Breeza Neutral Ab-Pelvic Image

Drug overview for BREEZA NEUTRAL AB-PELVIC IMAGE (sorbitol/mannitol/xanthan gum):

Generic name: sorbitol/mannitol/xanthan gum
Drug class:
Therapeutic class: Electrolyte Balance-Nutritional Products

No enhanced Introduction information available for this drug.

No enhanced Uses information available for this drug.

DRUG IMAGES

No Image Available

The following indications for BREEZA NEUTRAL AB-PELVIC IMAGE (sorbitol/mannitol/xanthan gum) have been approved by the FDA:

Indications:
None.

Professional Synonyms:
None.

The following drug interaction information is available for BREEZA NEUTRAL AB-PELVIC IMAGE (sorbitol/mannitol/xanthan gum):

Contraindicated
Severe
Moderate

There are 0 contraindications.

There are 2 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Polystyrene Sulfonate/Sorbitol SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Sorbitol may damage the intestinal mucosa, trigger vasospasms in the intestinal vasculature, and increase inflammation.(1) Polystyrene sulfonate crystals may deposit in these areas, resulting in further damage.(2,3) CLINICAL EFFECTS: Concurrent use of sorbitol and polystyrene sulfonate (either orally or rectally) may result in colonic necrosis, bleeding, ischemic colitis, and perforation of the gastrointestinal tract. Fatalities have been reported.(4) PREDISPOSING FACTORS: Predisposing factors may include a history of intestinal disease or surgery, hypovolemia, and/or renal insufficiency/failure. Premature infants may also be predisposed to the interaction.(4) PATIENT MANAGEMENT: The US manufacturer of sodium polystyrene sulfonate states that concurrent use with sorbitol (either orally or rectally) is not recommended.(4) In the event that sorbitol is used as a vehicle to administer polystyrene sulfonate rectally as an enema, particular attention should be given to administering a cleansing enema following the completion of the sodium polystyrene sulfonate enema.(4) Patients who have received concurrent polystyrene sulfonate and sorbitol should be monitored for signs of gastrointestinal complications and instructed to report abdominal pain and/or signs of gastrointestinal bleeding. If concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. DISCUSSION: There have been numerous case reports of intestinal necrosis following the use of sodium polystyrene sulfonate and sorbitol.(1,5-13) In the majority of these cases, sorbitol was used as a vehicle for rectal administration of sodium polystyrene sulfonate(5-10); however, there have also been reports with oral administration (1,11,12) and in patients who received both oral and rectal sodium polystyrene with sorbitol.(13,14) Fatalities have been reported.(1,5,6)	SODIUM POLYSTYRENE SULFONATE
Sorbitol/Lamivudine SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Sorbitol increases the osmotic pressure in the intestine, resulting in accelerated small intestinal transit time and decreased absorption and bioavailability of lamivudine. CLINICAL EFFECTS: Concurrent administration of sorbitol and lamivudine may result in decreased clinical efficacy of lamivudine.(1) Reduction in lamivudine exposure is sorbitol dose-dependent. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of lamivudine states that the concurrent use of lamivudine and sorbitol should be avoided.(1) Consider more frequent monitoring of HBV viral load when chronic coadministration cannot be avoided. DISCUSSION: In an open label, randomized sequence, 4-period, crossover trial in 16 healthy adults, coadministration of a single dose of lamivudine (300 mg) with sorbitol (3.2 grams) resulted in a dose-dependent decrease of lamivudine's area-under-the-curve (AUC(0-24), AUC infinity) and maximum concentration (Cmax) of 20%, 28%, and 28%. A single dose of lamivudine with sorbitol (10.2 grams) resulted in a decrease of lamivudine's AUC and Cmax of 39%, 52%, and 52%. A single dose of lamivudine with sorbitol (13.4 grams) resulted in a decrease of lamivudine's AUC and Cmax of 36%, 55%, and 55%.(1)	ABACAVIR-LAMIVUDINE, CIMDUO, DELSTRIGO, DOVATO, EFAVIRENZ-LAMIVU-TENOFOV DISOP, EPIVIR, LAMIVUDINE, LAMIVUDINE HBV, LAMIVUDINE-ZIDOVUDINE, SYMFI, TRIUMEQ, TRIUMEQ PD

Drug Interaction

Drug Names

Polystyrene Sulfonate/Sorbitol

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Sorbitol may damage the intestinal mucosa, trigger vasospasms in the intestinal vasculature, and increase inflammation.(1) Polystyrene sulfonate crystals may deposit in these areas, resulting in further damage.(2,3)

CLINICAL EFFECTS: Concurrent use of sorbitol and polystyrene sulfonate (either orally or rectally) may result in colonic necrosis, bleeding, ischemic colitis, and perforation of the gastrointestinal tract. Fatalities have been reported.(4)

PREDISPOSING FACTORS: Predisposing factors may include a history of intestinal disease or surgery, hypovolemia, and/or renal insufficiency/failure. Premature infants may also be predisposed to the interaction.(4)

PATIENT MANAGEMENT: The US manufacturer of sodium polystyrene sulfonate states that concurrent use with sorbitol (either orally or rectally) is not recommended.(4) In the event that sorbitol is used as a vehicle to administer polystyrene sulfonate rectally as an enema, particular attention should be given to administering a cleansing enema following the completion of the sodium polystyrene sulfonate enema.(4) Patients who have received concurrent polystyrene sulfonate and sorbitol should be monitored for signs of gastrointestinal complications and instructed to report abdominal pain and/or signs of gastrointestinal bleeding.

If concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling.

DISCUSSION: There have been numerous case reports of intestinal necrosis following the use of sodium polystyrene sulfonate and sorbitol.(1,5-13) In the majority of these cases, sorbitol was used as a vehicle for rectal administration of sodium polystyrene sulfonate(5-10); however, there have also been reports with oral administration (1,11,12) and in patients who received both oral and rectal sodium polystyrene with sorbitol.(13,14) Fatalities have been reported.(1,5,6)

SODIUM POLYSTYRENE SULFONATE

Sorbitol/Lamivudine

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Sorbitol increases the osmotic pressure in the intestine, resulting in accelerated small intestinal transit time and decreased absorption and bioavailability of lamivudine.

CLINICAL EFFECTS: Concurrent administration of sorbitol and lamivudine may result in decreased clinical efficacy of lamivudine.(1) Reduction in lamivudine exposure is sorbitol dose-dependent.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The manufacturer of lamivudine states that the concurrent use of lamivudine and sorbitol should be avoided.(1) Consider more frequent monitoring of HBV viral load when chronic coadministration cannot be avoided.

DISCUSSION: In an open label, randomized sequence, 4-period, crossover trial in 16 healthy adults, coadministration of a single dose of lamivudine (300 mg) with sorbitol (3.2 grams) resulted in a dose-dependent decrease of lamivudine's area-under-the-curve (AUC(0-24), AUC infinity) and maximum concentration (Cmax) of 20%, 28%, and 28%. A single dose of lamivudine with sorbitol (10.2 grams) resulted in a decrease of lamivudine's AUC and Cmax of 39%, 52%, and 52%. A single dose of lamivudine with sorbitol (13.4 grams) resulted in a decrease of lamivudine's AUC and Cmax of 36%, 55%, and 55%.(1)

ABACAVIR-LAMIVUDINE, CIMDUO, DELSTRIGO, DOVATO, EFAVIRENZ-LAMIVU-TENOFOV DISOP, EPIVIR, LAMIVUDINE, LAMIVUDINE HBV, LAMIVUDINE-ZIDOVUDINE, SYMFI, TRIUMEQ, TRIUMEQ PD

There are 0 moderate interactions.

The following precautions are available for BREEZA NEUTRAL AB-PELVIC IMAGE (sorbitol/mannitol/xanthan gum):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

No enhanced Pregnancy information available for this drug.

No enhanced Lactation information available for this drug.

No enhanced Geriatric Use information available for this drug.