PEG-3350/kcl/sod Lemon 4000ml
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 Cleansing Agent; 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 medicine is a large volume liquid that you drink to completely clean out your bowels before a medical procedure like a colonoscopy. It works by causing you to have many watery bowel movements, which helps your doctor get a clear view of your colon.
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 outlined below.
Take your medication exactly as directed by your doctor, including the timing, dosage, and any specific instructions related to food and drink before your exam.
If you have any questions or concerns, discuss them with your doctor to clarify any doubts.
When taking other oral medications, avoid taking them within 1 hour before each dose of this medication. In some cases, your doctor may advise a longer separation time between medications. Consult with your doctor to determine the best schedule for taking your medications together.
To prepare your medication, mix it with water as instructed before consumption. Do not swallow the dry powder.
Avoid mixing your medication with starch-based thickeners.
If your medication 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. If you have concerns, consult with your doctor.
Before use, shake the solution well.
While taking your medication, drink clear liquids before, during, and after consumption. Avoid drinking liquids that are purple or red, as well as milk and alcohol.
Do not eat solid food while taking your medication.
Storing and Disposing of Your Medication
Store the powder at room temperature.
After mixing, refrigerate the solution. If you are unsure about the storage duration after mixing, consult with your doctor or pharmacist.
Do not freeze the solution.
Keep all medications in a safe place, out of the reach of children and pets.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember.
If it is 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 extra doses.
If you are unable to complete your 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 outlined below.
Take your medication exactly as directed by your doctor, including the timing, dosage, and any specific instructions related to food and drink before your exam.
If you have any questions or concerns, discuss them with your doctor to clarify any doubts.
When taking other oral medications, avoid taking them within 1 hour before each dose of this medication. In some cases, your doctor may advise a longer separation time between medications. Consult with your doctor to determine the best schedule for taking your medications together.
To prepare your medication, mix it with water as instructed before consumption. Do not swallow the dry powder.
Avoid mixing your medication with starch-based thickeners.
If your medication 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. If you have concerns, consult with your doctor.
Before use, shake the solution well.
While taking your medication, drink clear liquids before, during, and after consumption. Avoid drinking liquids that are purple or red, as well as milk and alcohol.
Do not eat solid food while taking your medication.
Storing and Disposing of Your Medication
Store the powder at room temperature.
After mixing, refrigerate the solution. If you are unsure about the storage duration after mixing, consult with your doctor or pharmacist.
Do not freeze the solution.
Keep all medications in a safe place, out of the reach of children and pets.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember.
If it is 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 extra doses.
If you are unable to complete your medication before your exam, contact your doctor for guidance.
Lifestyle & Tips
- Follow a clear liquid diet starting the day before your procedure, as instructed by your doctor.
- Do not eat any solid food from the time you start the prep until after your procedure.
- Drink the solution as directed, typically 8 ounces every 10-15 minutes, until the entire amount is consumed or your bowel movements are clear and watery.
- Stay well-hydrated with other clear liquids (water, clear broth, apple juice, clear soda) in addition to the prep solution.
- Stay near a toilet once you start drinking the solution, as bowel movements will be frequent and urgent.
- Keep the solution chilled to improve palatability. You can add flavor packets if provided, but do not add anything else (e.g., sugar, artificial sweeteners, fruit pulp).
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
4 liters of solution taken orally. Typically, 240 mL (8 fl oz) every 10 to 15 minutes until the entire 4 liters are consumed or the rectal effluent is clear. Administration usually begins the evening before the procedure or split-dose regimen (half the evening before, half the morning of).
Dose Range:
4000 - 4000 mg
Condition-Specific Dosing:
colonoscopy_prep:
4 liters orally, typically 240 mL every 10-15 minutes until clear effluent or entire volume consumed. May be administered as a single dose or split dose.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established (use with extreme caution, specific protocols may exist for chronic constipation but not general bowel prep)
Child:
Not established for general bowel prep; specific protocols for chronic constipation or specific procedures may exist (e.g., 25 mL/kg/hour for 4 hours, or 1.5 g/kg/day for chronic constipation, but this is for PEG 3350 alone, not the full electrolyte solution prep). For bowel prep, doses are typically weight-based or age-based, e.g., 25 mL/kg/hour for 2-4 hours, up to 4L total, under strict medical supervision.
Adolescent:
Typically adult dosing, but with careful monitoring for fluid and electrolyte balance.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required, but monitor fluid and electrolyte status.
Moderate:
Use with caution; monitor fluid and electrolyte status closely. Risk of electrolyte imbalance may be increased.
Severe:
Use with extreme caution or avoid. Contraindicated in patients with impaired renal function where the risk of electrolyte imbalance is significant. Close monitoring of fluid and electrolytes is essential if used.
Dialysis:
Contraindicated or use with extreme caution and under strict medical supervision due to high risk of fluid and electrolyte shifts. Consult nephrologist.
Hepatic Impairment:
Mild:
No specific adjustment required.
Moderate:
No specific adjustment required.
Severe:
No specific adjustment required, as systemic absorption is minimal. However, monitor for dehydration if patient has ascites or other fluid balance issues.
Pharmacology
Mechanism of Action
Polyethylene Glycol (PEG) is an osmotic agent that causes water to be retained in the colon. This increases the intraluminal volume, leading to distension and promoting rapid bowel evacuation. The electrolyte components (sodium sulfate, sodium bicarbonate, sodium chloride, potassium chloride) are included to prevent significant shifts in fluid and electrolytes across the intestinal wall, maintaining isotonicity and minimizing dehydration or electrolyte imbalance during the rapid fluid loss.
Pharmacokinetics
Absorption:
Bioavailability:
<2% (minimally absorbed)
Tmax:
Not applicable (minimal systemic absorption)
FoodEffect:
Should be taken on an empty stomach or after a clear liquid diet for optimal bowel cleansing.
Distribution:
Vd:
Not applicable (minimal systemic absorption)
ProteinBinding:
Not applicable (minimal systemic absorption)
CnssPenetration:
No
Elimination:
HalfLife:
Not applicable (primarily excreted unchanged in feces)
Clearance:
Not applicable (primarily excreted unchanged in feces)
ExcretionRoute:
Fecal (unchanged)
Unchanged:
>98%
Pharmacodynamics
OnsetOfAction:
Within 1-2 hours (first bowel movement)
PeakEffect:
Continuous bowel movements until solution is consumed and bowel is clear (typically 4-6 hours)
DurationOfAction:
Until bowel is completely evacuated (typically 4-6 hours after initiation of dosing)
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
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 may 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
Fatigue or weakness
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 nausea 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 mild ones, it's essential to discuss any concerns with your doctor. If you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Stomach pain
Anal irritation
Bloating
Feeling full
Nausea or vomiting
Stomach cramps
Trouble sleeping
Increased appetite
This is not an exhaustive list of possible side effects. If you have questions or concerns, 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, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
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 may 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
Fatigue or weakness
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 nausea 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 mild ones, it's essential to discuss any concerns with your doctor. If you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Stomach pain
Anal irritation
Bloating
Feeling full
Nausea or vomiting
Stomach cramps
Trouble sleeping
Increased appetite
This is not an exhaustive list of possible side effects. If you have questions or concerns, 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 bloating that does not resolve
- Persistent vomiting
- Signs of dehydration (e.g., severe dizziness, lightheadedness, decreased urination, extreme thirst)
- Signs of allergic reaction (e.g., rash, itching, swelling, severe dizziness, trouble breathing)
- Rectal bleeding (other than minor irritation from frequent wiping)
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 allergic reaction and its symptoms.
Certain health conditions, including:
+ Bowel problems, such as a bowel block or hole in the bowel
+ Electrolyte imbalances (e.g., sodium, potassium, phosphate)
+ Dehydration (fluid loss)
+ Previous stomach or bowel surgery
This list is not exhaustive, and it is crucial to discuss all your medications and health issues with your doctor.
To ensure safe treatment, tell your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your overall health and any existing medical conditions
Do not start, stop, or change the dosage of any medication without first consulting your doctor to confirm it is safe to do so in conjunction with this medication.
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 allergic reaction and its symptoms.
Certain health conditions, including:
+ Bowel problems, such as a bowel block or hole in the bowel
+ Electrolyte imbalances (e.g., sodium, potassium, phosphate)
+ Dehydration (fluid loss)
+ Previous stomach or bowel surgery
This list is not exhaustive, and it is crucial to discuss all your medications and health issues with your doctor.
To ensure safe treatment, tell your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your overall health and any existing medical conditions
Do not start, stop, or change the dosage of any medication without first consulting your doctor to confirm it is safe to do so in conjunction with this medication.
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 has instructed 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. Consult with your doctor to determine if this drug is suitable for pediatric use and to discuss any concerns you may have about administering it 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 has instructed 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. Consult with your doctor to determine if this drug is suitable for pediatric use and to discuss any concerns you may have about administering it 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 dehydration
- Significant electrolyte imbalance (e.g., hypokalemia, hypernatremia, hyponatremia)
- Metabolic acidosis or alkalosis
- Cardiac arrhythmias
- Seizures
- Renal failure
What to Do:
Discontinue the solution immediately. Seek emergency medical attention. Management involves supportive care, correction of fluid and electrolyte imbalances, and monitoring of vital signs and cardiac rhythm. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Contraindicated Interactions
- Gastrointestinal obstruction or ileus
- Bowel perforation
- Toxic colitis
- Toxic megacolon
Major Interactions
- Oral medications taken within 1 hour of starting PEG-ES or during administration (may be flushed out of the GI tract and not absorbed)
- Drugs with narrow therapeutic index (e.g., digoxin, anti-epileptics, oral contraceptives, insulin, warfarin) - absorption may be significantly reduced
- Diuretics (especially loop or thiazide diuretics) - increased risk of dehydration and electrolyte imbalance (hypokalemia, hyponatremia)
- ACE inhibitors/ARBs - increased risk of electrolyte imbalance (e.g., hyperkalemia) and renal impairment in susceptible patients
- NSAIDs - increased risk of renal impairment in susceptible patients, especially with dehydration
Moderate Interactions
- Other laxatives (additive effect, increased risk of dehydration/electrolyte imbalance)
- Corticosteroids (increased risk of electrolyte imbalance, particularly hypokalemia)
- Drugs that prolong QT interval (e.g., antiarrhythmics, antipsychotics) - increased risk if electrolyte imbalances occur
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Electrolytes (Sodium, Potassium, Chloride, Bicarbonate)
Rationale: To establish baseline levels, especially in patients at risk for electrolyte disturbances (e.g., renal impairment, heart failure, concomitant medications).
Timing: Prior to administration, particularly in high-risk patients.
Renal function (BUN, Creatinine)
Rationale: To assess baseline kidney function, as impaired renal function increases risk of electrolyte imbalance.
Timing: Prior to administration, particularly in high-risk patients.
Hydration status
Rationale: To assess baseline hydration and identify patients at risk for dehydration.
Timing: Prior to administration.
Routine Monitoring
Fluid intake and output
Frequency: During and after administration until bowel is clear
Target: Maintain adequate hydration
Action Threshold: Signs of dehydration (decreased urine output, dry mucous membranes, orthostasis)
Electrolytes (Sodium, Potassium)
Frequency: Post-procedure or if symptoms of imbalance occur
Target: Within normal limits
Action Threshold: Significant deviations from baseline or normal range, especially in symptomatic patients
Bowel movements (frequency, consistency, clarity)
Frequency: Continuously during administration
Target: Clear, watery effluent
Action Threshold: Lack of bowel movements, persistent solid stool, or signs of obstruction
Vital Signs (BP, HR)
Frequency: Periodically during administration, especially in elderly or frail patients
Target: Within patient's normal range
Action Threshold: Significant changes (e.g., orthostatic hypotension, tachycardia) indicating dehydration or electrolyte imbalance
Symptom Monitoring
- Nausea
- Vomiting
- Abdominal cramping/pain
- Bloating
- Dizziness
- Weakness
- Signs of dehydration (dry mouth, decreased urination, excessive thirst)
- Signs of electrolyte imbalance (muscle cramps, irregular heartbeat, confusion)
Special Patient Groups
Pregnancy
Use with caution. While systemic absorption is minimal, there are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult with a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Minimal systemic absorption suggests low risk, but caution advised due to lack of data.
Second Trimester:
Minimal systemic absorption suggests low risk, but caution advised due to lack of data.
Third Trimester:
Minimal systemic absorption suggests low risk, but caution advised due to lack of data. Risk of dehydration in mother could indirectly affect fetus.
Lactation
Considered low risk. Due to minimal systemic absorption of PEG and electrolytes, excretion into breast milk is expected to be negligible. Infant exposure is unlikely to cause adverse effects. However, caution is advised, and a healthcare provider should be consulted.
Infant Risk:
Low risk due to minimal maternal systemic absorption.
Pediatric Use
Not routinely recommended for general bowel prep in young children without specific protocols and close medical supervision due to higher risk of fluid and electrolyte imbalances. Specific weight-based dosing regimens exist for chronic constipation or specific procedures, but these are often for PEG 3350 alone or require careful electrolyte monitoring. Use in adolescents typically follows adult guidelines with careful monitoring.
Geriatric Use
Use with caution. Elderly patients may be at increased risk for fluid and electrolyte disturbances, dehydration, and renal impairment. Monitor closely for signs of dehydration, orthostatic hypotension, and electrolyte imbalances. Adjust concomitant medications that may affect fluid/electrolytes (e.g., diuretics, ACE inhibitors).
Clinical Information
Clinical Pearls
- Ensure patient understands the importance of consuming the entire volume for effective cleansing.
- Advise patients to chill the solution and use flavor packets (if available) to improve palatability.
- Instruct patients to stay near a toilet once dosing begins due to rapid onset of bowel movements.
- Emphasize the importance of a clear liquid diet before and during the prep.
- Caution patients about potential for nausea, bloating, and abdominal cramping, which are common side effects.
- Remind patients to stop taking any oral medications (especially those with narrow therapeutic index) at least 1 hour before starting the prep, and to discuss timing with their physician.
- Assess patient's ability to tolerate large fluid volumes and their risk for aspiration, especially in frail or cognitively impaired individuals.
Alternative Therapies
- Magnesium Citrate (oral solution)
- Bisacodyl (oral tablets or suppositories)
- Senna (oral tablets)
- Other osmotic laxatives (e.g., Lactulose, Sorbitol - generally for constipation, not full bowel prep)
Cost & Coverage
Average Cost:
$20 - $100 per 4L kit
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (often covered by most insurance plans when prescribed for colonoscopy prep)
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 is a valuable resource for patients. Please read this guide carefully and review it again whenever you receive a refill of this medication. If you have any questions or concerns about this medication, we encourage you to discuss them with 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 detailed information, including the substance taken, the amount, and the time it occurred.