Dosing & Uses
Dosage Forms & Strengths
packet, oral
- 17g/packet
powder, oral
- 119g
- 238g
- 255g
- 510g
- 527g
- 850g
sodium sulfate/sodium bicarbonate/sodium chloride/ potassium chloride
powder for solution
- 22.72g/6.72g/5.84g/2.98g (240g)
- 22.74g/6.74g/5.86g/2.97g (236g)
- 21.5g/6.36g/5.53g/2.82g (227.1g)
sodium bicarbonate/sodium chloride/potassium chloride
powder for solution
- 5.72g/11.2g/1.48g (240g)
- 5,72g/11.2g/1.48g (420g)
Bowel Preparation
Powder for solution: 240 mL (8 oz) of powder for solution PO q10min until 4 L consumed or rectal effluent is clear; rapid drinking of each amount preferred to drinking small amounts continuously
NG: 20-30 mL/min until 4 L administered or rectal effluent clear
Oral powder: 17g (~1 heaping spoon) in 240 mL (8 oz) of clear liquid q10min until 2,000 mL of volume consumed (start within 6 hr after administering bisacodyl delayed-release tablets or magnesium citrate
See Administration
Constipation
17 g packet or ~1 heaping spoon of oral powder in 120-240 mL (4-8 oz) of beverage qDay; not to be used for >1-2 weeks depending on product, unless directed by health care professional
Dosage Forms & Strengths
Sodium bicarbonate/sodium chloride/potassium chloride
packet, oral
- 17g
powder, oral
- 119g
- 238g
- 255g
- 510g
- 527g
- 850g
powder for solution
- 5.72g/11.2g/1.48g (420g)
Bowel Preparation
<6 months: Safety and efficacy not established
Powder for solution
- ≥6 months: 25 mL/kg/hr O/NG over 4-10 hr until rectal effluent is clear; total dose not to exceed 4 L
Constipation
Neonate: Safety and efficacy not established
Packet/oral powder
- Infants, children, adolescents: 0.2-0.8 g/kg/day PO; not to exceed 17 g/day; individualize and adjust dosage to achieve desired effect; administer for no longer than 2 weeks; not to exceed 17 g/day
Adverse Effects
Frequency Not Defined
Abdominal bloating
Abdominal cramping
Abdominal distention
Colonic mucosal aphthous ulcerations
Diarrhea
Flatulence
Ischemic colitis
Nausea
Postmarketing Reports
Cardiovascular: Arrhythmia, atrial fibrillation, peripheral edema, asystole, and acute pulmonary edema after aspiration
Nervous system: Tremor, seizure
Hypersensitivity: Urticaria/rash, pruritus, dermatitis, rhinorrhea, dyspnea, chest and throat tightness, fever, angioedema, anaphylaxis and anaphylactic shock
Gastrointestinal: Nausea, abdominal fullness and bloating are the most common adverse reactions (occurred in up to 50% of patients); less common adverse reactions include: abdominal cramps, vomiting, “butterfly-like” infiltrates on chest X-ray after vomiting and aspirating PEG, anal irritation, and upper GI bleeding from Mallory-Weiss Tear, esophageal perforation [usually with gastroesophageal reflux disease (GERD)
Warnings
Contraindications
Hypersensitivity; ileus gastrointestinal obstruction, gastric retention, toxic colitis, bowel perforation, toxic megacolon
Cautions
Osmotic laxative products may produce colonic mucosal aphthous ulcerations, including reports of more serious cases of ischemic colitis necessitating hospitalization
Concomitant use of stimulant laxatives may increase risk of ischemic colitis; not recommended; consider potential for mucosal aphthous ulceration as a result of bowel preparation, especially when evaluating colonoscopy results in patients with known or suspected inflammatory bowel disease
Generalized tonic-clonic seizures and/or loss of consciousness reported in patients with no prior history of seizures, which resolved with correction of fluid and electrolyte abnormalities; use caution in patients with history of seizures or who are at increased risk of seizures, including concomitant administration of medications that lower seizures threshold, patients withdrawing from alcohol or benzodiazepines, and patients with unknown or suspected hyponatremia or low serum osmolality
Use with caution and observe unconscious or semiconscious patients with impaired gag reflex or other swallowing abnormalities or those who are otherwise prone to regurgitation or aspiration during administration; observe these patients during administration, especially if it is administered via nasogastric tube
Avoid use in patients with bowel obstruction, megacolon, perforated bowel, ulcerative colitis, toxic colitis, gastric retention
Not indicated for children <2 years because of risk of hypoglycemia, dehydration, and hypokalemia
When using PEG as laxative, do not give for >1 week
Electrolyte imbalance reported with prolonged use
Risk of fluid and electrolyte abnormalities; electrolyte abnormalities can lead to arrhythmias, seizures, and renal impairment; patients should maintain adequate hydration before, during, and after treatment; consider post colonoscopy lab test if patient becomes dehydrated or experiences significant vomiting after treatment
May cause arrhythmia; use caution with patients at risk of cardiac arrhythmia, including unstable angina, congestive heart failure, recent MI, uncontrolled arrhythmias, or cardiomyopathy; may consider pre- and post- dose ECG in patients at risk
Do not combine product with starch-based thickeners; polyethylene glycol (PEG), a component of the mixture, when mixed with starch-thickened liquids, reduces viscosity of the starch-thickened liquid; when a PEG-based product used for another indication was mixed in starch-based pre-thickened liquids used in patients with dysphagia, thinning of the liquid and cases of choking and potential aspiration were reported
Use caution in patients with renal impairment and/or in patients taking medications that may adversely affect renal function, including ACE inhibitors, NSAIDs, diuretics, and ARBs; instruct patients with renal impairment to remain adequately hydrated; may consider pre- and post-dose lab tests (electrolytes, creatinine, BUN) in these patients ; ensure adequate hydration, and consider laboratory testing
Directly observe administration to patients at risk for aspiration
Products are not for direct ingestion but require dilution with water
Use caution in patients >60 years; serious adverse events reported
Pregnancy & Lactation
Pregnancy category: C
Lactation: No data available
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Osmotic laxative; causes water retention in stool, causing increase in stool frequency
Absorption
Not absorbed
Bioavailability: 0.2%
Onset: 24-96 hr
Elimination
Excretion: Feces (93%), urine (0.2%)
Administration
Oral Administration
Product instructions vary for bowel prep; refer to instructions in package or provided by physician
Refrigerate before administering to improve palatability
Have patient fast at least 3-4 hr before administering PEG
Encourage rapid drinking of each portion
MiraLax: Bottle top is measuring cup marked to contain 17 g
Instruct patients to hydrate adequately with water and/or clear liquids before, during, and after use
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Formulary
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