LIQUID E-Z-PAQUE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for LIQUID E-Z-PAQUE (LIQUID E-Z-PAQUE).
Barium sulfate is a radiopaque agent that coats the mucosal surface of the gastrointestinal tract, attenuating X-rays and providing contrast on imaging studies.
| Metabolism | Not metabolized; eliminated unchanged in feces. |
| Excretion | Primarily fecal (oral route, unabsorbed); negligible renal excretion (<1% as intact drug). |
| Half-life | Not applicable (non-systemic agent); plasma half-life not clinically relevant. |
| Protein binding | Not applicable (non-systemic, low absorption). |
| Volume of Distribution | Not applicable (remains predominantly in gastrointestinal tract). |
| Bioavailability | Non-systemic; negligible systemic absorption (<0.1% orally). |
| Onset of Action | Oral: 15-30 minutes for colonic opacification. |
| Duration of Action | Sufficient for entire fluoroscopic or radiographic examination (approximately 30-60 minutes post-administration). |
Oral: 25-50 mL (barium sulfate 60% w/v) as a single dose for upper GI series; for double-contrast studies, 100-200 mL (barium sulfate 250% w/v) as a single dose. Rectal: For barium enema, 200-300 mL of a 15-20% w/v suspension instilled via enema tube.
| Dosage form | 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 as barium sulfate is not metabolized by the liver. |
| Pediatric use | Upper GI series: 5-10 mL/kg (barium sulfate 60% w/v) orally, maximum 50 mL; double-contrast: 2-5 mL/kg (barium sulfate 250% w/v) orally. Barium enema: 10-15 mL/kg of a 15% w/v suspension rectally, maximum 300 mL. |
| Geriatric use | Use standard adult dosing but consider increased risk of constipation and aspiration. Ensure adequate hydration and monitor for bowel obstruction. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for LIQUID E-Z-PAQUE (LIQUID E-Z-PAQUE).
| Breastfeeding | Barium sulfate is not absorbed into maternal circulation, so excretion into breast milk is negligible. The American College of Radiology considers it compatible with breastfeeding. No M/P ratio is available or necessary. |
| Teratogenic Risk | Barium sulfate is not absorbed systemically and is considered to have negligible teratogenic risk. However, routine use during pregnancy should be avoided due to radiation exposure. If required, the lowest effective dose should be used with fetal shielding. |
■ FDA Black Box Warning
None
| Serious Effects |
["Suspected gastrointestinal perforation","Known or suspected intestinal obstruction","Tracheoesophageal fistula","Severe dehydration","Known hypersensitivity to barium sulfate"]
| Precautions | ["Risk of aspiration leading to pneumonitis or granuloma formation","Risk of bowel perforation, peritonitis, and granuloma formation if extravasation occurs","Dehydration and electrolyte imbalance in susceptible patients","Allergic reactions, including anaphylaxis","Acute renal failure in patients with pre-existing renal impairment (rare)"] |
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| Fetal Monitoring |
| Monitor for signs of bowel perforation, aspiration, or allergic reaction. In pregnant patients, assess fetal radiation exposure; consider pregnancy testing prior to procedures with radiation. |
| Fertility Effects | No known adverse effects on fertility. Barium sulfate is non-absorbable and does not affect reproductive function. |