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# Ezivac Enema
## Overview
Ezivac enema is a commercially available osmotic laxative preparation typically containing **Sodium Phosphates** (monobasic sodium phosphate and dibasic sodium phosphate). It works by drawing water into the lumen of the colon, inducing peristalsis and evacuation.
## Primary Indications
* Relief of occasional constipation.
* Bowel evacuation prior to rectal examinations or surgical procedures.
## Adult Dosing
* **Standard dose:** One ready-to-use unit (generally 118 mL to 133 mL delivered volume).
* **Frequency:** Do not exceed one dose in a 24-hour period.
## Pediatric Dosing
* **Children 12 years and older:** Same as adult dosing.
* **Children 2 to 11 years:** Use specialized pediatric-sized units or follow specific institutional protocols. Generally, 59 mL (half an adult dose or pediatric specific product) is used.
* **Children under 2 years:** Contraindicated.
## Dose Adjustments
* **Renal Impairment:** Exercise extreme caution; risk of severe hyperphosphatemia, hypocalcemia, and hypernatremia. Use is generally contraindicated in patients with significant renal impairment.
* **Elderly:** Use with caution due to increased risk of fluid and electrolyte disturbances.
## Contraindications
* Hypersensitivity to any component.
* Known or suspected bowel obstruction, megacolon, or perforated bowel.
* Active inflammatory bowel disease (e.g., ulcerative colitis).
* Clinically significant renal impairment.
* Congestive heart failure or severe dehydration.
## Adverse Effects
* **Common:** Rectal irritation, abdominal pain, nausea, vomiting.
* **Serious:** Severe electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia), dehydration, acute phosphate nephropathy, and cardiac arrhythmias secondary to electrolyte shifts.
## Key Drug Interactions
* **Diuretics/ACE Inhibitors/ARBs:** Increased risk of renal failure or electrolyte disturbances.
* **Calcium Channel Blockers:** Use with caution; may increase risk of hypocalcemia.
* **Other laxatives:** Avoid concurrent use of other phosphate-containing laxatives.
## Monitoring
* Monitor for signs of dehydration (dizziness, tachycardia, thirst).
* Assess serum electrolytes (including calcium, phosphate, sodium, and potassium) in high-risk patients.
* Monitor for signs of rectal bleeding or failure to evacuate after administration.
## Clinical Pearls
* **Administration:** Patient should be in the left lateral decubitus position (Sims' position) for optimal distribution.
* **Dehydration:** Ensure adequate oral hydration before and after administration.
* **Speed:** Do not force the enema; if resistance is encountered, stop to avoid anal/rectal trauma.
* **Efficacy:** Evacuation usually occurs within 2 to 15 minutes.
* **Note:** Always verify specific product labeling, as formulations vary by region.
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**Disclaimer:** This information is for educational purposes only. Always consult the most current prescribing information (product monograph) or pharmacy resources for updated dosing and safety guidelines before clinical use.
