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PEG-3350 AND ELECTROLYTES
polyethylene glycol 3350,
sodium sulfate anhydrous,
sodium chloride and
potassium chloride powder, for solution
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PEG-3350 and Electrolytes
A white powder in a 4 liter jug for reconstitution, containing 236 g polyethylene glycol 3350, 22.74 g sodium sulfate (anhydrous), 6.74 g sodium bicarbonate, 5.86 g sodium chloride and 2.97 g potassium chloride. When dissolved in water to a volume of 4 liters, PEG-3350 and Electrolytes for Oral Solution is an isosmotic solution having a mildly salty taste. PEG-3350 and Electrolytes for Oral Solution is administered orally or via nasogastric tube as a gastrointestinal lavage.
PEG-3350 and Electrolytes for Oral Solution induces a diarrhea which rapidly cleanses the bowel, usually within four hours. The osmotic activity of polyethylene glycol 3350 and the electrolyte concentration result in virtually no net absorption or excretion of ions or water. Accordingly, large volumes may be administered without significant changes in fluid or electrolyte balance.
INDICATIONS AND USAGE:
PEG-3350 and Electrolytes for Oral Solution is indicated for bowel cleansing prior to colonoscopy and barium enema X-ray examination.
PEG-3350 and Electrolytes for Oral Solution is contraindicated in patients known to be hypersensitive to any of the components. PEG-3350 and Electrolytes for Oral Solution is contraindicated in patients with gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis, toxic megacolon or ileus.
No additional ingredients, e.g. flavorings, should be added to the solution. PEG-3350 and Electrolytes for Oral Solution should be used with caution in patients with severe ulcerative colitis.
General: Patients with impaired gag reflex, unconscious, or semiconscious patients, and patients prone to regurgitation or aspiration should be observed during the administration of PEG-3350 and Electrolytes for Oral Solution, especially if it is administered via nasogastric tube. If a patient experiences severe bloating, distention or abdominal pain, administration should be slowed or temporarily discontinued until the symptoms abate. If gastrointestinal obstruction or perforation is suspected, appropriate studies should be performed to rule out these conditions before administration of PEG-3350 and Electrolytes for Oral Solution.
Information for patients: PEG-3350 and Electrolytes for Oral Solution produces a watery stool which cleanses the bowel before examination. Prepare the solution according to the instructions on the bottle. It is more palatable if chilled. For best results, no solid food should be consumed during the 3 to 4 hour period before drinking the solution, but in no case should solid foods be eaten within 2 hours of taking PEG-3350 and Electrolytes for Oral Solution.
Drink 240 mL (8 oz.) every 10 minutes. Rapid drinking of each portion is better than drinking small amounts continuously. The first bowel movement should occur approximately one hour after the start of PEG-3350 and Electrolytes for Oral Solution administration. You may experience some abdominal bloating and distention before the bowels start to move. If severe discomfort or distention occur, 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 liters and it is best to drink all of the solution. Any unused portion should be discarded.
Drug Interactions: Oral medication administered within one hour of the start of administration of PEG-3350 and Electrolytes for Oral Solution may be flushed from the gastrointestinal tract and not absorbed.
Carcinogenesis, Mutagenesis, Impairment of Fertility: Carcinogenic and reproductive studies with animals have not been performed.
Pregnancy: Category C. Animal reproduction studies have not been conducted with PEG-3350 and Electrolytes for Oral Solution. It is also not known whether PEG-3350 and Electrolytes for Oral Solution can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. PEG-3350 and Electrolytes for Oral Solution should be given to a pregnant woman only if clearly needed. Pediatric Use: Safety and effectiveness in children have not been established.
Nausea, abdominal fullness and bloating are the most common adverse reactions (occurring in up to 50% of patients) to administration of PEG-3350 and Electrolytes for Oral Solution. Abdominal cramps, vomiting and anal irritation occur less frequently. These adverse reactions are transient and subside rapidly. Isolated cases of urticaria, rhinorrhea, dermatitis and (rarely) anaphylactic reaction have been reported which may represent allergic reactions.
Published literature contains isolated reports of serious adverse reactions following the administration of PEG-ELS products in patients over 60 years of age. These adverse events include upper GI bleeding from Mallory-Weiss Tear, esophageal perforation, asystole, sudden dyspnea with pulmonary edema, and “butterfly-like” infiltrates on chest X-ray after vomiting and aspirating PEG.
DOSAGE AND ADMINISTRATION:
The recommended dose for adults is 4 liters of PEG-3350 and Electrolytes for Oral Solution solution prior to gastrointestinal examination, as ingestion of this dose produces a satisfactory preparation in over 95% of patients. Ideally, the patient should fast for approximately three or four hours prior to PEG-3350 and Electrolytes for Oral Solution administration, but in no case should solid food be given for at least two hours before the solution is given.
PEG-3350 and Electrolytes for Oral Solution is usually administered orally, but may be given via nasogastric tube to patients who are unwilling or unable to drink the solution. Oral administration is at a rate of 240 mL (8 oz.) every 10 minutes, until 4 liters are consumed or the rectal effluent is clear. Rapid drinking of each portion is preferred to drinking small amounts continuously. Nasogastric tube administration is at the rate of 20-30 mL per minute (1.2-1.8 liters per hour). The first bowel movement should occur approximately one hour after the start of PEG-3350 and Electrolytes for Oral Solution administration.
Various regimens have been used. One method is to schedule patients for examination in midmorning or later, allowing the patients three hours for drinking and an additional one hour period for complete bowel evacuation. Another method is to administer PEG-3350 and Electrolytes for Oral Solution on the evening before the examination, particularly if the patient is to have a barium enema.
Preparation of the solution: PEG-3350 and Electrolytes for Oral Solution solution is prepared by filling the container to the 4 liter mark with water and shaking vigorously several times to ensure that the ingredients are dissolved. Dissolution is facilitated by using lukewarm water. The solution is more palatable if chilled before administration. The reconstituted solution should be refrigerated and used within 48 hours. Discard any unused portion.
In powdered form, for oral administration as a solution following reconstitution.
PEG-3350 and Electrolytes for Oral Solution is available in a disposable jug in powdered form containing:
Disposable Jug: polyethylene glycol 3350 236 g, sodium sulfate (anhydrous) 22.74 g, sodium bicarbonate 6.74 g, sodium chloride 5.86 g, potassium chloride 2.97 g. When made up to 4 liters volume with water, the solution contains PEG-3350 17.6 mmol/L, sodium 125 mmol/L, sulfate 40 mmol/L, chloride 35 mmol/L, bicarbonate 20 mmol/L and potassium 10 mmol/L (NDC 54868-6138-0).
Store in sealed container at 59°-86°F. When reconstituted, keep solution refrigerated. Use within 48 hours. Discard unused portion.
Revised: 10/2009 Physicians Total Care, Inc.
Reproduced with permission of U.S. National Library of Medicine
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