In 2006 the FDA warned consumers about kidney failure seen in some users of oral sodium phosphates (OSP) like Fleet’s Phospho-soda. FDA’s review of adverse event data did not show kidney problems when these over-the-counter oral products were used at lower doses for laxative use. But they did notice that higher doses typically used for bowel cleansing were causing serious harm. Since then, FDA required that manufacturers change the label. The use of OSP for bowel cleansing has been discontinued.
Consumers should also be aware of potential safety issues involving the phosphate content in Fleet enemas. This is especially true in elderly patients, who may use more than just one enema at a time and risk metabolic disorders and fatalities. When a Fleet enema is used, a second dose in quick succession to the first should not be used. Prolonged use or overuse can also lead to dehydration as well as fluid and electrolyte imbalances.
In March, the Department of Veteran’s Affairs (VA) issued a report about a patient who received multiple phosphate enemas in less than 12 hours. The patient subsequently developed critical electrolyte abnormalities and acute kidney injury and later died.
A concern that pharmacists also have about these products is the way that cartons are labeled. Fleet refers to the product as “Fleet Enema Saline and active ingredients (OSP) are not mentioned on the front of the box. Generic products are similarly labeled. Simply referring to the product as “saline” does not bring attention to the phosphate content in Fleet and similar generic enema products. Since health professionals and consumers often define the term “saline” as a mixture of just salt and water, this could be dangerous.