Osmo Prep is one of several options for preparing your bowel for a colonoscopy. When taken correctly in patients without certain medical conditions or who are taking particular medications, it has been found to be safe and effective. However, because of potential side effects that are not shared by other bowel prep choices, we find it necessary to provide patients with further information regarding Osmo Prep and its safety.

Recently, there have been reports of nephrocalcinosis following the administration of Osmo Prep. Nephrocalcinosis is renal tubular injury characterized by increased calcium phosphate deposits. The damage to the kidneys can lead to both acute as well as chronic renal problems. The exact risk of nephrocalcinosis is not known, but is felt to be small. This injury can occur soon after preparation or as long as one month following its administration.

Patients with the following may be at increased risk:

• Known impairment of kidney function
• A history of congestive heart failure
• A history of hypertension
• The elderly
• Patients taking certain blood pressure medications ACE Inhibitors, examples: captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril), fosinopril (Monopril), ramipril (Altace), perindopril (Aceon), quinapril (Accupril), moexipril (Univasc), and trandolapril (Mavik) or ARBs examples: valsartan (Diovan), losartan (Cozaar), irbesartan (Avapro), and candesartan (Atacand)
• Patients on medications for osteoporosis (bisphosphonates)
• Patients taking diuretics
• Patients who begin the preparation already dehydrated

If you choose to take this bowel preparation, you must maintain adequate hydration before, during, and after taking the prep. Follow hydration guidelines stated on the Osmo Prep instructions exactly.

Proper Preparation is Important! Please follow instructions carefully.

Prior to Starting Prep

Drink 8 oz. of clear liquid every hour for 6 hours (48 oz. total) preceding the 1st dose of Osmo Prep.

Day Before Procedure

Beginning at 5pm on the day before your procedure you should start your first regimen by taking 4 tablets with 8 oz. of any clear liquid. Repeat this every 15 minutes for a total of 5 doses (20 tablets).

Day of Procedure

In the early am on the day of procedure you should start your second regimen by taking 4 tablets with 8 oz. of any clear liquid. Repeat every 15 minutes for a total of 3 doses (12 tablets).

You must complete the entire prep to ensure the most effective cleansing!

Post Procedure

After procedure, when you are awake, drink 8 oz. of clear liquid every hour for 6 hours (48 oz. total).

For more information go to www.tabletprep.com.

Dosing Considerations in the Use of Sodium Phosphate Bowel Preparations for Colonoscopy

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