Beasley, Allen, Crow, Methvin, Portis & Miles, P.C.

A 62-year-old woman preparing for a colonoscopy followed her doctor’s orders and took a large dose of an oral sodium phosphate (OSP) solution to cleanse her bowel before the procedure. It wasn’t an unusual order. Many physicians either prescribe OSP pills or solutions for their patients or recommend over-the-counter OSP products. However, the patient’s kidneys began to fail. Doctors were able to partially resolve the problem, but the woman was left with stage 4 chronic kidney disease.

“In retrospect, multiple risk factors for this condition … were identified,” according to a case review published by the National Center for Biotechnology Information (NCBI). The woman had hypertension; used diuretics and AT-II receptor blocker; was of female gender and advanced age; and experienced volume depleting due to vomiting and nausea. “If these factors had been taken into consideration prior to prescribing this drug, acute and chronic renal failure would have been prevented.”

But, even patients without risk factors have experienced serious kidney injury following use of OSP products, which earlier this year prompted the Food and Drug Administration (FDA) to issue a black box warning on prescription OSP products such as Visicol and Osmo Prep. The agency expressed similar concern for over-the-counter OSP products, such as Fleet Phospho-soda and Fleet Accu-Prep. In turn, manufacturer C.B. Fleet issued a recall of its over-the-counter products.

Despite the warnings, authors of the NCBI article issued this opinion: “On the basis of the current state of knowledge the evidence seems to be quite compelling not to prescribe these drugs in patients with one or more associated risk factors. It could even be argued that these drugs should not be prescribed at all.”

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