Barium sulfate suspension

What is Barium sulfate suspension?

• Barium sulfate suspension is a radiographic contrast agent used to help doctors examine the esophagus (tube that connects the mouth and stomach), stomach, and intestine using x-rays or computed tomography (CAT scan, CT scan; a type of body scan that uses a computer to put together x-ray images to create cross-sectional or three dimensional pictures of the inside of the body).

Barium sulfate

What are the uses of this medicine?

• Barium sulfate suspension is used as single contrast radiographic examinations of the esophagus, stomach, and small bowel to visualize the gastrointestinal (GI) tract in adult and pediatric patients.

How does this medicine work?

Due to its high atomic number, barium is opaque to x-rays and therefore acts as a positive contrast agent for radiographic studies.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• known or suspected perforation of the GI tract
• known obstruction of the GI tract
• high risk of GI perforation such as those with a recent GI perforation, acute GI hemorrhage or ischemia, toxic megacolon, severe ileus, post GI surgery or biopsy, acute GI injury or burn, or recent radiotherapy to the pelvis
• high risk of aspiration such as those with prior aspiration, tracheo-esophageal fistula, or obtundation
• known severe hypersensitivity to barium sulfate or any of the excipients

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Is this medicine FDA approved?

• Barium sulfate has been known since the Middle Ages.
• In the United States it had come into common medical use by 1910.
• It is on the World health Organization's List of Essential Medicines.

How should this medicine be used?

Recommended dosage:

• Adults: 150 to 750 mL (87 g to 435 g of barium sulfate, respectively). Volumes closer to 150 mL are recommended for examination of the esophagus and stomach and volumes up to 750 mL are recommended for examination of the small bowel
• Pediatric Patients: Adjust dose based on GI volume
• For examinations of the upper GI tract, administer a volume sufficient to fully distend the esophagus or stomach.

For small bowel examinations:

• Age birth to less than 2 years: 30 mL to 75 mL
• Age 2 years to less than 17 years: 75 mL to 480 mL

Administration:

• Barium sulfate comes as a powder to be mixed with water, a suspension (liquid), a paste, and a tablet.
• The powder and water mixture and the suspension may be taken by mouth or may be given as an enema (liquid that is instilled into the rectum), and the paste and tablet are taken by mouth.
• Barium sulfate is usually taken one or more times before an x-ray examination or CT scan.
• If you are using a barium sulfate enema, the enema will be administered by medical staff at the testing center.
• If you are taking barium sulfate by mouth, you may be given the medication after you arrive at the testing center or you may be given the medication to take at home at specific times the night before and/or the day of your test.
• Swallow the tablets whole; do not split, chew, or crush them.
• Shake the liquid well before each use to mix the medication evenly.
• If you are given a powder to mix with water and take at home, be sure that you are also given directions for mixing and that you understand these directions.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As a powder to be mixed with water, a suspension (liquid), a paste, and a tablet

This medicine is available in fallowing brand namesː

• Anatrast
• Barobag
• Barosperse
• Cheetah
• Enhancer
• Entrobar
• HD 85
• HD 200
• Intropaste
• Polibar ACB
• Prepcat
• Scan C
• Tonopaque

What side effects can this medication cause?

The most common side effects of this medicine include:

• Nausea, vomiting, diarrhea and abdominal cramping
• constipation
• weakness
• pale skin
• sweating
• ringing in the ears

• Serious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes.

What special precautions should I follow?

• Barium sulfate preparations contain a number of excipients, including natural and artificial flavors and may induce serious hypersensitivity reactions. The manifestations include hypotension, bronchospasm and other respiratory impairments, dermal reactions including rashes, urticaria and itching. Emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction.
• Administration of Liquid Barium sulfate may result in leakage of barium from the GI tract in the presence of conditions such as carcinomas, GI fistula, inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, diverticulitis, and in patients with a severe stenosis at any level of the GI tract, especially distal to the stomach. Barium leakage has been associated with peritonitis and granuloma formation.
• Orally administered barium sulfate may accumulate proximal to a constricting lesion of the colon, causing obstruction or impaction with development of baroliths (inspissated barium associated with feces) and may cause abdominal pain, appendicitis, bowel obstruction, or rarely perforation. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration following a barium sulfate procedure.
• Barium sulfate products may occasionally intravasate into the venous drainage of the large bowel and enter the circulation as a "barium embolus" leading to potentially fatal complications. Monitor patients for potential intravasation when administering barium sulfate.
• Oral administration of barium is associated with aspiration pneumonitis, especially in patients with a history of food aspiration or with compromised swallowing mechanism. Vomiting following oral administration of barium sulfate may lead to aspiration pneumonitis. Discontinue administration of Liquid E-Z-PAQUE immediately if aspiration is suspected.
• Tell your doctor if you have recently had a rectal biopsy (removal of a small amount of tissue from the rectum for laboratory examination) and if you have any blockage, sores, or holes in the esophagus, stomach, or intestine; or swelling or cancer of the rectum.
• Barium sulfate products may be used during lactation.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• nausea
• vomiting
• stomach cramps
• diarrhea
• constipation

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.

Can this medicine be used in pregnancy?

• Radiation is known to cause harm to the unborn fetus exposed in utero.
• Therefore, radiographic procedures should only be used when, in the judgement of the physician, its use is deemed essential to the welfare of the pregnant patient.

Can this medicine be used in children?

• The efficacy of Barium sulfate products in pediatric patients from birth to less than 17 years of age is based on successful opacification of the esophagus, stomach, duodenum and small bowel during radiologic examinations.
• Safety and dosing recommendations in pediatric patients are based on clinical experience
• Barium sulfate is contraindicated in pediatric patients with tracheo-esophageal fistula.
• Pediatric patients with a history of asthma or food allergies may be at increased risk for development of hypersensitivity reactions.
• Pediatric patients with cystic fibrosis or Hirschsprung disease should be monitored for bowel obstruction after use.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• Barium Sulfate

Inactive ingredients:

• anhydrous citric acid
• benzoic acid
• dimethicone 350
• dimethicone 1000
• potassium sorbate
• saccharin sodium
• silicon dioxide
• sodium benzoate
• sorbitol
• trisodium citrate dihydrate
• water
• xanthan gum

Who manufactures and distributes this medicine?

Manufactured as E-Z-PAQUE for

• Bracco Diagnostics Inc.
• Monroe Township, NJ
• by EZEM Canada Inc

What should I know about storage and disposal of this medication?

• Store at USP controlled room temperature 20 to 25°C (68 to 77° F).
• Protect from freezing.

• Dailymed label info on Barium sulfate suspension
• FDA Barium sulfate suspension

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