DOSAGE FORMS & STRENGTHS SECTION.

3 DOSAGE FORMS AND STRENGTHS. Oral Paste: an off-white to lightly colored ready-to-use paste with vanilla aroma for oral administration supplied in multiple-dose polyethylene tubes containing either 30 mL or 230 mL of barium sulfate (40% w/v).. Oral paste: barium sulfate (40% w/v) in 30 mL or 230 mL multiple dose tube for oral administration (3).

GERIATRIC USE SECTION.

8.5 Geriatric Use. Clinical studies of VARIBAR PUDDING 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.

HOW SUPPLIED SECTION.

16 HOW SUPPLIED/STORAGE AND HANDLING. 16.1 How Supplied. VARIBAR PUDDING is an off-white to lightly colored ready-to-use paste with vanilla aroma for oral administration supplied in multiple-dose polyethylene tubes containing either 30 mL or 230 mL of barium sulfate (40% w/v).Provided as: 24 30 mL tubes (NDC 32909-125-54); 12 230 mL tubes (NDC 32909-125-22). 16.2 Storage and Handling. Store at USP controlled room temperature 20C to 25C (68F to 77F). Protect from freezing.Once opened, VARIBAR PUDDING may be used for up to 21 days when stored at USP controlled room temperature, 20C to 25C (68F to 77F).

INDICATIONS & USAGE SECTION.

1 INDICATIONS AND USAGE. VARIBAR PUDDING is indicated for modified barium swallow examinationsto evaluate the oral and pharyngeal function and morphology in adultand pediatric patients months of age and older.. VARIBAR PUDDING is radiographic contrast agent indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients months of age and older (1).

INFORMATION FOR PATIENTS SECTION.

17 PATIENT COUNSELING INFORMATION. After administration, advise patients to:Maintain adequate hydration.Seek medical attention for worsening of constipation or slow gastrointestinal passage.Seek medical attention for any delayed onset of hypersensitivity: rash, urticaria, or respiratory difficulty.Rx onlyManufactured forBracco Diagnostics Inc.Princeton, NJ 08540by EZEM Canada IncAnjou (Quebec) Canada H1J 2Z4VARIBAR(R) is registered trademark of E-Z-EM, Inc.Revised: May 2025CL87D-05. Maintain adequate hydration.. Seek medical attention for worsening of constipation or slow gastrointestinal passage.. Seek medical attention for any delayed onset of hypersensitivity: rash, urticaria, or respiratory difficulty.

LABOR & DELIVERY SECTION.

8.2Lactation. Risk SummaryVARIBAR PUDDING isnot absorbed systemically by the mother following oral administrationand breastfeeding is not expected to result in exposure of the infantto the drug. [see Clinical Pharmacology (12.3)].

MECHANISM OF ACTION SECTION.

12.1 Mechanism of Action. Due to its high atomic number, barium (the active ingredientin VARIBAR PUDDING) is opaque to x-rays and therefore acts as positivecontrast agent for radiographic studies.

NONCLINICAL TOXICOLOGY SECTION.

13 NONCLINICAL TOXICOLOGY. 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. No animal studies have been performed to evaluate the carcinogenic potential of barium sulfate or potential effects on fertility.

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL.

Varibar Pudding 230 mL External Label 05-25 CE87F-05Varibar Pudding 230 mL Tube Label 05-25 CT880-06Varibar Pudding 30 mL External Label 05-25 CE1378-02Varibar Pudding 30 mL Tube Label 05-25 CT0881-02. Varibar Pudding 230 mL External Label 05-25 CE87F-05. Varibar Pudding 230 mL Tube Label 05-25 CT880-06. Varibar Pudding 30 mL External Label 05-25 CE1378-02. Varibar Pudding 30 mL Tube Label 05-25 CT0881-02.

ADVERSE REACTIONS SECTION.

6 ADVERSE REACTIONS. The following adverse reactions have been identified from spontaneous reporting or clinical studies of barium sulfate administered orally. Because the reactions are reported voluntarily from population of uncertain size, it is not always possible to reliably estimate their frequency or to establish causal relationship to drug exposureNausea, vomiting, diarrhea and abdominal crampingSerious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes. Nausea, vomiting, diarrhea and abdominal cramping. Serious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes. Common adverse reactions include nausea, vomiting, diarrhea and abdominal cramping (6)To report SUSPECTED ADVERSE REACTIONS, contact Bracco Diagnostics at 1-800-257-5181 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION.

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. No animal studies have been performed to evaluate the carcinogenic potential of barium sulfate or potential effects on fertility.

CLINICAL PHARMACOLOGY SECTION.

12 CLINICAL PHARMACOLOGY. 12.1 Mechanism of Action. Due to its high atomic number, barium (the active ingredientin VARIBAR PUDDING) is opaque to x-rays and therefore acts as positivecontrast agent for radiographic studies.. 12.2 Pharmacodynamics. Barium sulfate is biologically inert and has no known pharmacological effects.. 12.3 Pharmacokinetics. Under physiological conditions, barium sulfate passes through the gastrointestinal tract in an unchanged form and is absorbed only in small, pharmacologically insignificant amounts.

CONTRAINDICATIONS SECTION.

4 CONTRAINDICATIONS. VARIBAR PUDDING is contraindicated in patients with:- known or suspected perforation of the gastrointestinal (GI) tract;- known obstruction of the GI tract;- high risk of GI perforation such as those with recent GI perforation, acute GI hemorrhage or ischemia, toxic megacolon, severe ileus, post GI surgery or biopsy, acute GI injury or burn, or recent radiotherapy to the pelvis;- high risk for aspiration such as those with known or suspected tracheo-esophageal fistula or obtundation;- known hypersensitivity to barium sulfate or any of the excipients of VARIBAR PUDDING.. VARIBAR PUDDING is contraindicated in patients with:Known or suspected perforation of the gastrointestinal (GI) tract (4)Conditions associated with high risk for GI perforation (4)Known obstruction of the GI tract (4)Patients with trachea-esophageal fistula (4)Known hypersensitivity to barium sulfate or any of the excipients of VARIBAR PUDDING (4). Known or suspected perforation of the gastrointestinal (GI) tract (4). Conditions associated with high risk for GI perforation (4). Known obstruction of the GI tract (4). Patients with trachea-esophageal fistula (4). Known hypersensitivity to barium sulfate or any of the excipients of VARIBAR PUDDING (4).

DESCRIPTION SECTION.

11 DESCRIPTION. VARIBAR PUDDING (barium sulfate) is radiographic contrast agent that is supplied as 40 w/v ready to use paste with vanilla aroma for oral administration. The active ingredient barium sulfate is designated chemically as BaSO4 with molecular weight of 233.4 g/mol and the following chemical structure:VARIBAR PUDDING has viscosity of 5000 cPs and contains the following excipients: artificial vanilla flavor, carboxymethylcellulose sodium, citric acid, ethyl vanillin, glycerin, maltodextrin, polysorbate 80, potassium sorbate, purified water, saccharin sodium, simethicone emulsion, sodium benzoate, xanthan gum, and xylitol.. barium-sulfate-structure.

DOSAGE & ADMINISTRATION SECTION.

2 DOSAGE AND ADMINISTRATION. For oral use only administered by syringe or spoon (2.1)Adults: mLPediatric patients: 1-3 mL Multiple doses may be administeredMaximum cumulative dose 30 mL. For oral use only administered by syringe or spoon (2.1)Adults: mLPediatric patients: 1-3 mL Adults: mL. Pediatric patients: 1-3 mL. Multiple doses may be administered. Maximum cumulative dose 30 mL. 2.1 RecommendedDosing. The recommended oral dose of VARIBAR PUDDING delivered by oral syringe or spoon:Adults mLPediatric patients 1-3 mL During single modified barium swallow examination, multiple doses of VARIBAR PUDDING may be administered as appropriate, to assess the patient during multiple swallows and different radiographic views.The maximum cumulative dose is 30 mL oral.Once opened, write the discard after date on the immediate container label. Discard any unused product after 21 days.. The recommended oral dose of VARIBAR PUDDING delivered by oral syringe or spoon:Adults mLPediatric patients 1-3 mL Adults mL. Pediatric patients 1-3 mL. During single modified barium swallow examination, multiple doses of VARIBAR PUDDING may be administered as appropriate, to assess the patient during multiple swallows and different radiographic views.. The maximum cumulative dose is 30 mL oral.. Once opened, write the discard after date on the immediate container label. Discard any unused product after 21 days.. 2.2 ImportantAdministration Instructions. Advise patients to hydrate following the barium sulfate procedure.Advise patient at risk for constipation or delayed gastrointestinal transit to monitor for worsening of their condition after administration of barium sulfate and seek medical attention if worsening and advise using laxatives to enhance gastrointestinal transit.. Advise patients to hydrate following the barium sulfate procedure.. Advise patient at risk for constipation or delayed gastrointestinal transit to monitor for worsening of their condition after administration of barium sulfate and seek medical attention if worsening and advise using laxatives to enhance gastrointestinal transit.

PEDIATRIC USE SECTION.

8.4 Pediatric Use. The efficacy of VARIBAR PUDDING in pediatric patients above months of age is based on successful opacification of the pharynx during modified barium swallow examinations [see Clinical Pharmacology (12.1)]. Safety and dosing recommendations in pediatric patients above months of age are based on clinical experience [see Indications (1), Dosage and Administration (2.1)].VARIBAR PUDDING is contraindicated in pediatric patients with tracheo-esophageal fistula. [see Contraindications (4)]. Pediatric patients with history of asthma or food allergies may be at increased risk for development of hypersensitivity reactions [see Warnings and Precautions (5.1)]. Pediatric patients with cystic fibrosis or Hirschsprung disease should be monitored for bowel obstruction after use [see Warnings and Precautions (5.3)].

PHARMACODYNAMICS SECTION.

12.2 Pharmacodynamics. Barium sulfate is biologically inert and has no known pharmacological effects.

PHARMACOKINETICS SECTION.

12.3 Pharmacokinetics. Under physiological conditions, barium sulfate passes through the gastrointestinal tract in an unchanged form and is absorbed only in small, pharmacologically insignificant amounts.

PREGNANCY SECTION.

8.1Pregnancy. Risk SummaryVARIBAR PUDDING is not absorbed systemically following oral administration, and maternal use is not expected to result in fetal exposure to the drug. [see Clinical Pharmacology (12.3)].

SPL UNCLASSIFIED SECTION.

2.1 RecommendedDosing. The recommended oral dose of VARIBAR PUDDING delivered by oral syringe or spoon:Adults mLPediatric patients 1-3 mL During single modified barium swallow examination, multiple doses of VARIBAR PUDDING may be administered as appropriate, to assess the patient during multiple swallows and different radiographic views.The maximum cumulative dose is 30 mL oral.Once opened, write the discard after date on the immediate container label. Discard any unused product after 21 days.. The recommended oral dose of VARIBAR PUDDING delivered by oral syringe or spoon:Adults mLPediatric patients 1-3 mL Adults mL. Pediatric patients 1-3 mL. During single modified barium swallow examination, multiple doses of VARIBAR PUDDING may be administered as appropriate, to assess the patient during multiple swallows and different radiographic views.. The maximum cumulative dose is 30 mL oral.. Once opened, write the discard after date on the immediate container label. Discard any unused product after 21 days.

STORAGE AND HANDLING SECTION.

16.2 Storage and Handling. Store at USP controlled room temperature 20C to 25C (68F to 77F). Protect from freezing.Once opened, VARIBAR PUDDING may be used for up to 21 days when stored at USP controlled room temperature, 20C to 25C (68F to 77F).

USE IN SPECIFIC POPULATIONS SECTION.

8 USE IN SPECIFIC POPULATIONS. 8.1Pregnancy. Risk SummaryVARIBAR PUDDING is not absorbed systemically following oral administration, and maternal use is not expected to result in fetal exposure to the drug. [see Clinical Pharmacology (12.3)] 8.2Lactation. Risk SummaryVARIBAR PUDDING isnot absorbed systemically by the mother following oral administrationand breastfeeding is not expected to result in exposure of the infantto the drug. [see Clinical Pharmacology (12.3)] 8.4 Pediatric Use. The efficacy of VARIBAR PUDDING in pediatric patients above months of age is based on successful opacification of the pharynx during modified barium swallow examinations [see Clinical Pharmacology (12.1)]. Safety and dosing recommendations in pediatric patients above months of age are based on clinical experience [see Indications (1), Dosage and Administration (2.1)].VARIBAR PUDDING is contraindicated in pediatric patients with tracheo-esophageal fistula. [see Contraindications (4)]. Pediatric patients with history of asthma or food allergies may be at increased risk for development of hypersensitivity reactions [see Warnings and Precautions (5.1)]. Pediatric patients with cystic fibrosis or Hirschsprung disease should be monitored for bowel obstruction after use [see Warnings and Precautions (5.3)].. 8.5 Geriatric Use. Clinical studies of VARIBAR PUDDING 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.

WARNINGS AND PRECAUTIONS SECTION.

5 WARNINGS AND PRECAUTIONS. Hypersensitivity reactions: Emergency equipment and trained personnel should be immediately available (5.1)Intra-abdominal leakage: May occur with conditions which increase the risk for perforation such as carcinomas, GI fistula, Inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, diverticulitis, or severe stenosis or obstructing lesions of the GI tract (5.2)Obstruction: Patients should maintain adequate hydration in days following barium sulfate procedure to avoid obstruction or impaction by baroliths (5.3)Aspiration Pneumonitis: Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration (5.4). Hypersensitivity reactions: Emergency equipment and trained personnel should be immediately available (5.1). Intra-abdominal leakage: May occur with conditions which increase the risk for perforation such as carcinomas, GI fistula, Inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, diverticulitis, or severe stenosis or obstructing lesions of the GI tract (5.2). Obstruction: Patients should maintain adequate hydration in days following barium sulfate procedure to avoid obstruction or impaction by baroliths (5.3). Aspiration Pneumonitis: Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration (5.4). 5.1 HypersensitivityReactions. Barium sulfate preparations contain number of excipients, includingnatural and artificial flavors and may induce serious hypersensitivityreactions. The manifestations include: hypotension, bronchospasm andother respiratory impairments, and dermal reactions including rashes,urticaria, and itching. history of bronchial asthma, atopy, foodallergies, or previous reaction to contrast agent may increasethe risk for hypersensitivity reactions. Emergency equipment and trainedpersonnel should be immediately available for treatment of hypersensitivityreaction.. 5.2 Intra-abdominalBarium Leakage. Administration of VARIBAR PUDDING may result in leakage of barium from the GI tract in the presence of conditions and ailments that increase the risk of perforation such as known carcinomas, GI fistula, inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, or diverticulitis, and in patients with severe stenosis at any level of the gastrointestinal tract, especially if it is distal to the stomach. The barium leakage has been associated with peritonitis and granuloma formation. The use of VARIBAR PUDDING is contraindicated in patients at high risk of perforation of the GI tract [see Contraindications (4)].. 5.3 DelayedGastrointestinal Transit and Obstruction. Orally administered barium sulfate may accumulate proximal to 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, with impaired gastrointestinal motility, electrolyte imbalance, dehydration, on 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 and consider the administration of laxatives.. 5.4 Aspiration Pneumonitis. Oral administration of barium is associated with aspiration pneumonitis, especially in patients with 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 small ingested volume of VARIBAR PUDDING. The use of VARIBAR PUDDING is contraindicated in patients with trachea-esophageal fistula [see Contraindications (4)]. Monitor the patient closely for aspiration, discontinue administration of VARIBAR PUDDING 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 large bowel and enter the circulation as 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 barium sulfate suspension, monitor patients for potential intravasation when administering barium sulfate.