polyethylene glycol & electrolytes (Rx, OTC)

Brand and Other Names:GoLytely, MiraLax, more...Glycolax, GoEvac, CoLav, CoLyte, GaviLyte-C, GaviLyte-G, GaviLyte-N, NuLYTELY, polyethylene glycol electrolyte soln, polyethylene glycol powder, TriLyte
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Dosing & Uses

AdultPediatric

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
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Adverse Effects

Frequency Not Defined

Abdominal bloating

Abdominal cramping

Abdominal distention

Colonic mucosal aphthous ulcerations

Diarrhea

Flatulence

Ischemic colitis

Nausea

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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 those who are otherwise prone to regurgitation or aspiration during administration

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

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

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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.

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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%)

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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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Images

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Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.