumulate in the colon, causing impaction and may lead to abdominal pain, appendicitis, GI obstruction, or rarely GI perforation with consequent peritonitis and granuloma formation. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration after a barium sulfate procedure. Advise patients to seek medical attention for worsening constipation or slow GI passage.
Barium sulfate preparations contain a number of excipients and may induce serious hypersensitivity reactions, including hypotension, bronchospasm or other respiratory impairments, rash (unspecified), urticaria, and pruritus. Emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction. Advise patients to seek medical attention for any delayed hypersensitivity like rash, urticaria, or respiratory difficulty. Serious adverse reactions and fatalities include aspiration pneumonitis, vasovagal episodes, and syncope. With insertion of an enema tip into patient, care must be taken to avoid pressure on the vagus nerve which could lead to vasovagal reaction and syncopal episodes. With distention of the colon, cardiac arrhythmia exacerbation or other cardiac side effects can occur. Rarely, an infection or a tear in the rectal wall can result from the enema procedure. A barium embolus may enter systemic circulation through venous drainage of the large bowel, which could result in potentially fatal complications such as a systemic or pulmonary embolism, disseminated intravascular coagulation (DIC), septicemia, and severe hypotension. Monitor patients for potential intravasation.
Barium sulfate is contraindicated in patients with a known severe barium sulfate hypersensitivity; use with caution in patients with a known radiopaque contrast media hypersensitivity, as they may be more likely to have reactions to other contrast agents. Due to the increased likelihood of allergic reactions in atopic patients, use barium sulfate with caution in patients with a history of atopy, food allergies, eczema, or bronchial asthma. Signs and symptoms of a hypersensitivity reaction may include hypotension, bronchospasm, respiratory impairment, rash, pruritus, and urticaria. Avoid accidental exposure of the skin to barium as this may cause contact sensitivity. Before drug administration, ensure emergency equipment used in the treatment of hypersensitivity reactions and trained personnel are readily available.
Aspiration of orally administered barium sulfate may cause severe complications (e.g., pneumonitis, granuloma); therefore, the oral use of barium is contraindicated in patients at high risk for aspiration, such as those with prior aspiration, dysphagia, known or suspected tracheo-esophageal fistula, later stage Alzheimer's dementia, or obtundation. When considering use in patients potentially at risk for aspiration, begin the procedure with a small ingested volume. Monitor patients for vomiting, as vomiting may result in aspiration pneumonitis. Immediately discontinue use of the drug if aspiration is suspected.
Use caution when administering barium sulfate enemas rectally to patients with known latex hypersensitivity as enema accessories may contain latex. Allergic reactions may occur immediately or be delayed and result in contact dermatitis; appropriate medical intervention must be available. Use vinyl or non-latex containing gloves during the administration process.
Barium should never be administered parenterally (e.g., intravenous administration). If barium enters the cardiovascular system through a severed vessel, the barium can form an embolus which could be fatal.
Barium sulfate is contraindicated in patients with known or suspected GI obstruction, GI perforation, and in patients who are at high risk for GI perforation (i.e., recent prior GI perforation, acute GI bleeding, GI ischemia, toxic megacolon, severe ileus, post GI surgery or biopsy, acute GI injury or burn, recent radiation therapy to the pelvis). Avoid barium sulfate use in patients with inflammatory bowel disease, peptic ulcer disease, appendicitis, diverticulitis, or severe stenosis at any level of the GI tract (e.g., pyloric stenosis). If barium enters the cardiovascular system through a perforation or fistula, the barium can form an embolus leading to fatal complications including systemic or pulmonary embolism, disseminated intravascular coagulation, septicemia, and prolonged severe hypotension. If barium enters the peritoneal cavity through a perforation or fistula, the barium can cause peritonitis and granuloma formulation. Monitor patients for signs and symptoms of these complications during therapy. In addition, orally administered barium sulfate may accumulate proximal to a constricting lesion of the colon, resulting in obstruction or impaction with the development of baroliths (inspissated barium associated with feces). Conditions placing patients at higher risk of fecal impaction or GI obstruction from barium sulfate administration include severe stenosis at any level of the GI tract, impaired GI motility, electrolyte imbalance, dehydration, low residue diet, constipation, pediatric patients with cystic fibrosis or Hirschsprung disease, and advanced age (geriatric patients) as well as receiving concomitant medications that delay GI motility. To reduce the risk of GI transit delay, ensure patients maintain adequate hydration after drug administration and consider use of laxatives.
Barium sulfate has been found to be effective in pediatric patients based on successful opacification of the gastrointestinal (GI) tract during computed tomography (CT) and opacification of the pharynx during modified barium swallow examinations; however, use and specific dosing recommendations vary by product. Administration should occur under direct supervision of a physician with dose adjustment being made based on relative GI volume. Although safety data are also lacking, adverse drug effects experienced by neonates, infants, and children are not expected to be different from those experienced by adults. Barium sulfate is contraindicated in pediatric patients with tracheo-esophageal fistula, which increases aspiration risk. Pediatric patients with a history of asthma or food allergies may be at increased risk of developing hypersensitivity reactions to barium sulfate. After administration, closely monitor for signs of bowel obstruction, as neonates and pediatric patients with cystic fibrosis or Hirschsprung disease are at increased risk for impaction.
In patients with increased intracranial pressure, barium sulfate suspension enemas present an additional risk of further increasing intracranial pressure.
Before administering barium sulfate oral suspension, assess patients for a history of hereditary fructose intolerance; if present, avoid the use of barium sulfate oral suspension in these patients. The oral suspension contains sorbitol, which may induce severe symptoms if ingested by a patient with hereditary fructose intolerance. Associated reactions may include vomiting, hypoglycemia, jaundice, hemorrhage, hepatomegaly, hyperuricemia, and renal failure.
Barium sulfate is not systemically absorbed, and fetal exposure is considered unlikely. However, safe use of barium sulfate during pregnancy has not been established. In general, radiographic procedures should only be used during pregnancy if, in the judgment of the physician, use is deemed essential to the welfare of the mother. Radiation exposure is known to cause harm to the exposed unborn fetus.
Barium sulfate does not pass into the breast milk. Barium sulfate is not absorbed systemically by the mother, and breast-feeding is not expected to result in exposure of the infant to barium sulfate.
For use in radiographic examination of the gastrointestinal (GI) tract (gastrointestinal radiography):
NOTE: Diagnostic procedures that involve administration of radiopaque agents must be carried out under the direction of personnel with the requisite training and thorough knowledge of the procedure to be performed.
-for use as a contrast in upper GI studies:
Oral dosage (Entero VU):
Adults: 600 mL (144 g barium sulfate) PO once for evaluation of the small bowel.
Oral dosage (E-Z-HD):
Adults: 65 to 135 mL (155 to 321 g of barium sulfate, respectively) PO; volumes closer to 65 mL are recommended for esophageal examination, and up to 135 mL for entire upper GI tract examination. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Children and Adolescents 12 to 17 years: 65 to 135 mL (155 to 321 g of barium sulfate, respectively) PO; volumes closer to 65 mL are recommended for esophageal examination, and up to 135 mL for entire upper GI tract examination. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Oral dosage (E-Z-CAT DRY, READI-CAT 2, and READI-CAT 2 SMOOTHIES):
Adults: 450 to 900 mL (9 to 18 g of barium sulfate, respectively) PO with larger volumes (up to 900 mL) for distal GI tract examination. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Children and Adolescents 12 to 17 years: 450 to 900 mL (9 to 18 g of barium sulfate, respectively) PO with larger volumes (up to 900 mL) for distal GI tract examination. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Children 1 to 11 years: Administer under supervision of a physician with dosage adjusted based on relative GI volume. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Oral dosage (E-Z-Disk):
Adults: 1 tablet (700 mg of barium sulfate) PO once immediately prior to fluoroscopic examination of the esophagus. Administering a tablet of known diameter (i.e., 0.5 inches) illustrates the presence of significant esophageal narrowing and provides a technique to measure the lumen at stricture site.
Oral dosage (E-Z-PAQUE):
Adults and Adolescents 17 years: 150 to 750 mL (169 to 450 g of barium sulfate, respectively) PO; volumes closer to 150 mL are recommended for esophageal and stomach examinations, and up to 750 mL for small bowel examinations. Use suspension concentrations up to 115% w/v for examinations of the esophagus and upper GI tract. For small bowel examinations, use a 60% w/v suspension. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Children and Adolescents 2 to 16 years: Adjust dose based on relative GI volume. For upper GI tract examinations, administer a volume sufficient to fully distend the esophagus or stomach. Use suspension concentrations up to 115% w/v for examinations of the esophagus and upper GI tract. For small bowel examinations, 75 to 480 mL of a 60% w/v suspension PO. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Neonates, Infants, and Children younger than 2 years: Adjust dose based on relative GI volume. For upper GI tract examinations, administer a volume sufficient to fully distend the esophagus or stomach. Use suspension concentrations up to 115% w/v for examinations of the esophagus and upper GI tract. For small bowel examinations, 30 to 75 mL of a 60% w/v suspension PO. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Oral dosage (E-Z-Paste):
Adults: 5 to 20 mL (3 to 12 g of barium sulfate, respectively) PO as required to examine the esophagus, pharynx, and hypopharynx. The dose to be administered will depend on the degree and extent of contrast required in the areas under examination and on the equipment and technique employed.
Oral dosage (Liquid E-Z-PAQUE):
Adults and Adolescents 17 years: 150 to 750 mL (87 to 435 g of barium sulfate, respectively) PO; volumes closer to 150 mL are recommended for esophageal and stomach examinations, and up to 750 mL for small bowel examinations. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Children and Adolescents 2 to 16 years: Adjust dose based on relative GI volume. For upper GI tract examinations, administer a volume sufficient to fully distend the esophagus or stomach. For small bowel examinations, 75 to 480 mL (43.5 to 278.4 g of barium sulfate, respectively) PO. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Neonates, Infants, and Children younger than 2 years: Adjust dose based on relative GI volume. For upper GI tract examinations, administer a volume sufficient to fully distend the esophagus or stomach. For small bowel examinations, administer 30 to 75 mL (17.4 to 43.5 g of barium sulfate, respectively) PO. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
Oral dosage (Liquid Polibar Plus):
Adults: 60 to 300 mL (undiluted) PO for esophageal examinations; 150 to 340 mL (undiluted or diluted) PO for stomach examinations, and 340 to 750 mL (undiluted or diluted) PO for small bowel examinations. Individual technique and technology of the specific procedure, and the desired level of contrast density will determine the barium suspension volume and concentration to be used.
Oral dosage (Varibar Honey):
Adults: 5 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Infants 6 months and older, Children, and Adolescents: 1 to 3 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Oral dosage (Varibar Nectar):
Adults: 5 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Infants 6 months and older, Children, and Adolescents: 1 to 3 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Neonates and Infants 1 to 5 months: 0.5 to 1 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Oral dosage (Varibar Pudding):
Adults: 5 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Infants 7 months and older, Children, and Adolescents: 1 to 3 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Oral dosage (Varibar Thin Honey):
Adults: 5 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Infants, Children, and Adolescents: 1 to 3 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 30 mL.
Oral dosage (Varibar Thin Liquid):
Adults: 5 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 80 mL.
Infants 6 months and older, Children, and Adolescents: 1 to 3 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 80 mL.
Neonates and Infants 1 to 5 months: 0.5 to 1 mL PO per dose. During a single modified swallow examination, multiple doses may be administered to assess oral and pharyngeal function and morphology. Max: 80 mL.
Oral dosage (VoLumen):
Adults: 900 to 1,350 mL (0.9 to 1.35 g of barium sulfate, respectively) PO beginning 20 to 30 minutes prior to procedure. In patients where marking may be problematic (i.e., obesity, delayed transit), the total volume consumed may be increased up to 1,800 mL. Individual technique and technology of the specific procedure, the desired level of contrast density, and patient age and size will determine the barium suspension viscosity, quantity, and concentration to be used.
- for use as a contrast in lower GI studies (barium enema):
Rectal dosage (Liquid Polibar Plus):
Adults: 1,000 to 2,500 mL (diluted) rectally for single-contrast colon examinations, and 500 to 1,500 mL (undiluted) rectally for double-contrast colon examinations. Individual technique and technology of the specific procedure, and the desired level of contrast density will determine the barium suspension volume and concentration to be used.
For use as a fecal tagging agent during computed tomography (CT) imaging of the colon:
Oral dosage (Tagitol V):
Adults: 20 mL (8 g of barium sulfate) PO with each meal (breakfast, lunch, and dinner) the day before the CT colonography examination. The total dose is 60 mL (24 g of barium sulfate).
Maximum Dosage Limits:
Maximum dosage dependent on specific product chosen.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
*non-FDA-approved indication
Bictegravir; Emtricitabine; Tenofovir Alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Brexpiprazole: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics such as brexpiprazole should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post procedure.
Caffeine: (Major) Avoid caffeine containing products for at least 48 hours before myelography and for at least 24 hours postprocedure.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Emtricitabine; Tenofovir alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Ethiodized Oil: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Iodixanol: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Iohexol: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Iomeprol: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Iopamidol: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Iopromide: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Ioversol: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Isosulfan Blue: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Non-Ionic Contrast Media: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Tenofovir Alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Tenofovir Alafenamide: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein.
Barium sulfate is opaque to X-rays and acts as a positive contrast during radiographic examination.
Barium sulfate is administered orally or rectally. It is an inert, radiopaque material that is not absorbed or metabolized and is eliminated intact from the body via the feces. The elimination rate is a function of the gastrointestinal transit time.
Affected cytochrome P450 isoenzymes and drug transporters: none