Drug General Information (ID: DDI2HQCZG5)
Drug Name			Sodium sulfate		Drug Info		Castor oil		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Laxatives				Nutritional Supplements
Structure

Mechanism of Sodium sulfate-Castor oil Interaction (Severity Level: Moderate)
Increased risk of GI mucosal injury/bleeding risk Click to Show/Hide Mechanism Graph
Drug Name		Sodium sulfate				Castor oil
Mechanism		Increase the risk of colonic mucosal ulceration or ischemic colitis combined with stimulant laxative				Stimulant laxative
Key Mechanism Factor 1
		Factor Name		Gastrointestinal toxicity
		Factor Description		The risk and severity of gastrointestinal toxicity, including inflammation, bleeding, ulceration, and perforation, increases when drugs with gastrointestinal mucosal irritant effects are combined.
Mechanism Description		Increased risk of GI mucosal injury/bleeding risk by the combination of Sodium sulfate and Castor oil

Recommended Action
Management		The manufacturers for some osmotic bowel cleansing products recommend avoiding the concurrent use of stimulant laxatives. However, stimulant laxatives, in particular bisacodyl and sodium picosulfate, are sometimes used with PEG in certain bowel cleansing regimens to help reduce dose volume and improve patient tolerability and acceptance. Please consult individual product labeling for specific recommendations and guidance. Patients using osmotic bowel cleansing products and stimulant laxatives who present with sudden abdominal pain, rectal bleeding, or other symptoms of ischemic colitis should be evaluated promptly.

References
1	Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates). Braintree Laboratories, Braintree, MA.
2	Product Information. MoviPrep (polyethylene glycol 3350 with electrolytes). Physicians Total Care, Tulsa, OK.
3	Soh JS, Kim KJ. Combination could be another tool for bowel preparation? World J Gastroenterol. 2016 Mar 14;22(10):2915-21. doi: 10.3748/wjg.v22.i10.2915.