atopy, food allergies, or a previous reaction to a contrast agent may increase the risk for hypersensitivity reactions. emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction. 5.2 intra-abdominal barium leakage the use of varibar thin honey is contraindicated in patients at high risk of perforation of the gi tract [see contraindications ( 4 )] . administration of varibar thin honey may result in leakage of barium from the gi tract in the presence of conditions such as carcinomas, gi fistula, inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, or diverticulitis, and in patients with a severe stenosis at any level of the gi tract, especially if it is distal to the stomach. the barium leakage has been associated with peritonitis and granuloma formation. 5.3 delayed gastrointestinal transit and obstruction orally administered barium sulfate may accumulate proximal to a constricting lesion of the colon, causing obstruction or impaction with development of baroliths (inspissated barium associated with feces) and may lead to abdominal pain, appendicitis, bowel obstruction, or rarely perforation. patients with the following conditions are at higher risk for developing obstruction or baroliths: severe stenosis at any level of the gi tract, impaired gi motility, electrolyte imbalance, dehydration, on a low residue diet, taking medications that delay gi motility, constipation, pediatric patients with cystic fibrosis or hirschsprung disease, and the elderly [see use in specific populations ( 8.4 , 8.5 )]. to reduce the risk of delayed gi transit and obstruction, patients should maintain adequate hydration after the barium sulfate procedure. 5.4 aspiration pneumonitis the use of varibar thin honey is contraindicated in patients with trachea-esophageal fistula [see contraindications ( 4 )] . oral administration of barium is associated with aspiration pneumonitis, especially in patients with a history of food aspiration or with compromised swallowing mechanism. vomiting following oral administration of barium sulfate may lead to aspiration pneumonitis. in patients at risk for aspiration, begin the procedure with a small ingested volume of varibar thin honey. monitor the patient closely for aspiration, discontinue administration of varibar thin honey if aspiration is suspected, and monitor for development of aspiration pneumonitis. 5.5 systemic embolization barium sulfate products may occasionally intravasate into the venous drainage of the gi tract and enter the circulation as a "barium embolus" leading to potentially fatal complications which include systemic and pulmonary embolism, disseminated intravascular coagulation, septicemia and prolonged severe hypotension. although this complication is exceedingly uncommon after oral administration of a barium sulfate suspension, monitor patients for potential intravasation when administering barium sulfate.

( 5.1 )]. monitor patients with cystic fibrosis or hirschsprung disease for bowel obstruction after use [see warnings and precautions ( 5.3 )] . 8.5 geriatric use clinical studies of varibar thin honey did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. other reported clinical experience has not identified differences in responses between the elderly and younger patients. in general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.