Polyethylene Glycol-Electrolyte SolutionU.S. Brand Names: Colyte�(r); GlycoLax™; GoLYTELY�(r); MiraLax™; NuLYTELY�(r); TriLyte™
Synonyms: Electrolyte Lavage Solution
Generic Available: Yes
Canadian Brand Names: Colyte™; Klean-Prep�(r); Klean-Prep�(r); Lyteprep™; PegLyte�(r); Peglyte™
Use: Bowel cleansing prior to GI examination or following toxic ingestion (electrolyte containing solutions only); treatment of occasional constipation (MiraLax™)
Pregnancy Risk Factor: C
Pregnancy Implications: Reproduction studies have not been conducted in animals or in humans.
Lactation: Excretion in breast milk unknown/use caution
Contraindications: Hypersensitivity to polyethylene glycol or any component of the formulation; gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis, megacolon
Warnings/Precautions: Do not add flavorings as additional ingredients before use; observe unconscious or semiconscious patients with impaired gag reflex or those who are otherwise prone to regurgitation or aspiration during administration; use with caution in ulcerative colitis, caution against the use of hot loop polypectomy. Evaluate patients with symptoms of bowel obstruction (nausea, vomiting, abdominal pain or distension) prior to use. MiraLax™: For treatment of constipation only; do not use for longer than 2 weeks. Not intended for use as a bowel evacuant prior to GI examination
Adverse Reactions: Frequency not defined. Dermatologic: Dermatitis, rash, urticaria Gastrointestinal: Nausea, abdominal fullness, bloating, abdominal cramps, vomiting, anal irritation, diarrhea, flatulence Postmarketing and/or case reports: Upper GI bleeding, Mallory-Weiss tear, esophageal perforation, asystole, dyspnea (acute), pulmonary edema, vomiting with aspiration of PEG, anaphylaxis; dehydration and hypokalemia have been reported in children
Drug Interactions: Oral medications should not be administered within 1 hour of start of therapy
Stability: Store at 15°C to 30°C (59°F to 86°F) before reconstitution. Powder for solution (with electrolytes): Use within 48 hours of preparation; refrigerate reconstituted solution; tap water may be used for preparation of the solution; shake container vigorously several times to ensure dissolution of powder. Do not add additional flavorings to solution. MiraLax™: Dissolve powder in 8 ounces of water, juice, cola, or tea
Mechanism of Action: Induces catharsis by strong electrolyte and osmotic effects
Pharmacodynamics/Kinetics: Onset of effect: Oral: Bowel cleansing: ~1-2 hours; Constipation: 48-96 hours
Dosage: Oral: Children
6 months: Bowel cleansing prior to GI exam (solutions with electrolytes only): 25-40 mL/kg/hour for 4-10 hours (until rectal effluent is clear). Ideally, patients should fast for ~3-4 hours prior to administration; absolutely no solid food for at least 2 hours before the solution is given. The solution may be given via nasogastric tube to patients who are unwilling or unable to drink the solution. Patients <2 years should be monitored closely. Adults: Bowel cleansing prior to GI exam (solutions with electrolytes only): 240 mL (8 oz) every 10 minutes, until 4 L are consumed or the rectal effluent is clear; rapid drinking of each portion is preferred to drinking small amounts continuously. Ideally, patients should fast for ~3-4 hours prior to administration; absolutely no solid food for at least 2 hours before the solution is given. The solution may be given via nasogastric tube to patients who are unwilling or unable to drink the solution. Occasional constipation (MiraLax™): 17 g of powder (~1 heaping tablespoon) dissolved in 8 oz of water; once daily; do not use for >2 weeks. Nasogastric tube: Children
6 months: Bowel cleansing prior to GI exam (solutions with electrolytes only): 25 mL/kg/hour until rectal effluent is clear. Ideally, patients should fast for ~3-4 hours prior to administration; absolutely no solid food for at least 2 hours before the solution is given. Adults: Bowel cleansing prior to GI exam (solutions with electrolytes only): 20-30 mL/minute (1.2-1.8 L/hour); the first bowel movement should occur ~1 hour after the start of administration. Ideally, patients should fast for ~3-4 hours prior to administration; absolutely no solid food for at least 2 hours before the solution is given.
Administration: Bowel cleansing prior to GI exam (solutions with electrolytes only): Oral: Rapid drinking of each portion is preferred to drinking small amounts continuously. Do not add flavorings as additional ingredients before use. Chilled solution often more palatable.
Monitoring Parameters: Electrolytes, serum glucose, BUN, urine osmolality; children <2 years of age should be monitored for hypoglycemia, dehydration, hypokalemia
Dietary Considerations: Bowel cleansing prior to GI exam: Ideally, the patient should fast for ~3-4 hours prior to administration, but in no case should solid food be given for at least 2 hours before the solution is given.
Patient Education: Follow instructions exactly; directions will differ according to the formulation and the purpose for which this medication is taken. Do not eat any solid foods for at least 2 -3 hours before taking and do not take any other oral medication for 1 hour before taking. For bowel cleansing prior to GI exam, take 240 mL (8 oz) every 10 minutes, until 4 L is consumed or the rectal effluent is clear. Rapid drinking of each portion is preferred to drinking small amounts continuously. The first bowel movement should occur approximately 1 hour after the start of administration. May cause abdominal bloating and distention before bowel starts to move. If severe discomfort or distention occurs, stop drinking temporarily or drink each portion at longer intervals until these symptoms disappear. Continue drinking until the watery stool is clear and free of solid matter. This usually requires at least 3 L. It is best to drink all of the solutions. Discard any unused portion. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.
Dental Health: Effects on Dental Treatment: No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions: No information available to require special precautions
Mental Health: Effects on Mental Status: None reported
Mental Health: Effects on Psychiatric Treatment: Oral medications should not be administered within 1 hour of start of therapy
Dosage Forms: Powder, for oral solution: PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL) Colyte�(r): PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL) [available with citrus berry, lemon lime, cherry, and pineapple flavor packets] PEG 3350 227.1 g, sodium sulfate 21.5 g, sodium bicarbonate 6.36 g, sodium chloride 5.53 g, and potassium chloride 2.82 g (4000 mL) [regular and pineapple flavor] GlycoLax™: PEG 3350 17 g/packet (14s); PEG 3350 255 g (16 oz); PEG 3350 527 g (24 oz) GoLYTELY�(r): Disposable jug: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate 6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL) [regular and pineapple flavor] Packets: PEG 3350 227.1 g, sodium sulfate 21.5 g, sodium bicarbonate 6.36 g, sodium chloride 5.53 g, and potassium chloride 2.82 g (4000 mL) [regular flavor] MiraLax™: PEG 3350 17 g/packet (12s); PEG 3350 255 g (14 oz); PEG 3350 527 g (26 oz) NuLYTELY�(r): PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, and potassium chloride 1.48 (4000 mL) [cherry, lemon-lime, and orange flavors] TriLyte™: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, and potassium chloride 1.48 (4000 mL) [supplied with flavor packets]
References: Harris CR and Kingston R, "Gastrointestinal Decontamination, Which Method Is Best?"Postgrad Med, 1992, 92(2):116-22, 125, 128. Olsen KM, Gurley BJ, Davis GA, et al, "Comparison of Fluid Volumes With Whole Bowel Irrigation in a Simulated Overdose of Ibuprofen,"Ann Pharmacother, 1995, 29(3):246-50. Porter RS and Baker EB, "Drug Clearance by Diarrhea Induction,"Am J Emerg Med, 1985, 3(3):182-6. Scharman EJ, Lembersky R, and Krenzelok EP, "Efficiency of Whole Bowel Irrigation With and Without Metoclopramide Pretreatment,"Am J Emerg Med, 1994, 12(3):302-5. Sondheimer JM, Sokol RJ, Taylor SF, et al, "Safety, Efficacy and Tolerance of Intestinal Lavage in Pediatric Patients Undergoing Diagnostic Colonoscopy,"J Pediatr, 1991, 119(1):148-52. Tuggle DW, Hoelzer DJ, Tunell WP, et al, "The Safety and Cost-Effectiveness of Polyethylene Glycol Electrolyte Solution Bowel: Preparation in Infants and Children,"J Pediatr Surg, 1987, 22(6):513-5. Woolf A and Pearson K, "Presence of Diethylene Glycol in Commercial Polyethylene Glycol (PEG) Solutions,"J Toxicol Clin Toxicol, 1995, 33(5):490.
International Brand Names: Colyte™ (CA); Klean-Prep�(r) (CA); Lyteprep™ (CA); Peglyte™ (CA)
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