polyethylene glycol [PEG] (Go-Lytely, CoLyte, Miralax, Glycolax)
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Introduction
Tradenames: Go-Lytely, CoLyte, Miralax (OTC), Glycolax
Indications
- bowel cleansing prior to GI exam
- constipation[6]
- not approved for long-term daily use[8]
- hepatic encephalopathy[7]
- twice as effective as lactulose
Dosage
- patients should fast at least 6 hours prior to administration
- 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:
- PEG 3350 227 g
- sodium sulfate 21.5 g
- sodium bicarbonate 6.36 g
- sodium chloride 5.53 g
- potassium chloride 2.82 g
- 4800 mL
Packets: 17 g (for constipation), mix with 8 oz of liquid
Miralax is PEG without the electrolytes
Pharmacokinetics
- elimination: not absorbed
- onset of bowel relief is in 30-60 minutes
elimination via feces
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- 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
- non-absorbable osmotic agent
- large amounts may be given without loss of electrolytes
Notes
- small amounts of ethylene glycol & diethylene glycol may contaminate polyethylene glycol (Miralax)
More general terms
Component of
- polyethylene glycol/polyvinyl alcohol ophthalmic
- magnesium sulfate/polyethylene glycol/potassium chloride/sodium chloride/sodium sulfate
- magnesium sulfate/polyethylene glycol/potassium chloride/potassium sulfate/sodium bicarbonate/sodium chloride
- polyethylene glycol/tetrahydrozoline
- polyethylene glycol/polyvinyl alcohol
- naphazoline/polyethylene glycol
- magnesium sulfate/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride
- glycerol/hydroxypropyl methylcellulose/polyethylene glycol/tetrahydrozoline/zinc sulfate
- glycerol/hydroxypropyl methylcellulose/polyethylene glycol
- dextran/polyethylene glycol/tetrahydrozoline
- bisacodyl/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride
- glycerol/hydroxypropyl methylcellulose/polyethylene glycol/tetrahydrozoline
- dextran/polyethylene glycol/povidone/tetrahydrozoline
- polyethylene glycol/propylene glycol
- hco3 /polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride/sodium sulfate
- polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride
- glycerol/polyethylene glycol
- dextran/polyethylene glycol
- ascorbate/polyethylene glycol/potassium chloride/sodium chloride/sodium sulfate
- peginterferon alfa 2b (Pegintron)
- peginterferon alfa 2a (Pegasys)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ Prescriber's Letter 14(5): 2007 Medications for Constipation Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230503&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/17403074
- ↑ 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/25243839
- ↑ 8.0 8.1 8.2 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