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Overview

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Name

Polyethylene Glycol

Precaution

Before using **Polyethylene Glycol (PEG)**, it is crucial for patients to consult with their healthcare provider to ensure its suitability, as certain conditions require special considerations: - **Electrolyte Imbalance**: Polyethylene Glycol, especially in its use as a bowel prep agent or laxative, can lead to fluid and electrolyte imbalances. Patients with conditions like **kidney disease**, **heart disease**, or **high blood pressure** should be monitored for dehydration or alterations in electrolyte levels, particularly sodium and potassium. - **Gastrointestinal Conditions**: PEG should be used cautiously in patients with a history of gastrointestinal obstructions, such as **intestinal perforations**, **ileus**, or **bowel obstructions**, as it can worsen these conditions. - **Renal Impairment**: Polyethylene Glycol is eliminated via the kidneys, and patients with severe renal dysfunction may require dose adjustments. Kidney function should be monitored in these individuals. - **Pregnancy and Lactation**: Polyethylene Glycol is generally considered safe during pregnancy, but like all medications, it should be used only if the potential benefits justify the risks. Its safety during breastfeeding has not been thoroughly studied, so it should be used with caution during this period. - **Children**: PEG is commonly used in pediatric bowel preparation and constipation treatment. However, it should be dosed appropriately for age and weight, as improper use in children can lead to adverse effects, such as dehydration or an imbalance in electrolytes.

Indication

Polyethylene Glycol (PEG) is primarily used as a **laxative** and is often prescribed for: - **Chronic Constipation**: PEG is widely used to treat constipation in both adults and children. It works by drawing water into the colon, softening the stool and making bowel movements easier. - **Bowel Preparation for Medical Procedures**: PEG solutions are frequently used as part of **bowel cleansing** before diagnostic procedures like colonoscopies. The high volume of PEG solution works by flushing out the bowel to ensure clear visualization during the procedure. - **Fecal Impaction**: In certain cases of severe constipation or fecal impaction, PEG can be used to relieve impacted stool by improving bowel motility. - **Irritable Bowel Syndrome (IBS)**: PEG is sometimes used off-label to manage symptoms of IBS with constipation (IBS-C), providing relief from abdominal discomfort and irregular bowel movements. The effectiveness of PEG in these uses is primarily due to its osmotic action, which draws water into the colon, softening stool and facilitating bowel movements.

Contra indication

Polyethylene Glycol should not be used in certain situations or conditions due to potential risks: - **Bowel Obstruction**: PEG is contraindicated in patients with known or suspected **bowel obstruction**, **gastrointestinal perforation**, or **ileus**. It may worsen the condition by causing further distension and discomfort. - **Hypersensitivity**: Patients who have a known allergy or hypersensitivity to Polyethylene Glycol or any of its ingredients should avoid its use. Symptoms of hypersensitivity may include rash, difficulty breathing, and swelling. - **Severe Renal Dysfunction**: Severe kidney disease or impaired renal function may impair the elimination of PEG, potentially leading to drug accumulation and adverse effects. In such cases, PEG should be avoided or used under strict medical supervision. - **Severe Dehydration**: PEG should not be used in patients who are severely dehydrated, as it may exacerbate the condition. Rehydration should be prioritized before using PEG in such cases.

Side Effect

Polyethylene Glycol is generally well-tolerated, but it can cause side effects, particularly with long-term use or at high doses: - **Common Side Effects**: - **Bloating and Gas**: Some patients may experience mild bloating, flatulence, or abdominal discomfort when using PEG, especially during the early stages of treatment. - **Nausea**: In some cases, PEG may cause nausea, particularly when used for bowel preparation or in patients who are sensitive to the taste or volume of the solution. - **Diarrhea**: Overuse or high doses of PEG may lead to diarrhea or loose stools, especially during bowel prep. If diarrhea persists, discontinuing PEG may be necessary. - **Serious Side Effects**: - **Severe Dehydration**: If PEG leads to excessive fluid loss, it can cause dehydration, which may manifest as dizziness, dry mouth, decreased urination, or weakness. - **Electrolyte Imbalance**: Long-term use or large doses of PEG can lead to low potassium or sodium levels (hypokalemia or hyponatremia), leading to muscle weakness, confusion, or heart irregularities. - **Abdominal Pain or Cramping**: Though rare, some patients may experience severe abdominal pain or cramping, especially when taking high doses or using PEG as a bowel prep. Patients should contact their healthcare provider if they experience any unusual or severe side effects, such as signs of dehydration or severe abdominal discomfort.

Pregnancy Category ID

0

Mode of Action

**Polyethylene Glycol (PEG)** works as an **osmotic laxative**, primarily by attracting water into the colon. This mechanism helps soften stool, increase stool frequency, and ease the passage of bowel movements. The key points of its action include: - **Osmotic Effect**: PEG is a large, water-soluble molecule that does not get absorbed by the body. When ingested, it draws water from surrounding tissues into the colon through osmosis. This increases the water content of the stool, softening it and making it easier to pass. - **Increased Stool Volume**: As the colon absorbs more water, the stool becomes larger and softer, which triggers normal bowel movement and peristalsis (the muscular contractions that move stool through the intestines). - **Bowel Cleansing**: In preparation for medical procedures like colonoscopy, PEG works by flushing out the bowel, clearing it of stool and debris to ensure that the colon can be properly visualized during the procedure. In summary, PEG increases stool volume and moisture content, facilitating more comfortable and effective bowel movements.

Interaction

Polyethylene Glycol generally has a low potential for drug interactions, but several important considerations should be kept in mind: - **Electrolyte Disturbances**: When used in high doses, such as during bowel preparation, PEG may alter the levels of electrolytes in the body. It can lower levels of **sodium** and **potassium**, potentially leading to **hypokalemia** or **hyponatremia** when used with medications that affect these electrolytes. - **Diuretics**: Diuretic medications (e.g., **furosemide**) that cause electrolyte imbalances or dehydration should be used cautiously with PEG, as both can have synergistic effects that may lead to severe dehydration or electrolyte abnormalities. - **Lithium**: Polyethylene Glycol can interfere with the absorption of **lithium**, possibly leading to fluctuating lithium levels. Regular monitoring is recommended for patients taking lithium while using PEG. - **Warfarin**: Though rare, there have been reports of changes in warfarin (a blood thinner) levels when combined with PEG, requiring more frequent monitoring of INR (International Normalized Ratio) levels. Patients should always inform their healthcare provider of all medications, including over-the-counter drugs and supplements, to avoid potential interactions.

Pregnancy Category Note

Information not available

Adult Dose

For **adults**, the dosing of **Polyethylene Glycol** depends on the indication: - **For Chronic Constipation**: The typical dose is **17 grams** (1 heaping tablespoon) mixed with **4 to 8 ounces** of water, taken once daily. The dose may be adjusted based on the response. - **For Bowel Preparation**: The recommended dose for **bowel cleansing** before a procedure like a colonoscopy is often a high-dose regimen, such as **240 mL every 10 minutes** for 2 to 4 hours, typically starting the evening before the procedure. It is essential to follow specific instructions provided by the healthcare provider or the product packaging, as dosing regimens can vary depending on the formulation used.

Child Dose

For children, **Polyethylene Glycol** is commonly used to treat constipation or for bowel cleansing before procedures. The dose varies based on age and weight: - **For Chronic Constipation**: For children aged **6 months to 6 years**, the typical dose is **1 to 1.5 grams per kilogram of body weight** per day, mixed with fluids. The dose for children **7 years and older** may range from **17 grams** once daily. - **For Bowel Preparation**: In children, the dose for bowel prep will typically follow adult guidelines but adjusted for body weight. This is usually administered as a split-dose regimen. It is important to consult a pediatrician to determine the appropriate dosage for children based on their individual health needs and conditions.

Renal Dose

For patients with **renal impairment**, especially those with **severe kidney disease**, **Polyethylene Glycol** should be used cautiously: - **Mild to Moderate Renal Impairment**: Generally, no dose adjustment is required for patients with mild to moderate renal dysfunction, but careful monitoring for signs of dehydration or electrolyte disturbances is recommended. - **Severe Renal Impairment**: In patients with severe renal dysfunction or those on dialysis, PEG should be used under medical supervision, and doses may need to be adjusted. These patients are at higher risk for drug accumulation and electrolyte imbalances.

Administration

Information not available