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polyethylene glycol [PEG] (Go-Lytely, CoLyte, Miralax, Glycolax)

Tradenames: Go-Lytely, CoLyte, Miralax (OTC), Glycolax Indications: 1) bowel cleansing prior to GI exam 2) constipation [6] - not approved for long-term daily use [8] 3) hepatic encephalopathy [7] - twice as effective as lactulose Dosage: 1) patients should fast at least 6 hours prior to administration 2) 4 liters PO over 4 hours for complete bowel evacuation, or 250 mL per nasogastric tube every 15 min for 4 hours Solution: 4 liter bottle. Powder for oral solution: 1) PEG 3350 227 g 2) sodium sulfate 21.5 g 3) sodium bicarbonate 6.36 g 4) sodium chloride 5.53 g 5) potassium chloride 2.82 g 6) 4800 mL Packets: 17 g (for constipation), mix with 8 oz of liquid Miralax is PEG without the electrolytes Pharmacokinetics: 1) elimination: not absorbed 2) onset of bowel relief is in 30-60 minutes Adverse effects: 1) common (> 10%) - nausea, abdominal fullness, bloating 2) less common (1-10%) - abdominal cramps, vomiting, anal irritation 3) uncommon (< 1%) - rash 4) other - GI adverse effects may be reduced by premedication with single doses of simethicone & metoclopramide given 30 minutes to 1 hour prior preparation - FDA is investigating whether use in children could be linked to obsessive-compulsive disorder, tics, & tremors [8] Mechanism of action: 1) non-absorbable osmotic agent 2) large amounts may be given without loss of electrolytes Notes: - small amounts of ethylene glycol & diethylene glycol may contaminate polyethylene glycol (Miralax)

General

laxative

Properties

MISC-INFO: elimination route FECES pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Department of Veterans Affairs, VA National Formulary
  5. Prescriber's Letter 14(5): 2007 Medications for Constipation Detail-Document#: 230503 (subscription needed) http://www.prescribersletter.com
  6. Dipalma JA, Cleveland MV, McGowan J, Herrera JL. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol. 2007 Jul;102(7):1436-41. Epub 2007 Mar 31. PMID: 17403074
  7. Rahimi RS et al. Lactulose vs. polyethylene glycol 3350-eletrolyte solution for treatment of overt hepatic encephalopathy: The HELP randomized clinical trial. JAMA Intern Med 2014 Sep 22 PMID: 25243839
  8. Young K, Fairchild DG, Di Francesco L DA Questioning Miralax Use in Kids. Physician's First Watch, Jan 7, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org

Component-of

ascorbate/polyethylene glycol/potassium chloride/sodium chloride/sodium sulfate bisacodyl/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride dextran/polyethylene glycol dextran/polyethylene glycol/povidone/tetrahydrozoline dextran/polyethylene glycol/tetrahydrozoline glycerol/hydroxypropyl methylcellulose/polyethylene glycol glycerol/hydroxypropyl methylcellulose/polyethylene glycol/tetrahydrozoline glycerol/hydroxypropyl methylcellulose/polyethylene glycol/tetrahydrozoline/zinc sulfate glycerol/polyethylene glycol hco3 /polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride/sodium sulfate magnesium sulfate/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride naphazoline/polyethylene glycol peginterferon alfa 2a (Pegasys) peginterferon alfa 2b (Pegintron) polyethylene glycol/polyvinyl alcohol polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride polyethylene glycol/propylene glycol polyethylene glycol/tetrahydrozoline polyethylene glycol/tetrahydrozoline/zinc sulfate