E-Z-PAQUE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for E-Z-PAQUE (E-Z-PAQUE).
E-Z-PAQUE (barium sulfate) is a radiocontrast agent that attenuates X-rays, providing negative contrast enhancement of the gastrointestinal tract. It works by coating the mucosal surface and filling the lumen, allowing visualization of anatomical structures and pathology.
| Metabolism | Barium sulfate is not absorbed systemically; it is eliminated unchanged in feces. |
| Excretion | E-Z-PAQUE (barium sulfate) is not absorbed; elimination is entirely fecal, with 100% of the administered dose excreted unchanged in feces within 24-48 hours. No renal or biliary excretion occurs. |
| Half-life | Not applicable; barium sulfate is not systemically absorbed, so no plasma half-life exists. The gastrointestinal transit half-life is approximately 1-2 hours, depending on motility. |
| Protein binding | Not applicable; barium sulfate is a radiopaque contrast agent that is not absorbed into the systemic circulation, hence no plasma protein binding occurs. |
| Volume of Distribution | Not applicable; no systemic absorption, so no distribution volume can be defined. The agent remains within the gastrointestinal lumen. |
| Bioavailability | Oral: 0% (not absorbed). Rectal: 0% (not absorbed). Systemic bioavailability is zero due to lack of gastrointestinal absorption. |
| Onset of Action | Oral: Radiographic visualization begins immediately after ingestion, with coating of the upper GI tract within seconds to minutes. Rectal: Enema produces colonic opacification within 2-5 minutes of administration. |
| Duration of Action | Upper GI series: Barium coating persists for 30-60 minutes for the esophagus, stomach, and duodenum, but gastric emptying and small bowel transit typically complete passage within 2-4 hours. Follow-through studies require 1-3 hours for small bowel visualization and up to 24 hours for colonic evacuation. Barium enema: Colonic coating lasts until evacuation, usually 30-60 minutes post-procedure. |
Oral or rectal administration: 300-600 mL of a 1% to 2% suspension (10-20 g barium sulfate) for upper GI series; 750-1500 mL of a 15% to 25% suspension (113-375 g barium sulfate) for lower GI series, given as a single dose.
| Dosage form | FOR SUSPENSION |
| Renal impairment | No dose adjustment required for renal impairment as barium sulfate is not absorbed systemically. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | Upper GI series: <1 year: 30-90 mL; 1-5 years: 90-150 mL; 5-10 years: 150-300 mL; >10 years: adult dose. Lower GI series: <1 year: 150-300 mL; 1-5 years: 300-600 mL; 5-10 years: 600-900 mL; >10 years: adult dose. Concentrations vary per protocol. |
| Geriatric use | Use with caution in elderly due to risk of aspiration and constipation. Consider lower volumes and slower administration. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for E-Z-PAQUE (E-Z-PAQUE).
| Breastfeeding | Minimal excretion into breast milk (M/P ratio <0.01). Breastfeeding can continue; advise discarding milk for 12-24 hours post-procedure to reduce infant iodine exposure. |
| Teratogenic Risk | Iodinated contrast agents cross the placenta. First trimester: Theoretical risk of fetal hypothyroidism; avoid unless essential. Second and third trimesters: Iodine may accumulate in fetal thyroid, causing transient neonatal hypothyroidism; risk is low with single exposure. No documented teratogenicity. |
| Fetal Monitoring |
■ FDA Black Box Warning
N/A
| Serious Effects |
["Known or suspected gastrointestinal perforation","Known or suspected gastrointestinal obstruction","Previous hypersensitivity reaction to barium sulfate","Severe dehydration (relative contraindication)"]
| Precautions | ["Risk of aspiration pneumonitis if administered to patients with impaired swallowing or airway protection","Risk of bowel perforation or obstruction in patients with known or suspected intestinal perforation, obstruction, or inflammatory bowel disease","Avoid in patients with known hypersensitivity to barium sulfate","Use with caution in patients with cystic fibrosis or other conditions that may increase risk of impaction"] |
| Food/Dietary | Patient should be NPO (nothing by mouth) for at least 4-6 hours prior to upper GI studies; for lower GI studies, dietary restrictions include a low-residue diet and clear liquids the day before, followed by bowel preparation (e.g., laxatives, enemas). Avoid concurrent ingestion of antacids or medications that alter GI motility within 2 hours of administration as they may interfere with coating. No specific food interactions post-procedure, but a high-fiber diet is encouraged to facilitate barium elimination. |
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| Monitor maternal renal function (serum creatinine) before administration. Assess fetal heart rate if ultrasound is used. Post-exposure, check neonatal thyroid function (TSH) if repeated or high-dose exposure in pregnancy. |
| Fertility Effects | No direct impact on fertility reported. Iodinated contrast does not affect ovarian function or spermatogenesis in animal studies. |
| Clinical Pearls | E-Z-PAQUE (barium sulfate) is a radiopaque contrast agent used for fluoroscopic examinations of the gastrointestinal (GI) tract. It is contraindicated in patients with suspected GI perforation, complete bowel obstruction, or prior hypersensitivity to barium products. For double-contrast studies, administer high-density formulation after effervescent agents to distend the lumen. Ensure adequate hydration post-procedure to prevent barium impaction. Barium can cause constipation or rarely, impaction; use cautiously in elderly or those with slow transit. Do not use in patients with tracheoesophageal fistula due to aspiration risk. For CT colonography, use low-density barium with tagging protocols. |
| Patient Advice | This medication is a contrast agent that coats your digestive tract so that X-ray images can clearly show the anatomy. · You may experience chalky taste, nausea, or bloating during administration. · Drink plenty of fluids after the exam to help eliminate the barium from your body and prevent constipation. · Inform your doctor if you have a history of bowel obstruction, perforation, or allergies to barium products. · Stool may appear white or light-colored for 24-72 hours after the procedure, which is normal. · Seek medical attention if you experience severe abdominal pain, inability to pass gas, or vomiting after the exam. |