Frequently Asked Questions

About VARIBAR^® (barium sulfate)

How do I prepare VARIBAR (barium sulfate) products?

VARIBAR^® (barium sulfate) products are the only premixed, premeasured, and precise barium formulations that are ready to use.* This eliminates the need to mix liquids with barium powders, pastes, and thickening agents. Your preparation time and overall waste of materials are reduced, as are expenditures over time.

*VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension is supplied as a powder and constituted to a standard volume with water.

Can VARIBAR THIN LIQUID (barium sulfate) for oral suspension be warmed?

VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension can be moderately warmed without signﬁcantly impacting the viscosity of the product or the results of the test.

Is VARIBAR (barium sulfate) indicated for use in pre-term babies?

VARIBAR^® THIN HONEY (barium sulfate) oral suspension, VARIBAR^® NECTAR (barium sulfate) oral suspension, and VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension are broadly indicated for use in pediatric patients.^1-5

Is VARIBAR (barium sulfate) gluten free? Kosher?

There is no gluten in any of the VARIBAR^®(barium sulfate) products.

VARIBAR^® (barium sulfate) products do not contain animal origin ingredients; the products do not have a kosher certiﬁcation.

How does VARIBAR (barium sulfate) match up to IDDSI levels?

The Insights page has a link to a paper by Dr. Catriona Steele that maps our products to the IDDSI framework!⁶

How do we store VARIBAR (barium sulfate)?

Before opening, all VARIBAR^® (barium sulfate) products should be stored at room temperature (USP controlled room temperature 20 to 25 °C (68 to 77 °F)). Protect from freezing.

After opening, VARIBAR^® NECTAR (barium sulfate) oral suspension, VARIBAR^® THIN HONEY (barium sulfate) oral suspension, VARIBAR^® HONEY (barium sulfate) oral suspension and VARIBAR^® PUDDING (barium sulfate) oral paste should all continue to be stored at room temperature (USP controlled room temperature 20 to 25 °C (68 to 77 °F). Protect from freezing. Any unused product should all be discarded 21 days after opening.

After reconstitution, store VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension in a refrigerator at 2 to 8 °C (36 to 46 °F) for up to 72 hours. Protect from freezing. Any unused product should be discarded after 72 hours.

Can I refrigerate the VARIBAR (barium sulfate) products since some patients seem to prefer it cold?

The only product that should be refrigerated is the VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension, which needs to be stored in a refrigerator after reconstitution at 2 to 8 °C (36 to 46 ºF) for up to 72 hours. Protect from freezing. Any unused product should be discarded after 72 hours.

All other VARIBAR^®(barium sulfate) products should be stored at room temperature (USP controlled room temperature 20 to 25 °C (68 to 77 °F). Protect from freezing. The viscosity of these products can be affected by temperature.

What if I am concerned about allergens?

None of the major food allergens (milk, eggs, soybeans, ﬁsh, crustacean shellﬁsh, tree nuts, peanuts, and gluten-containing grains (wheat, barley, rye)) are added to the VARIBAR^® (barium sulfate) products. Some ingredients are derived from either corn or soy, but neither corn nor soy is added, and due to extensive processing, it is unlikely that proteins from the original raw material are present; however, testing to conﬁrm their absence has not been performed. For further information, please reach out to your VARIBAR^® (barium sulfate) Specialist.

Why don’t you have an IDDSI Level 1/Slightly Thick? Also why no cookie?

We are always discussing the possibility of bringing new products to market. VARIBAR^® (barium sulfate) products have a long legacy of being clinician-driven. To suggest products, or to inquire about products in planning, please reach out to your VARIBAR^® (barium sulfate) Specialist or use the Contact Us form.

Is VARIBAR (barium sulfate) approved for multiple patients per bottle?

YES! Please see the Prescribing Information for each product for more details.

I am in a facility that dilutes VARIBAR THIN LIQUID (barium sulfate) for oral suspension to make an “ultrathin.” Is this ok?

By diluting VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension, a clinician loses the standardization of the 40% w/v concentration of barium sulfate. The MBSImP uses VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension without dilution and has been validated to optimize the detection of physiological impairment.⁸

VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension has been mapped by Dr. Catriona Steele to the IDDSI framework and tests as an IDDSI 0/Thin Liquid. You can ﬁnd this paper by Dr. Steele in our Resources section.

I am having trouble getting VARIBAR (barium sulfate) product from our distributor, is it on backorder?

Practically never! Bracco does not directly sell barium sulfate products to facilities. Instead, we sell to distributors, who then sell to facilities. If you are told VARIBAR^® (barium sulfate) is on backorder, or that your facility cannot get it, please contact your VARIBAR^® (barium sulfate) Specialist and we will try to help!

Our facility has a strict single patient use policy, what should we do?

VARIBAR^® (barium sulfate) products are indicated for multi-patient use, and this information can be found on the Prescribing Information of each product.

Why is there a Honey and a Thin Honey? What is the difference, and which one should I use? What if I use the MBSImP™© – which product is used?

VARIBAR^® HONEY (barium sulfate) oral suspension was the “original” honey-thick consistency. After a few years of use in the ﬁeld, clinicians requested a viscosity between VARIBAR^® NECTAR (barium sulfate) oral suspension and VARIBAR^® HONEY
(barium sulfate) oral suspension. E-Z-EM, Inc. complied, and because of the limitations of changing the name of an existing product, the new product was named “Thin Honey.” VARIBAR^® HONEY (barium sulfate) oral suspension has a viscosity of 3000 cP, and VARIBAR^® THIN HONEY (barium sulfate) oral suspension has a viscosity of 1500 cP. For questions on which product might be best for your facility, please contact your VARIBAR^® (barium sulfate) Specialist.

The MBSImP™© uses VARIBAR^® THIN HONEY (barium sulfate) oral suspension – the 1500 cP product – in its protocol.^9,10

The Radiology department orders and pays for our barium sulfate products. What resources do you have that would help me educate them on the need for VARIBAR (barium sulfate) for MBSS/VFSS?

We have a section in our Insights page that is of special interest to Radiologists, Radiology Technologists and other personnel in Radiology. It includes the most recent Practice Parameters for the Modiﬁed Barium Swallow study from the American College of Radiology and Society of Pediatric Radiology.

This document states that “Use of a standardized and validated set of commercially prepared barium consistencies and volumes is recommended whenever possible, to ensure the ability to reproduce or compare repeat evaluation results, risks associated with aspiration of these substances, and infection control issues.”¹¹ This might be a great document for your colleagues in Radiology.

What food should I mix with VARIBAR (barium sulfate) for soft solids/IDDSI 5 (Minced and Moist), etc.?

VARIBAR^® (barium sulfate) is intended to be used “as is,” with the exception of the addition of water to reconstitute the VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension. To assess mastication, the MBSImP™© does use 3 mL of VARIBAR^®PUDDING (barium sulfate) oral paste on a 1/2 cookie. It is important to remember that the MBSS is not a “food test” – its purpose is NOT to simply look for aspiration and recommend a diet that the patient didn’t aspirate during the procedure, but rather to be a “videoﬂuoroscopic evaluation of the functional anatomy and physiology of swallowing”.¹²

How long can VARIBAR THIN LIQUID (barium sulfate) for oral suspension be left out at room temperature once mixed with water?

After reconstitution, the VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension needs to be stored in a refrigerator at 2 to 8 °C (36 to 46 ºF) for up to 72 hours. Protect from freezing. Any unused product should be discarded after 72 hours. VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension does not contain preservatives.

Is the “max dosage” listed on the Prescribing Information meant to be max per product or total barium for the patient?

The dosing for each VARIBAR^® (barium sulfate) product is listed in its respective Prescribing Information. Approved doses are per product, not a cumulative for the entire procedure.

Who is my VARIBAR (barium sulfate) Specialist and what do they do?

Your VARIBAR^® (barium sulfate) Specialist can help you ﬁnd resources, provide pricing and ordering information, organize product overviews for clinical (and non-clinical) teams, arrange for product samples, complete guest lectures for university programs and more! Reach out your Specialist today to get the collaboration started!

What if my question is not here?

Great question! Please either reach out to us by using the Contact Us form, or you can reach out directly to the Specialist in your area.

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

VARIBAR^® (barium sulfate)

IMPORTANT SAFETY INFORMATION:

For Oral Administration. This product should not be used in patients with known or suspected perforation of the GI tract, known obstruction of the GI tract, high risk of aspiration, or hypersensitivity to barium sulfate products. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium sulfate contrast agents. Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration.

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

VARIBAR^® (barium sulfate)

INDICATIONS
VARIBAR^® THIN HONEY (barium sulfate) oral suspension, VARIBAR^® NECTAR (barium sulfate) oral suspension, and VARIBAR^® THIN LIQUID (barium sulfate) oral suspension are radiographic contrast agents indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients.

VARIBAR^® HONEY (barium sulfate) oral suspension and VARIBAR^® PUDDING (barium sulfate) oral paste are radiographic contrast agents indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients 6 months of age and older.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
These products should not be used 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 a 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 of aspiration such as those with known or suspected tracheo-esophageal fistula or obtundation; known severe hypersensitivity to barium sulfate or any of the excipients of the product used.

WARNINGS AND PRECAUTIONS

Hypersensitivity Reactions
Barium sulfate preparations contain a number of excipients, including natural and artificial flavors, and may induce serious hypersensitivity reactions. The manifestations include hypotension, bronchospasm and other respiratory impairments, and dermal reactions including rashes, urticaria, and itching. A history of bronchial asthma, 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.

Intra-abdominal Barium Leakage
The use of VARIBAR PRODUCTS is contraindicated in patients at high risk of perforation of the GI tract. Administration of VARIBAR PRODUCTS 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.

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. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration after the barium sulfate procedure. When administering VARIBAR PUDDING, consider the administration of laxatives.

Aspiration Pneumonitis
The use of VARIBAR PRODUCTS is contraindicated in patients with trachea-esophageal fistula. 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 PRODUCTS. Monitor the patient closely for aspiration, discontinue administration of VARIBAR PRODUCTS if aspiration is suspected, and monitor for development of aspiration pneumonitis.

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.

ADVERSE REACTIONS
The most common adverse reactions are 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.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please click here for full Prescribing Information for VARIBAR^® THIN LIQUID (barium sulfate) oral suspension.

Please click here for full Prescribing Information for VARIBAR^® THIN HONEY (barium sulfate) oral suspension.

Please click here for full Prescribing Information for VARIBAR^® NECTAR (barium sulfate) oral suspension.

Please click here for full Prescribing Information for VARIBAR^® HONEY (barium sulfate) oral suspension.

Please click here for full Prescribing Information for VARIBAR^® PUDDING (barium sulfate) oral paste.

VARIBAR is manufactured by E-Z-EM Canada Inc., for E-Z-EM, Inc., a subsidiary of Bracco Diagnostics Inc., Princeton, NJ 08540.

VARIBAR is a registered trademark of E-Z-EM, Inc.

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

VARIBAR® (barium sulfate)

IMPORTANT SAFETY INFORMATION:

For Oral Administration. This product should not be used in patients with known or suspected perforation of the GI tract, known obstruction of the GI tract, high risk of aspiration, or hypersensitivity to barium sulfate products. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium sulfate contrast agents. Aspiration may occur during the modified barium swallow examination, monitor the patient for aspiration.

References:

1. VARIBAR^® HONEY (barium sulfate) oral suspension full Prescribing Information. Princeton, NJ: Bracco Diagnostics Inc.; August 2024.

2. VARIBAR^® NECTAR (barium sulfate) oral suspension full Prescribing Information. Princeton, NJ: Bracco Diagnostics Inc.; August 2024.

3. VARIBAR^® PUDDING (barium sulfate) oral paste full Prescribing Information. Princeton, NJ: Bracco Diagnostics Inc.; August 2024.

4. VARIBAR^® THIN HONEY (barium sulfate) oral suspension full Prescribing Information. Princeton, NJ: Bracco Diagnostics Inc.; August 2024.

5. VARIBAR^® THIN LIQUID (barium sulfate) for oral suspension full Prescribing Information. Princeton, NJ: Bracco Diagnostics Inc.; April 2023.

6. Steele CM, Martin-Harris B, Gosa M, Allen SE. Diagnosis and Management of Swallowing Physiology: Standardized Contrast, the MBSImP™, & the IDDSI Framework. Published May 1, 2021. https://appliedradiology.com/articles/diagnosis-and-management-of-swallowing-physiology-standardized-contrast-the-mbsimp-the-iddsi-framework. Accessed February 19, 2025.

7. Data on file. Bracco Diagnostics Inc. July 2022.

8. Hazelwood RJ, Armeson KE, Hill EG, et al. Identification of swallowing tasks from a modified barium swallow study that optimize the detection of physiological impairment. J Speech Lang Hear Res. 2017 Jul 12;60(7):1855-1863.

9. Martin-Harris B, Humphries K, (Focht) Garand KL. The modified barium swallow impairment profile (MBSImP™©) – innovation, dissemination and implementation. Perspectives of the ASHA Special Interest Groups. 2017;2(13):129-138.

10. Martin-Harris B, Brodsky MB, Michel Y, et al. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.

11. American College of Radiology (October 2023). ACR–SPR Practice Parameter for the Performance of the Modified Barium Swallow. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Modified-Ba-Swallow.pdf

12. Martin-Harris B, Canon CL, Bonilha HS, et al. Best practices in modified barium swallow studies. Am J Speech Lang Pathol. 2020 Jul;29(2S):1078-1093.