ratory impairments, dermal reactions including rashes, urticaria, and itching. a history of bronchial asthma, atopy, 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 e-z-hd is contraindicated in patients at high risk of perforation of the gi tract [see contraindications ( 4 )]. administration of e-z-hd 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 during and in the days following a barium sulfate procedure. consider the administration of laxatives. 5.4 aspiration pneumonitis the use of e-z-hd is contraindicated in patients at high risk of aspiration [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 e-z-hd. discontinue administration of e-z-hd immediately if aspiration is suspected. 5.5 systemic embolization barium sulfate products may occasionally intravasate into the venous drainage of the large bowel 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. 5.6 risk with hereditary fructose intolerance e-z-hd contains sorbitol which may cause severe reactions if ingested by patients with hereditary fructose intolerance, such as: vomiting, hypoglycemia, jaundice, hemorrhage, hepatomegaly, hyperuricemia, and kidney failure. before administration of e-z-hd assess patients for a history of hereditary fructose intolerance and avoid use in these patients.

on bottle and shake vigorously for 30 seconds wait 5 minutes and re-shake bottle thoroughly. reconstitution yields approximately 140 ml of e-z-hd for oral suspension containing 2.38 grams of barium sulfate per ml 2.3 administration instructions administer the reconstituted e-z-hd for oral suspension immediately upon reconstitution to use with a straw, remove the adhesive label from top of the cap. remove cap and use straw to push out cap liner. replace cap discard any unused suspension advise patients to hydrate following the barium sulfate procedure

linical studies of e-z-hd 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.