Label: E-Z-PAQUE- barium sulfate suspension
- NDC Code(s): 32909-186-02, 32909-187-02
- Packager: E-Z-EM Canada Inc
- Category: HUMAN PRESCRIPTION DRUG LABEL
- DEA Schedule: None
- Marketing Status: New Drug Application
Updated October 9, 2020
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HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use Liquid E-Z-PAQUE safely and effectively. See full prescribing information for Liquid E-Z-PAQUE.
Liquid E-Z-PAQUE (barium sulfate) oral suspension
Initial U.S. Approval: 2016
INDICATIONS AND USAGE
Liquid E-Z-PAQUE is a radiographic contrast agent indicated for use in single contrast radiographic examinations of the esophagus, stomach, and small bowel to visualize the gastrointestinal (GI) tract in adult and pediatric patients (1)
DOSAGE AND ADMINISTRATION
DOSAGE FORMS AND STRENGTHS
- Oral suspension 213 g barium sulfate (60% w/v) (3)
WARNINGS AND PRECAUTIONS
- Hypersensitivity reactions: Emergency equipment and trained personnel should be immediately available (5.1)
- Intra-abdominal barium leakage: May occur in conditions such as GI fistula, ulcer, inflammatory bowel disease, appendicitis or diverticulitis, severe stenosis or obstructing lesions of the GI tract (5.2)
- Delayed GI transit and obstruction: Patients should maintain adequate hydration in days following a barium sulfate procedure to avoid obstruction or impaction (5.3)
- Aspiration pneumonitis: Patients with history of food aspiration or with swallowing disorders are at increased risk (5.4)
Common adverse reactions include nausea, vomiting, diarrhea and abdominal cramping (6)
To report SUSPECTED ADVERSE REACTIONS, contact Bracco Diagnostics Inc at 1-800-257-5181 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch
See 17 for PATIENT COUNSELING INFORMATION.
Table of Contents
FULL PRESCRIBING INFORMATION: CONTENTS*
- Sections or subsections omitted from the full prescribing information are not listed.
- 1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 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
2.2 Administration Instructions
- For oral use only
- Shake bottle vigorously for 30 seconds prior to oral administration to fully suspend product
- Administer undiluted
- Ensure patients have nothing by mouth for the following
time period prior to the examination:
- Neonates and Infants < 3 months 2 hours
- Infants 3-12 months 3 hours
- > 12 months of age 4 hours
- Discard any unused suspension
- Encourage patients to maintain hydration following the barium sulfate procedure
- 3 DOSAGE FORMS AND STRENGTHS
- 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 of Liquid E-Z-PAQUE
5.1 Hypersensitivity Reactions
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. A history of bronchial asthma, atopy or a previous reaction to a contrast agent may increase the risk for hypersensitivity reactions. Emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction.
5.2 Intra-abdominal Barium Leakage
The use of Liquid E-Z-PAQUE is contraindicated in patients at high risk of perforation of the GI tract [see Contraindications (4)]. Administration of Liquid E-Z-PAQUE 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.
5.3 Delayed Gastrointestinal Transit and Obstruction
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. Patients with the following conditions are at higher risk for developing obstruction or baroliths: severe stenosis at any level of the GI tract, impaired GI motility, electrolyte imbalance, dehydration, on a low residue diet, on medications that delay GI motility, constipation, cystic fibrosis or Hirschsprung disease, and the elderly [see Use in Specific Populations (8.4, 8.5)]. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration following a barium sulfate procedure.
5.4 Aspiration Pneumonitis
The use of Liquid E-Z-PAQUE is contraindicated in patients at high risk of aspiration [see Contraindications (4)]. 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. In patients at risk for aspiration, begin the procedure with a small ingested volume of Liquid E-Z-PAQUE. Discontinue administration of Liquid E-Z-PAQUE immediately if aspiration is suspected.
5.5 Systemic Embolization
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 which include systemic and pulmonary embolism, disseminated intravascular coagulation, septicemia and prolonged severe hypotension. Although this complication is exceedingly uncommon after oral administration of barium sulfate suspension, monitor patients for potential intravasation when administering barium sulfate.
5.6 Risk with Hereditary Fructose Intolerance
Liquid E-Z-PAQUE contains sorbitol which may cause severe symptoms if ingested by patients with hereditary fructose intolerance. Severe symptoms may include the following: vomiting, hypoglycemia, jaundice, hemorrhage, hepatomegaly, hyperuricemia, and kidney failure. Before administration of Liquid E-Z-PAQUE assess patients for a history of hereditary fructose intolerance and avoid use in these patients.
6 ADVERSE REACTIONS
The following adverse reactions have been identified from spontaneous reporting or clinical studies of barium sulfate administered orally. Because the reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or to establish a causal relationship to drug exposure:
- Nausea, vomiting, diarrhea and abdominal cramping
- Serious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes
8 USE IN SPECIFIC POPULATIONS
Liquid E-Z-PAQUE is not absorbed systemically following oral administration, and maternal use is not expected to result in fetal exposure to the drug [see Clinical Pharmacology (12.3)].
Liquid E-Z-PAQUE is not absorbed systemically by the mother following oral administration, and breastfeeding is not expected to result in exposure of the infant to Liquid E-Z-PAQUE [see Clinical Pharmacology (12.3).
8.4 Pediatric Use
The efficacy of Liquid E-Z-PAQUE in pediatric patients from birth to less than 17 years of age is based on successful opacification of the esophagus, stomach, and small bowel during single contrast radiographic procedures [see Clinical Pharmacology (12.1)]. Safety and dosing recommendations in pediatric patients are based on clinical experience [see Dosage and Administration (2.1)].
Liquid E-Z-PAQUE is contraindicated in pediatric patients with tracheo-esophageal fistula. [see Contraindications (4)]. Pediatric patients with a history of asthma or food allergies may be at increased risk for development of hypersensitivity reactions [see Warnings and Precautions (5.1)]. Monitor pediatric patients with cystic fibrosis or Hirschsprung disease for bowel obstruction after use [see Warnings and Precautions (5.3)]
8.5 Geriatric Use
Clinical studies of Liquid E-Z-PAQUE do not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Liquid E-Z-PAQUE (barium sulfate) is a radiographic contrast agent supplied as a white to lightly colored barium sulfate suspension (60%w/v) for oral administration. The active ingredient barium sulfate is designated chemically as BaSO4 with a molecular weight of 233.4 g/mol, a density of 4.5 g/cm3, and the following chemical structure:
Liquid E-Z-PAQUE contains the following excipients: carboxymethyl cellulose sodium, citric acid, natural and artificial strawberry lemon cream flavor, polysorbate 80, potassium sorbate, purified water, saccharin sodium, simethicone emulsion, sodium benzoate, sodium citrate, sorbitol solution, xanthan gum.
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
- 13 NONCLINICAL TOXICOLOGY
16 HOW SUPPLIED/STORAGE
17 PATIENT COUNSELING INFORMATION
- Maintain adequate hydration
- Seek medical attention for worsening of constipation or slow gastrointestinal passage
- Seek medical attention for any delayed onset of hypersensitivity, such as: rash, urticaria, or respiratory difficulty
- PRINCIPAL DISPLAY PANEL
INGREDIENTS AND APPEARANCE
barium sulfate suspension
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:32909-186 Route of Administration ORAL Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength Barium Sulfate (UNII: 25BB7EKE2E) (Barium Sulfate - UNII:25BB7EKE2E) Barium Sulfate 0.6 g in 1 mL Inactive Ingredients Ingredient Name Strength CARBOXYMETHYLCELLULOSE SODIUM (UNII: K679OBS311) ANHYDROUS CITRIC ACID (UNII: XF417D3PSL) DIMETHICONE 350 (UNII: 2Y53S6ATLU) DIMETHICONE 1000 (UNII: MCU2324216) POLYSORBATE 80 (UNII: 6OZP39ZG8H) POTASSIUM SORBATE (UNII: 1VPU26JZZ4) WATER (UNII: 059QF0KO0R) SACCHARIN SODIUM (UNII: SB8ZUX40TY) SILICON DIOXIDE (UNII: ETJ7Z6XBU4) SODIUM BENZOATE (UNII: OJ245FE5EU) TRISODIUM CITRATE DIHYDRATE (UNII: B22547B95K) SORBITOL (UNII: 506T60A25R) XANTHAN GUM (UNII: TTV12P4NEE) Product Characteristics Color WHITE Score Shape Size Flavor STRAWBERRY Imprint Code Contains Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:32909-186-02 1 in 1 CARTON 03/01/2017 10/31/2021 1 355 mL in 1 BOTTLE, PLASTIC; Type 0: Not a Combination Product Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NDA NDA208143 03/01/2017 10/31/2021 E-Z-PAQUE
barium sulfate suspension
Product Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:32909-187 Route of Administration ORAL Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength Barium Sulfate (UNII: 25BB7EKE2E) (Barium Sulfate - UNII:25BB7EKE2E) Barium Sulfate 0.6 g in 1 mL Inactive Ingredients Ingredient Name Strength CARBOXYMETHYLCELLULOSE SODIUM (UNII: K679OBS311) ANHYDROUS CITRIC ACID (UNII: XF417D3PSL) DIMETHICONE 350 (UNII: 2Y53S6ATLU) DIMETHICONE 1000 (UNII: MCU2324216) POLYSORBATE 80 (UNII: 6OZP39ZG8H) POTASSIUM SORBATE (UNII: 1VPU26JZZ4) WATER (UNII: 059QF0KO0R) SACCHARIN SODIUM (UNII: SB8ZUX40TY) SILICON DIOXIDE (UNII: ETJ7Z6XBU4) SODIUM BENZOATE (UNII: OJ245FE5EU) TRISODIUM CITRATE DIHYDRATE (UNII: B22547B95K) SORBITOL (UNII: 506T60A25R) XANTHAN GUM (UNII: TTV12P4NEE) Product Characteristics Color WHITE Score Shape Size Flavor STRAWBERRY Imprint Code Contains Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:32909-187-02 12 in 1 CARTON 11/01/2020 1 355 mL in 1 BOTTLE, PLASTIC; Type 0: Not a Combination Product Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NDA NDA208143 11/01/2020 Labeler - E-Z-EM Canada Inc (204211163) Registrant - BRACCO DIAGNOSTICS INC (849234661) Establishment Name Address ID/FEI Business Operations E-Z-EM Canada Inc 204211163 PACK(32909-186, 32909-187) , MANUFACTURE(32909-186, 32909-187) , LABEL(32909-187, 32909-186) , ANALYSIS(32909-187, 32909-186)