PEG-3350 & Electrolytes Unflav
It is used to clean out the GI (gastrointestinal) tract.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Bowel Evacuant; Laxative, Osmotic
Pharmacologic Class
Polyethylene Glycol-Electrolyte Solution
Pregnancy Category
Category C
FDA Approved
Sep 1984
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a powerful laxative solution used to completely clean out your bowels before a colonoscopy or surgery. It works by drawing a lot of water into your intestines, causing you to have frequent, watery bowel movements until your bowels are clear.
How to Use This Medicine
Taking Your Medication Correctly
To ensure you get the most out of your medication, follow your doctor's instructions carefully. Read all the information provided to you and adhere to the guidelines. Take your medication as directed by your doctor, paying attention to the timing, any food or drink restrictions before your exam, and when to stop eating and drinking beforehand. If you have any questions or concerns, discuss them with your doctor.
Important Administration Instructions
Do not take any other oral medications within 1 hour of taking this medication. Some medications may require a longer separation time, so consult your doctor for guidance on taking other medications with this one.
Mix the medication with water as instructed before taking it. Do not swallow the dry powder.
Avoid mixing the medication with starch-based thickeners.
If your product comes with flavorings, only use the flavors provided with the kit.
Chilling the solution may improve the taste, but do not give chilled solution to an infant. Consult your doctor for advice.
Shake the solution well before use.
Drink clear liquids before, during, and after taking the medication. Avoid drinking liquids that are purple or red, as well as milk and alcohol.
Do not eat solid food while taking this medication.
Storage and Disposal
Store the powder at room temperature.
After mixing, refrigerate the solution. If you have questions about the solution's shelf life after mixing, consult your doctor or pharmacist.
Do not freeze the solution.
Keep all medications in a safe place, out of the reach of children and pets.
Missing a Dose
If you miss a dose, take it as soon as you remember.
If it's close to the time for your next dose, skip the missed dose and resume your regular schedule.
Do not take two doses at the same time or take extra doses.
If you're unable to finish the medication before your exam, contact your doctor for guidance.
To ensure you get the most out of your medication, follow your doctor's instructions carefully. Read all the information provided to you and adhere to the guidelines. Take your medication as directed by your doctor, paying attention to the timing, any food or drink restrictions before your exam, and when to stop eating and drinking beforehand. If you have any questions or concerns, discuss them with your doctor.
Important Administration Instructions
Do not take any other oral medications within 1 hour of taking this medication. Some medications may require a longer separation time, so consult your doctor for guidance on taking other medications with this one.
Mix the medication with water as instructed before taking it. Do not swallow the dry powder.
Avoid mixing the medication with starch-based thickeners.
If your product comes with flavorings, only use the flavors provided with the kit.
Chilling the solution may improve the taste, but do not give chilled solution to an infant. Consult your doctor for advice.
Shake the solution well before use.
Drink clear liquids before, during, and after taking the medication. Avoid drinking liquids that are purple or red, as well as milk and alcohol.
Do not eat solid food while taking this medication.
Storage and Disposal
Store the powder at room temperature.
After mixing, refrigerate the solution. If you have questions about the solution's shelf life after mixing, consult your doctor or pharmacist.
Do not freeze the solution.
Keep all medications in a safe place, out of the reach of children and pets.
Missing a Dose
If you miss a dose, take it as soon as you remember.
If it's close to the time for your next dose, skip the missed dose and resume your regular schedule.
Do not take two doses at the same time or take extra doses.
If you're unable to finish the medication before your exam, contact your doctor for guidance.
Lifestyle & Tips
- Follow a clear liquid diet as instructed by your doctor, typically starting the day before the procedure. No solid food.
- Drink the entire prescribed amount of solution at the recommended pace, even if you feel full or nauseous. This is crucial for a successful bowel prep.
- Stay near a toilet once you start drinking the solution, as bowel movements will be frequent and urgent.
- Stay well-hydrated with additional clear liquids (water, clear broth, apple juice, clear sodas) during the prep, unless otherwise instructed.
- Avoid red or purple liquids, as they can stain the colon and interfere with the procedure.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
4 liters (L) of solution orally, typically as 240 mL (8 oz) every 10 to 15 minutes until the entire 4 L is consumed or rectal effluent is clear. Administration usually begins the evening before the procedure or split-dose.
Dose Range:
4000 - 4000 mg
Condition-Specific Dosing:
Bowel Preparation:
4 L orally, administered over 2-3 hours (rapid) or 4-6 hours (standard), or as a split-dose regimen (2 L evening prior, 2 L morning of procedure).
Pediatric Dosing
Neonatal:
Not established for routine use; specific protocols for severe constipation or bowel prep may exist under specialist supervision.
Infant:
Not established for routine use; specific protocols for severe constipation or bowel prep may exist under specialist supervision. Dosing for chronic constipation is typically 0.8-1.5 g/kg/day of PEG 3350 without electrolytes.
Child:
For bowel preparation: 25 mL/kg/hour orally until rectal effluent is clear, up to 4 L. For chronic constipation: PEG 3350 without electrolytes is preferred, typically 0.4-0.8 g/kg/day. Use of electrolyte solution for chronic constipation in children should be under medical supervision due to electrolyte balance concerns.
Adolescent:
Similar to adult dosing for bowel preparation (4 L). For chronic constipation, PEG 3350 without electrolytes is typically 17g daily.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
Use with caution; monitor fluid and electrolyte status. No specific dose adjustment typically required due to minimal systemic absorption.
Severe:
Use with extreme caution; monitor fluid and electrolyte status closely. Consider alternative bowel preparation methods if possible. No specific dose adjustment typically required due to minimal systemic absorption, but risk of electrolyte imbalance is higher.
Dialysis:
Use with extreme caution; monitor fluid and electrolyte status closely. Consult nephrologist. No specific dose adjustment typically required due to minimal systemic absorption, but risk of electrolyte imbalance is higher.
Hepatic Impairment:
Mild:
No specific adjustment.
Moderate:
No specific adjustment.
Severe:
No specific adjustment.
Pharmacology
Mechanism of Action
Polyethylene glycol (PEG) is an osmotic agent that causes water to be retained in the lumen of the colon. The addition of electrolytes (sodium sulfate, sodium bicarbonate, sodium chloride, potassium chloride) prevents significant net absorption or secretion of ions, thus minimizing fluid and electrolyte shifts across the intestinal wall. The large volume of unabsorbed fluid distends the colon, inducing rapid and thorough evacuation.
Pharmacokinetics
Absorption:
Bioavailability:
<2%
Tmax:
Not applicable (minimal systemic absorption)
FoodEffect:
Should be taken on an empty stomach or with clear liquids only to ensure effective bowel cleansing.
Distribution:
Vd:
Primarily confined to the gastrointestinal tract.
ProteinBinding:
Not applicable (minimal systemic absorption)
CnssPenetration:
No
Elimination:
HalfLife:
Not applicable (minimal systemic absorption)
Clearance:
Not applicable (minimal systemic absorption)
ExcretionRoute:
Excreted unchanged in feces.
Unchanged:
>98%
Pharmacodynamics
OnsetOfAction:
Typically 1 hour (first bowel movement), but can vary.
PeakEffect:
Continuous bowel evacuation until solution is consumed and bowel is clear.
DurationOfAction:
Until the entire solution is consumed and bowel movements become clear, typically 4-6 hours after initiation.
Confidence:
Medium
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Immediately
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
+ Swelling of the abdomen
Severe headache
Vomiting blood or coffee ground-like material
Black, tarry, or bloody stools
Rectal bleeding or pain
This medication can also cause dehydration or electrolyte imbalances, which can be severe or life-threatening. If you experience any of the following symptoms, contact your doctor right away:
Dizziness or fainting
Feeling tired or weak
Inability to pass urine
Fast or abnormal heartbeat
Seizures
Headache
Mood changes
Confusion
Muscle pain or weakness
Increased thirst
Decreased appetite
Dry mouth or eyes
Severe stomach upset or vomiting
Changes in urine output
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor if you're bothered by any of the following:
Stomach pain
Anal irritation
Bloating
Feeling full
Upset stomach or vomiting
Stomach cramps
Trouble sleeping
Increased appetite
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
+ Swelling of the abdomen
Severe headache
Vomiting blood or coffee ground-like material
Black, tarry, or bloody stools
Rectal bleeding or pain
This medication can also cause dehydration or electrolyte imbalances, which can be severe or life-threatening. If you experience any of the following symptoms, contact your doctor right away:
Dizziness or fainting
Feeling tired or weak
Inability to pass urine
Fast or abnormal heartbeat
Seizures
Headache
Mood changes
Confusion
Muscle pain or weakness
Increased thirst
Decreased appetite
Dry mouth or eyes
Severe stomach upset or vomiting
Changes in urine output
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor if you're bothered by any of the following:
Stomach pain
Anal irritation
Bloating
Feeling full
Upset stomach or vomiting
Stomach cramps
Trouble sleeping
Increased appetite
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe abdominal pain or cramping that does not subside
- Persistent vomiting that prevents you from drinking the solution
- Signs of severe dehydration (e.g., extreme dizziness, fainting, very little or no urination)
- Allergic reaction (e.g., rash, itching, swelling, severe dizziness, trouble breathing)
- Bloody or tarry stools (after the initial dark stools from the prep)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Certain health conditions, including:
+ Bowel obstruction, perforation, or other bowel problems
+ Electrolyte imbalances (e.g., abnormal sodium, potassium, or phosphate levels)
+ Dehydration (fluid loss)
+ Previous stomach or bowel surgery
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, please inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
* Your complete medical history
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Certain health conditions, including:
+ Bowel obstruction, perforation, or other bowel problems
+ Electrolyte imbalances (e.g., abnormal sodium, potassium, or phosphate levels)
+ Dehydration (fluid loss)
+ Previous stomach or bowel surgery
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, please inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
* Your complete medical history
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
To avoid potential interactions, do not use other laxatives or stool softeners unless your doctor advises you to do so.
If you have phenylketonuria (PKU), consult with your doctor before taking this medication, as some products contain phenylalanine.
Adults over 60 years old should exercise caution when using this drug, as they may be more susceptible to side effects.
When considering the use of this medication in children, caution is advised. Discuss with your doctor to determine if this medication is suitable for pediatric use and to address any questions or concerns you may have about administering this drug to a child.
If you are pregnant, planning to become pregnant, or are breast-feeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
To avoid potential interactions, do not use other laxatives or stool softeners unless your doctor advises you to do so.
If you have phenylketonuria (PKU), consult with your doctor before taking this medication, as some products contain phenylalanine.
Adults over 60 years old should exercise caution when using this drug, as they may be more susceptible to side effects.
When considering the use of this medication in children, caution is advised. Discuss with your doctor to determine if this medication is suitable for pediatric use and to address any questions or concerns you may have about administering this drug to a child.
If you are pregnant, planning to become pregnant, or are breast-feeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Severe diarrhea
- Significant fluid and electrolyte imbalance (e.g., severe dehydration, hypokalemia, hyponatremia)
- Metabolic acidosis or alkalosis
- Abdominal distension, pain
- Nausea, vomiting
What to Do:
Discontinue the medication. Provide supportive care, including fluid and electrolyte replacement as needed. Monitor vital signs and electrolyte levels. In severe cases, hospitalization may be required. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Major Interactions
- Oral medications taken within 1 hour of starting PEG-electrolyte solution: May be flushed from the GI tract and not absorbed. Consider adjusting timing of other medications.
- Drugs that prolong the QT interval (e.g., antiarrhythmics, antipsychotics, macrolide antibiotics): Increased risk of arrhythmias due to potential electrolyte disturbances (hypokalemia, hypomagnesemia) if not adequately hydrated or if underlying cardiac issues exist.
Moderate Interactions
- Diuretics (thiazide, loop): Increased risk of fluid and electrolyte imbalance (especially hypokalemia, hyponatremia) due to significant fluid loss.
- ACE inhibitors, Angiotensin Receptor Blockers (ARBs): Increased risk of hypovolemia and renal impairment, especially in patients with pre-existing renal dysfunction or heart failure.
- NSAIDs: Increased risk of renal impairment in dehydrated patients.
- Laxatives (other): Concurrent use may increase risk of abdominal cramping, bloating, and electrolyte disturbances.
- Oral contraceptives: Efficacy may be reduced due to rapid transit time; advise alternative contraception.
Monitoring
Baseline Monitoring
Electrolytes (Sodium, Potassium, Calcium, Magnesium)
Rationale: To identify pre-existing imbalances, especially in patients at risk (e.g., renal impairment, heart failure, concomitant medications).
Timing: Prior to administration, especially in high-risk patients.
Renal Function (BUN, Creatinine)
Rationale: To assess baseline kidney function, as dehydration can worsen renal impairment.
Timing: Prior to administration, especially in high-risk patients.
Fluid Status
Rationale: To assess hydration status before starting the prep.
Timing: Prior to administration.
Routine Monitoring
Fluid Intake and Output
Frequency: During and after administration
Target: Maintain adequate hydration; output should be clear liquid.
Action Threshold: Signs of dehydration (decreased urine output, dry mucous membranes, orthostasis) or excessive fluid retention.
Electrolytes (Sodium, Potassium, Calcium, Magnesium)
Frequency: Post-procedure, if concerns arise or in high-risk patients.
Target: Within normal limits.
Action Threshold: Significant deviations from baseline or normal range, especially hypokalemia or hyponatremia.
Bowel Movements
Frequency: Continuously during administration
Target: Clear, watery rectal effluent without solid particles.
Action Threshold: Persistent solid or cloudy stool after significant volume consumed, indicating inadequate prep.
Symptom Monitoring
- Abdominal pain or cramping (severe or persistent)
- Nausea and vomiting (persistent or severe)
- Bloating or distension (severe)
- Signs of dehydration (dizziness, lightheadedness, excessive thirst, decreased urination, dry mouth)
- Signs of electrolyte imbalance (muscle weakness, irregular heartbeat, confusion, seizures)
Special Patient Groups
Pregnancy
Generally considered low risk due to minimal systemic absorption. However, use only if clearly needed and potential benefits outweigh risks. Category C.
Trimester-Specific Risks:
First Trimester:
Minimal systemic absorption suggests low risk of teratogenicity, but data are limited.
Second Trimester:
Minimal systemic absorption suggests low risk.
Third Trimester:
Minimal systemic absorption suggests low risk. Potential for electrolyte imbalance in the mother could theoretically affect the fetus, but unlikely with proper hydration.
Lactation
Considered compatible with breastfeeding (L1). Minimal systemic absorption means negligible excretion into breast milk. Infant exposure is unlikely to cause adverse effects.
Infant Risk:
Low risk.
Pediatric Use
Use with caution and under medical supervision, especially in younger children or those with underlying conditions. Dosing must be carefully calculated based on weight. Risk of fluid and electrolyte imbalance is higher in children. Not for routine chronic constipation in infants/young children; PEG 3350 without electrolytes is preferred.
Geriatric Use
Use with caution. Elderly patients may be more susceptible to fluid and electrolyte disturbances (e.g., hypokalemia, hyponatremia, dehydration), especially if they have pre-existing renal impairment, heart failure, or are on medications affecting fluid/electrolytes (e.g., diuretics). Monitor closely for signs of dehydration and electrolyte imbalance.
Clinical Information
Clinical Pearls
- Chilling the solution can improve palatability. Adding clear, sugar-free flavorings (e.g., lemon, lime, orange) can also help, but avoid red or purple.
- Use a straw to drink the solution, as it can help bypass taste buds.
- Patients should be advised to apply petroleum jelly or a barrier cream to the perianal area to prevent skin irritation from frequent bowel movements.
- Ensure patients understand the importance of completing the entire prep for a successful procedure, as incomplete prep can lead to repeat procedures or missed pathology.
- Advise patients to stay well-hydrated with additional clear liquids throughout the prep to minimize the risk of dehydration.
- For patients struggling with nausea, slowing the pace of drinking or taking a short break (15-30 minutes) may help, but ensure the entire volume is still consumed within the recommended timeframe.
Alternative Therapies
- Magnesium Citrate (osmotic laxative)
- Bisacodyl (stimulant laxative, often used in combination with osmotic agents)
- Senna (stimulant laxative)
- Lactulose (osmotic laxative, for constipation, not typically for bowel prep)
- PEG 3350 without electrolytes (for chronic constipation, not bowel prep)
Cost & Coverage
Average Cost:
Varies widely by brand and generic; typically $20-$100+ per 4L kit
Generic Available:
Yes
Insurance Coverage:
Generally covered by most prescription drug plans (Tier 1 or 2 for generics, higher for brands).
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information for patients. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.