Polyethylene glycol (PEG), electrolytes, and ascorbic acid are used together for bowel evacuation and cleaning before colonoscopy. PEG 3350-electrolytes solutions have been used medicinally for decades. Compared to other PEG 3350-electrolyte solutions for bowel prep, PEG; electrolytes, and ascorbic acid has the additional ingredients of ascorbic acid and sodium ascorbate, but no sodium bicarbonate. Polyethylene glycol compounds exhibit practically no systemic absorption from the intestine at molecular masses exceeding 3000, and thus act as osmotic laxatives. Electrolytes are added to the solution to maintain water and electrolyte balance in most patients, even after administration of large volumes. Ascorbic acid and sodium ascorbate potentiate the osmotic action of polyethylene glycol, resulting in less volume needed for adequate bowel cleansing. Moviprep is administered either as a split dose (2-day) method or day before (1-day) method. Plenvu is administered either as a split dose (2-day) method or morning of (1-day) method.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
Moviprep:
-For oral use only. The first bowel movement should occur approximately 1 hour after the start of solution administration.
-Patients should follow fasting instructions and instructions for clear liquids as their practitioner prescribes. Patients should be instructed to consume only clear liquids and no solid food after starting the first dose and to stop drinking clear liquids for at least 2 hours before the colonoscopy. Examples of clear liquids are water, flavored water, lemonade (no pulp), ginger ale, or apple juice. Do not drink any liquids colored purple or red or any other foods containing pulp material.
-Do not administer other oral medications within 1 hour before or after starting each dose.
-Do not administer other laxatives while taking polyethylene glycol; electrolytes; ascorbic acid.
-Instruct patients that on the day before the colonoscopy, they can consume breakfast, followed by a light lunch consisting of clear soup and/or plain yogurt (no solid foods), which must be completed at least 1 hour prior to the start of the first dose.
-If severe bloating, abdominal discomfort or distention occurs, the patient may stop drinking the solution temporarily or drink each portion at longer intervals until these symptoms resolve.
-There are 2 possible administration regimens; a preferred split dose (2-day) regimen and an alternative evening only (1-day) regimen.-Split dose (2-day) method: Administer the first dose the evening before the colonoscopy, 10 to 12 hours before the second dose. Then, schedule patients for the exam midmorning or later, allowing them 1.5 hours for drinking the second dose and an additional 2-hour period for complete bowel evacuation on the day of the colonoscopy.
-Day before (1-day) method: Administer both doses the evening before the examination. The first dose is administered at least 3.5 hours before bedtime, then the second dose is administered 1.5 hours after starting the first dose.
-For the first dose, patients should be instructed to consume 8 ounces (240mL) of the mixed solution every 15 minutes until they have consumed all 1000 mL (1 liter). This should take about 1 hour. Patients taking the split dose regimen should be instructed to consume an additional 16 ounces of clear liquid and drink all this liquid before going to bed.
-For the second dose, patients should be instructed to drink 8 ounces (240 mL) of the mixed solution every 15 minutes until they have consumed all 1000 mL (1 liter). This should take about 1 hour. After completing the second dose, patients taking the split dose regimen should be instructed to drink an additional 16 ounces of clear liquid and drink all this liquid at least 2 hours before the colonoscopy. In the day before regimen, patients should be instructed to refill the mixing container to the fill line (32 ounces) with a clear liquid and drink all this liquid before going to bed.
Reconstitution:
-Using the mixing container provided, dilute the contents of pouch A and pouch B with lukewarm drinking water to the Fill Line on the mixing container (32 fluid ounces). DO NOT reconstitute with other liquids and/or add starch-based thickeners to the mixing container as this can lead to choking and aspiration in certain patients.
-Thoroughly mix with a spoon or shake with lid on securely until the contents of Pouch A and B are completely dissolved.
-The solution is more palatable if chilled before administration. Once reconstituted, keep solution in an upright position and keep refrigerated. Use within 24 hours of reconstitution. Discard unused portion.
Plenvu:
-For oral use only. The first bowel movement may happen about 1 to 2 hours after the start of solution administration.
-Patients should be instructed to consume only clear liquids and no solid food after starting the first dose and to stop drinking clear liquids for at least 2 hours before the colonoscopy.
-There are 2 possible administration regimens; a preferred split dose (2-day) regimen and an alternative morning (1-day) regimen.-Split dose (2-day) method: Instruct patients they can consume a light breakfast followed by a light lunch, which must be completed at least 3 hours prior to the start of the first dose. Administer the first dose the evening before the colonoscopy, between approximately 4 PM and 8 PM. The second dose is administered the next morning on the day of the colonoscopy, approximately 12 hours after the start of Dose 1 (between approximately 4 AM and 8 AM. Then, schedule patients for the exam midmorning or later, allowing them 1 hour for drinking the second dose and an additional 2-hour period for complete bowel evacuation on the day of the colonoscopy.
-Morning (1-day) method: Instruct adult patients that on the day before the clinical procedure, they can consume a light breakfast followed by a light lunch, and clear broth soup and/or plain yogurt for dinner, which should be completed by approximately 8 PM. Administer both doses the morning of the examination. The first dose is administered between approximately 3 AM and 7 AM, then the second dose is administered a minimum of 2 hours after starting the first dose.
-For the first dose, patients should be instructed to consume 16 ounces (480 mL) of the mixed solution over 30 minutes until they have consumed all of it. Patients should be instructed to consume an additional 16 ounces of clear liquids over the next 30 minutes after the first dose.
-For the second dose, patients should be instructed to drink 16 ounces (480 mL) of the mixed solution over 30 minutes until they have consumed all of it. After completing the second dose, patients should be instructed to drink an additional 16 ounces of clear liquids over the next 30 minutes. In the split dose regimen, this should be consumed at least 2 hours before the colonoscopy.
Reconstitution:
-Reconstitute only with water; DO NOT reconstitute with other liquids and/or add starch-based thickeners to the mixing container as this can lead to choking and aspiration in certain patients.
-For Dose 1: Using the mixing container provided, dilute the contents of Dose 1 with drinking water to the fill line.
Thoroughly mix the solution with a spoon or shake with lid on securely until completely dissolved (which may take 2 to 3 minutes).
-For Dose 2: Using the mixing container provided, dilute the contents of Dose 2 Pouch A and Dose 2 Pouch B with drinking water to the fill line. Thoroughly mix the solution with a spoon or shake with lid on securely until completely dissolved (which may take 2 to 3 minutes).
-Once reconstituted, keep solution at controlled room temperature. The solution may also be stored in a refrigerator. Use within 6 hours after it is mixed in water.
During clinical evaluation of polyethylene glycol; electrolytes; ascorbic acid solution, abdominal distension or bloating (59.8%), anal discomfort (51.5%), thirst or polydipsia (47.3%), nausea (14.4 to 47.3%), and abdominal pain (13.3 to 39.1%) were some of the most common adverse reactions reported. Other GI related events reported include: hunger (30.2%), vomiting (7.1 to 7.8%), and dyspepsia (2.8%). During postmarketing experience, upper gastrointestinal bleeding from a Mallory-Weiss tear, and esophageal perforation [usually gastroesophageal reflux disease (GERD)] were reported. Cases of choking and potential aspiration were reported in patients with dysphagia who received polyethylene glycol (PEG)-based oral solutions mixed with starch-thickened liquids. When polyethylene glycol (PEG) is mixed with starch-thickened liquids, it reduces the viscosity of the starch-thickened liquid resulting in thinning of the liquid.
During clinical evaluation of polyethylene glycol; electrolytes; ascorbic acid solution, general reactions such as malaise (19.4 to 26.6%), sleep disorder (34.9%), chills or rigors (33.7%), dizziness (6.5%), and headache (1.8%) were reported as drug-related adverse reactions that were possibly, probably, or definitely related to the study drug. Postmarketing surveillance of polyethylene glycol; electrolytes; ascorbic acid has included reports of syncope, tremor, and seizures.
There have been rare reports of serious arrhythmia exacerbation associated with the use of ionic osmotic laxative products for bowel preparation. Postmarketing surveillance of polyethylene glycol; electrolytes; ascorbic acid include reports of cardiovascular events such as sinus tachycardia, palpitations, hypertension, arrhythmia, atrial fibrillation, peripheral edema, asystole, and acute pulmonary edema after aspiration. Use caution, and consider performing baseline and post-colonoscopy ECGs, in patients at increased risk of serious cardiac arrhythmias.
Anaphylactoid reactions, in some cases anaphylactic shock, have been rarely reported during post marketing surveillance of polyethylene glycol; electrolyte bowel preparations. Other isolated cases of reported hypersensitivity reactions include angioedema, chest tightness, dehydration, dyspnea, fever, pruritus, rash (unspecified), urticaria, and throat tightness. In addition, isolated cases of rhinorrhea and dermatitis have also been reported with polyethylene glycol based products. Polyethylene glycol compounds are found in numerous medications and food additives, and have been reported to cause allergic reactions.
Dehydration may occur secondary to fluid losses from bowel evacuation with polyethylene glycol; electrolytes; ascorbic acid solution. Post-market surveillance of polyethylene glycol; electrolytes; ascorbic acid has included reports of renal impairment and/or renal failure (unspecified).
Polyethylene glycol; electrolytes; ascorbic acid contains polyethylene glycol (PEG) and lemon flavoring (containing citral, lemon and lime oil, maltodextrin, xanthan gum, and vitamin E) and may cause serious hypersensitivity reactions. Cases of anaphylaxis (some of which were severe, including shock), angioedema, rash, urticaria, and pruritus have been reported during postmarketing experience. Inform patients of the signs and symptoms of anaphylaxis, and instruct them to seek immediate medical care should signs and symptoms occur.
Polyethylene glycol; electrolytes; ascorbic acid solution is contraindicated for use in patients with known or suspected GI obstruction or ileus, GI perforation, gastric retention, toxic colitis, or toxic megacolon. Patients with symptoms suggestive of bowel obstruction (e.g., acute abdomen or symptoms of appendicitis, abdominal pain, distension, nausea, or vomiting) should be evaluated prior to initiating bowel evacuation. Osmotic laxatives may produce colonic mucosal aphthous ulcerations; serious cases of ischemic colitis requiring hospitalization have been reported. The risk of ulceration increases with concomitant laxative use and is therefore not recommended. When interpreting the colonoscopic findings of patients with known or suspected inflammatory bowel disease, the potential for mucosal ulcerations resulting from bowel preparation should be considered. Further, use polyethylene glycol; electrolytes; ascorbic acid solution with caution in the presence of severe ulcerative colitis or other conditions where there may be compromised integrity of the bowel wall (e.g., diverticulitis). The rapidity of administration of the PEG; electrolytes; ascorbic acid solution may lead to very rare instances of bowel perforation in such patients. Administration of PEG; electrolytes; ascorbic acid solution should be slowed or temporarily discontinued if the patient experiences severe bloating, distention, or abdominal pain. Advise patients to hydrate adequately before, during, and after bowel preparation. If persistent vomiting or signs of dehydration develop, consider performing post-colonoscopy laboratory tests (sodium, potassium, calcium, creatinine, and BUN). Fluid shifts, hypovolemia, and electrolyte abnormalities can lead to serious adverse events.
There have been rare reports of generalized tonic-clonic seizures associated with use of polyethylene glycol colon preparation products in patients with no prior history of seizure disorder. The seizure cases were associated with electrolyte imbalance (e.g., hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia) and low serum osmolality. The neurologic abnormalities resolved with correction of fluid and electrolyte abnormalities. Therefore, patients with electrolyte abnormalities should have them corrected prior to bowel preparation. In addition, polyethylene glycol; electrolytes; ascorbic acid preparations should be used with caution in patients with a history of seizures, withdrawing from alcohol or benzodiazepines, taking concomitant medications that lower the seizure threshold, taking concomitant medications that increase the risk of electrolyte abnormalities, or in patients with known or suspected hyponatremia. Consider performing baseline and post-colonoscopy laboratory tests (sodium, potassium, calcium, creatinine, and BUN) in these patients.
Avoid polyethylene glycol; electrolytes; ascorbic acid in patients with phenylketonuria or in patients who must restrict intake of phenylalanine. Polyethylene glycol; electrolytes; ascorbic acid solution contains aspartame and phenylalanine.
Polyethylene glycol; electrolytes; ascorbic acid solution contains sodium ascorbate and ascorbic acid; use with caution in patients with G6PD deficiency (glucose-6-phosphate dehydrogenase deficiency) especially G6PD deficiency patients with an active infection, with a history of hemolysis, or taking concomitant medications known to precipitate hemolytic reactions.
There have been rare reports of serious cardiac arrhythmias (including atrial fibrillation) associated with the use of ionic osmotic laxative products for bowel preparation. Therefore, caution is warranted when polyethylene glycol; electrolytes; ascorbic acid is used in patients at increased risk of arrhythmias. Such patients include those with a history of QT prolongation, uncontrolled cardiac arrhythmias, recent history of myocardial infarction, unstable angina, congestive heart failure, cardiomyopathy, electrolyte imbalance, or other cardiac diease that may increase the risk of experiencing a cardiac arrhythmia. Consider performing baseline and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.
Bowel preparations containing polyethylene glycol; electrolytes; ascorbic acid should be used with caution in patients with renal impairment or in patients on concomitant medications that may affect renal function. Because such patients may be at an increased risk of developing electrolyte abnormalities associated with bowel preparation, advise on the importance of adequate hydration. In addition, consider performing baseline and post-colonoscopy laboratory tests (sodium, potassium, calcium, creatinine, and BUN) in these patients.
Due to the potential choking hazard, use polyethylene glycol; electrolytes; ascorbic acid solution with caution in those patients prone to aspiration or regurgitation (e.g., coma, gag reflex depression, dysphagia, esophageal stricture, semiconscious, or impaired mental status, like dementia). Do not combine the solution with starch-based thickeners. When polyethylene glycol (PEG) is mixed with starch-thickened liquids, it reduces the viscosity of the starch-thickened liquid resulting in thinning of the liquid; cases of choking and potential aspiration were reported in patients with dysphagia. The solution may be administered down a nasogastric (NG) tube if needed.
Administer polyethylene glycol; electrolytes; ascorbic acid solution (PEG-3350 with electrolytes and ascorbic acid) for bowel preparation during pregnancy only if clearly needed and with caution. Animal reproduction studies have not been performed. While high-molecular weight polyethylene glycol 3350 is not significantly absorbed from the GI tract, there are no data to inform a drug-associated risk for adverse developmental outcomes when these bowel preparation products are used as intended. However, when use is absolutely necessary, evidence appears to favor PEG-electrolyte solutions as preferred agents versus sodium phosphate (which might have a higher association with fluid and electrolyte abnormalities) when complete bowel evacuation is necessary during pregnancy.
There are no data available to assess the presence of polyethylene glycol; electrolytes; ascorbic acid solution in human milk, the effects on the breastfed child or the effects on milk production. The lack of clinical data during lactation precludes a clear determination of the risk of polyethylene glycol; electrolytes; ascorbic acid to the child during lactation; therefore the developmental and health benefits of breast-feeding should be considered along with the mother's clinical need for the drug and any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition. Consensus documents indicate that PEG-containing bowel preparations represent a low risk when used during breast-feeding.
For use as a bowel evacuant to clean the colon prior to colonoscopy (bowel preparation):
Oral dosage (Moviprep):
Adults: Administer 240 mL of mixed solution PO every 15 minutes until gone, which should take about 1 hour (total volume is 1000 mL). The bowel preparation regimen consists of 2 doses given in the same manner with administration times dependent on the regimen used (split-dose or day before) and the time of the colonoscopy. In both regimens, additional clear liquids must be consumed by the patient to ensure adequate hydration. Moviprep is considered interchangeable with other PEG; electrolyte preparations that do not contain ascorbic acid or sodium ascorbate.
Oral dosage (Plenvu):
Adults: For Dose 1, empty the contents of Dose 1 into the mixing container that comes with the product. Add at least 16 fluid ounces of water; thoroughly mix and then drink over the next 30 minutes. Refill the mixing container with at least 16 fluid ounces of clear liquids and drink over the next 30 minutes. For the second dose, empty the contents of Dose 2 Pouch A and Dose 2 Pouch B into the mixing container and add at least 16 fluid ounces; thoroughly mix and then drink over the next 30 minutes. Refill the mixing container with at least 16 fluid ounces of clear liquids and have the patient drink over the next 30 minutes. The bowel preparation regimen consists of 2 doses given in the same manner with administration times dependent on the regimen used (split-dose or morning of) and the time of the colonoscopy. In both regimens, additional clear liquids must be consumed by the patient to ensure adequate hydration.
Maximum Dosage Limits:
-Adults
2 liters/24 hours PO (Moviprep); 32 ounces/24 hours PO (Plenvu).
-Geriatric
2 liters/24 hours PO (Moviprep); 32 ounces/24 hours PO (Plenvu).
-Adolescents
Safety and efficacy have not been established.
-Children
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Ensure adequate hydration in patients with renal impairment.
*non-FDA-approved indication
Acetaminophen; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Acetaminophen; Ibuprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Amiloride: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Amlodipine; Benazepril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Amlodipine; Celecoxib: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Amlodipine; Olmesartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Amlodipine; Valsartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Angiotensin II receptor antagonists: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Angiotensin-converting enzyme inhibitors: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Atenolol; Chlorthalidone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Atropine; Difenoxin: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Azilsartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Azilsartan; Chlorthalidone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Benazepril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Bisacodyl: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis. (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Bumetanide: (Moderate) Monitor renal function and serum electrolytes and ensure adequate hydration before and after concomitant loop diuretic and polyethylene glycol 3350 use. Concomitant use may increase the risk for fluid and electrolyte abnormalities and renal injury. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Bupivacaine; Meloxicam: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Calcium Phosphate, Supersaturated: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery. Use in patients using small doses of polyethylene glycol 3350 (e.g., Miralax) may be permissable, as long as the patient does not use their chronic laxative therapy on the day of the preparation. Watch for electrolyte and fluid abnormalities in all patients using bowel preparations.
Candesartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Captopril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Castor Oil: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Celecoxib: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Celecoxib; Tramadol: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Chlorothiazide: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Chlorpheniramine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Chlorpromazine: (Major) Administer chlorpromazine at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of chlorpromazine may be reduced by chelation with magnesium sulfate.
Chlorthalidone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Ciprofloxacin: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Delafloxacin: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Demeclocycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Dichlorphenamide: (Moderate) Use dichlorphenamide and magnesium sulfate; potassium sulfate; sodium sulfate together with caution. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Measure potassium concentrations at baseline and periodically during dichlorphenamide treatment. If hypokalemia occurs or persists, consider reducing the dichlorphenamide dose or discontinuing dichlorphenamide therapy. (Moderate) Use dichlorphenamide and polyethylene glycol; electrolytes together with caution. Dichlorphenamide increases potassium excretion and can cause hypokalemia and should be used cautiously with other drugs that may cause hypokalemia including laxatives. Measure potassium concentrations at baseline and periodically during dichlorphenamide treatment. If hypokalemia occurs or persists, consider reducing the dichlorphenamide dose or discontinuing dichlorphenamide therapy.
Diclofenac: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Diclofenac; Misoprostol: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Diflunisal: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Digoxin: (Moderate) Administer digoxin at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of digoxin may be reduced by chelation with magnesium sulfate.
Diphenhydramine; Ibuprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Diphenhydramine; Naproxen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Diphenoxylate; Atropine: (Moderate) Diphenoxylate can decrease GI motility. Drugs used to treat constipation, such as laxatives, would counteract the effect of antidiarrheals. In general, it would be illogical to concurrently administer these drugs at the same time. If an antidiarrheal medication is needed, it would be wise to temporarily discontinue use of agents with laxative effects.
Diuretics: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Docusate Sodium; Senna: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Doxycycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Enalapril, Enalaprilat: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Eprosartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Ethacrynic Acid: (Moderate) Monitor renal function and serum electrolytes and ensure adequate hydration before and after concomitant loop diuretic and polyethylene glycol 3350 use. Concomitant use may increase the risk for fluid and electrolyte abnormalities and renal injury. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Etodolac: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Fenoprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Ferric Maltol: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Flurbiprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Fosinopril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Furosemide: (Moderate) Monitor renal function and serum electrolytes and ensure adequate hydration before and after concomitant loop diuretic and polyethylene glycol 3350 use. Concomitant use may increase the risk for fluid and electrolyte abnormalities and renal injury. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Gemifloxacin: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Guaifenesin; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Homatropine; Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Hydrocodone: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone; Ibuprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs). (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Hydrocodone; Pseudoephedrine: (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as magnesium sulfate; potassium sulfate; sodium sulfate, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events. (Minor) Concurrent use of hydrocodone with strong laxatives that rapidly increase gastrointestinal motility, such as polyethylene glycol, may decrease hydrocodone absorption. Closely monitor patients for changing analgesic requirements or adverse events.
Ibuprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Ibuprofen; Famotidine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Ibuprofen; Oxycodone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Ibuprofen; Pseudoephedrine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Indapamide: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Indomethacin: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Irbesartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Iron Salts: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Iron: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Ketoprofen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Ketorolac: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Lactulose: (Major) In general, other laxatives, such as polyethylene glycol 3350, should not be used concurrently with lactulose, especially during the initial phase of therapy for portal-systemic encephalopathy, because the loose stools resulting from their use may falsely suggest that adequate lactulose dosage has been achieved.
Levofloxacin: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Lisinopril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Loop diuretics: (Moderate) Monitor renal function and serum electrolytes and ensure adequate hydration before and after concomitant loop diuretic and polyethylene glycol 3350 use. Concomitant use may increase the risk for fluid and electrolyte abnormalities and renal injury.
Losartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Meclofenamate Sodium: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Mefenamic Acid: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Meloxicam: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Metolazone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Minocycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Moexipril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Moxifloxacin: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Nabumetone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Naproxen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Naproxen; Esomeprazole: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Naproxen; Pseudoephedrine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Nebivolol; Valsartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Nonsteroidal antiinflammatory drugs: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Ofloxacin: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Olmesartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Omadacycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Oxaprozin: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Penicillamine: (Major) Administer penicillamine at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of penicillamine may be reduced by chelation with magnesium sulfate.
Perindopril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Perindopril; Amlodipine: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Pimozide: (Moderate) According to the manufacturer of pimozide, the drug should not be coadministered with drugs known to cause electrolyte imbalances, such as polyethylene glycol used in colon-cleansing regimens, except when indicated. Use in patients using small doses of polyethylene glycol 3350 (e.g., Miralax) may be permissable, as long as not excessive. Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes (TdP), and electrolyte imbalances (e.g., hypokalemia, hypocalcemia, hypomagnesemia) may increase the risk of life-threatening arrhythmias. Pimozide is contraindicated in patients with known hypokalemia or hypomagnesemia.
Piroxicam: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Polyethylene Glycol; Electrolytes; Bisacodyl: (Major) Avoid use of stimulant laxatives, such as bisacodyl, with magnesium sulfate; potassium sulfate; sodium sulfate. Concurrent use may increase the risk of mucosal ulceration or ischemic colitis. (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Polysaccharide-Iron Complex: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Quinapril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Quinolones: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.
Ramipril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Sacubitril; Valsartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Sarecycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Senna: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate: (Major) Administer iron at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of iron may be reduced by chelation with magnesium sulfate.
Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous should not be combined with additional laxatives or purgatives when being used to evacuate the bowel prior to colonic radiologic examinations or surgery. Use in patients using small doses of polyethylene glycol 3350 (e.g., Miralax) may be permissable, as long as the patient does not use their chronic laxative therapy on the day of the preparation. Watch for electrolyte and fluid abnormalities in all patients using bowel preparations.
Spironolactone: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Stimulant Laxatives: (Moderate) When polyethylene glycol is used as pre-procedure bowel preparation, avoid concomitant use of stimulant laxatives. Colonic mucosal aphthous ulcerations and ischemic colitis have been observed following use of osmotic laxatives for bowel preparation and concomitant use of stimulant laxatives may increase this risk.
Sulindac: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Sumatriptan; Naproxen: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Telmisartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Telmisartan; Amlodipine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Tetracycline: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Tetracyclines: (Major) Administer tetracyclines at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate.
Tolmetin: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Torsemide: (Moderate) Monitor renal function and serum electrolytes and ensure adequate hydration before and after concomitant loop diuretic and polyethylene glycol 3350 use. Concomitant use may increase the risk for fluid and electrolyte abnormalities and renal injury. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Trandolapril: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Trandolapril; Verapamil: (Moderate) Monitor renal function during concomitant angiotensin-converting enzyme inhibitor and magnesium sulfate; potassium sulfate; sodium sulfate bowel preparation due to risk for renal injury; ensure adequate hydration.
Triamterene: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
Valsartan: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin II receptor antagonists. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
The use of polyethylene glycol; electrolytes in combination with ascorbic acid and sodium ascorbate results in an improved osmotic effect that is greater than if the drugs are used as single entities.
-Polyethylene glycol 3350 (PEG): PEG is an osmotic agent that binds water and causes water to be retained within the stool. The lack of intestinal enzymatic degradation or bacterial metabolism of PEG contributes to the drug's effectiveness; tachyphylaxis does not normally occur with intermittent use. PEG softens stool consistency, increases stool frequency, and facilitates stool evacuation. PEG does not affect colonic transit time.
-Electrolytes: Electrolytes (e.g., sodium, chloride, and potassium) are added to the solution to counteract losses resulting from bowel evacuation. The concentration of electrolytes in the PEG; electrolytes; ascorbic acid solution causes no net absorption or secretion of electrolytes; thus water and electrolyte balance are usually maintained even after administration of large volumes.
-Ascorbic acid: A high dose of ascorbic acid and sodium ascorbate are added to produce an osmotic effect in the gut that works synergistically with PEG to reduce the total volume needed for adequate bowel cleansing.
Polyethylene glycol; electrolytes; ascorbic acid solution is administered orally as a solution in water. Any systemically absorbed dose is quickly excreted in the urine. Unmetabolized ascorbate is not excreted with normal dietary intake (80 mg/day or less); however, renal excretion increases proportionately with higher intake. When body stores become saturated, excess ascorbic acid is excreted unchanged in the urine. The first bowel movement should occur approximately 1 hour after the start of solution administration.
-Route-Specific Pharmacokinetics
Oral Route
-Polyethylene glycol: After oral administration, the dosage essentially remains within the GI tract. Complete recovery of an administered dose occurs. Roughly 0.2% of a dose has been absorbed systemically in some studies of PEG 3350. PEG 3350 is not fermented within the GI tract by the colonic microflora and no metabolism occurs locally.
-Ascorbic acid: After oral administration, the dosage is absorbed through a saturable sodium-dependent active transport at the small intestine. Approximately 70% to 90% of the usual dietary intake of ascorbic acid (30 to 180 mg/day) is absorbed, although absorption falls to 50% or less with doses above 1 g/day or in patients with GI disease (e.g., short bowel syndrome). Most ascorbic acid is reversibly oxidized to dehydroascorbic acid. The remainder is metabolized to the inactive metabolites (ascorbic acid-2-sulfate and oxalic acid).