Flee From Fleet? Danger With Some Enemas and Solutions Used for Constipation

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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The kidneys don’t like a sodium phosphate load. Over the counter enemas and oral solutions for constipation can cause serious harm if used too often or in those with kidney impairment. As physicians we’ve known this, now the Food and Drug Administration (FDA) has issued an alert.

What should you know?
If you use more than 1 dose in 24 hours of over the counter sodium phosphate drugs to treat constipation, you may cause serious harm to your kidneys and heart, and even death.

Which products are these?
First, know there are many safe over the counter meds for constipation. The ones you need to pay attention to are oral solutions and enemas containing sodium phosphate. You’ll know these as the brand name Fleet or generic products like CVS brand Phospho-soda solution as an example.

What can happen?

When you give a huge solute (sodium and phosphate for example) load to the kidneys it may result in dehydration and kidney failure: water follows the solute out of the gut and kidneys resulting in impressive water loss. There have been reports of severe dehydration and changes in serum electrolytes levels in folks taking more than the recommended dose of OTC sodium phosphate products, resulting in serious adverse effects on organs, and in some cases death.

Who really should NOT use sodium phosphate containing enemas or oral solutions?

Young children, persons older than 55 years, patients with dehydration, kidney disease, or patients who take medications that may affect kidney function (diuretics, for example, or nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen).

It’s clear on the front label which products are sodium-phosphate or sodium-bisphosphonate containing so keep your eyes peeled.

Dr O.

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