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  • CLASSES

    Bowel Prep Combinations

    DEA CLASS

    Rx

    DESCRIPTION

    Used for bowel evacuation/cleaning prior to GI exam
    Osmotic laxative that is not systemically absorbed; electrolytes maintain water/electrolyte balance
    NuLYTELY contains 52% less sodium and may be more palatable than other formulations

    COMMON BRAND NAMES

    Colyte, GaviLyte-C, GaviLyte-G, GaviLyte-N, GoLYTELY, NuLYTELY, TriLyte

    HOW SUPPLIED

    Colyte/GaviLyte-C/GaviLyte-G/GaviLyte-N/GoLYTELY/NuLYTELY/Polyethylene Glycol 3350, Potassium Chloride, Sodium Bicarbonate, Sodium Chloride/Polyethylene Glycol 3350, Potassium Chloride, Sodium Bicarbonate, Sodium Chloride, Sodium Sulfate/TriLyte Oral Pwd F/Recon
    Colyte/GaviLyte-G/GaviLyte-N/GoLYTELY/NuLYTELY/Polyethylene Glycol 3350, Potassium Chloride, Sodium Bicarbonate, Sodium Chloride/Polyethylene Glycol 3350, Potassium Chloride, Sodium Bicarbonate, Sodium Chloride, Sodium Sulfate/TriLyte Nasogastric Pwd F/Recon

    DOSAGE & INDICATIONS

    For use as a bowel evacuant to clean the colon prior to colonoscopy or barium enema X-ray examination (bowel preparation).
    For dosing in adults and/or adolescents.
    Oral dosage (Colyte and generic equivalents, GaviLyte-C, GaviLyte-G, GavilLyte-N, Golytely, NuLYTELY, and TriLyte)
    Adults and Adolescents

    The patient should fast for at least 3 to 4 hours before administration, with no solid foods consumed within 2 hours before administration. Administration is at a rate of 240 mL (approximately 8 oz) PO 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. May also be given via a NG tube at a rate of 20 to 30 mL/minute (1.2 to 1.8 liters per hour). NOTE: Guidelines recommend split-dose (One-half [50%] prep the evening before exam, one-half [50%] prep the morning of) over single-dose bowel preparation as a key measure for improving the quality and cost-effectiveness of colonoscopies as a screening test.

    For dosing in children and older infants.
    Oral dosage (NuLytely, GaviLyte-N, and Trilyte only)
    Infants and Children 6 months and older

    The patient should fast for at least 3 to 4 hours before administration, with no solid foods consumed within 2 hours before administration. Administer at a rate of 25 mL/kg/hour PO or via nasogastric tube (NG), until the rectal effluent is clear (usually takes 4 to 10 hours). Rapid drinking of each portion is preferred to drinking small amounts continuously.

    For the treatment of chronic constipation†.
    Oral dosage (Colyte, Golytely, Nulytely, and Trilyte)
    Adults

    240 to 250 mL (roughly 8 oz) PO once to twice daily has been reported to be effective. A bowel movement is expected in 30 to 60 minutes after a dosage. These products should be used for 2 weeks or less or as directed by the prescriber.

    †Indicates off-label use

    MAXIMUM DOSAGE

    Adults

    4 liters/24 hours PO.

    Geriatric

    4 liters/24 hours PO.

    Adolescents

    4 liters/24 hours PO.

    Children

    25 ml/kg/hour PO (NuLytely, GaviLyte-N, and Trilyte only).

    Infants

    >= 6 months: 25 ml/kg/hour PO (NuLytely, GaviLyte-N, and Trilyte only).

    DOSING CONSIDERATIONS

    Hepatic Impairment

    Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

    Renal Impairment

    Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. However, due to an increased risk of developing electrolyte abnormalities and serious adverse events use caution when prescribing polyethylene glycol; electrolytes to patients with renal impairment (see Contraindications/Precautions).

    ADMINISTRATION

    For storage information, see specific product information within the How Supplied section.

    Oral Administration

    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.
    When used as a bowel prep, various regimens have been used. Administration regimens may vary by the specific product formulation. Follow individual product labeling for proper administration technique.
    For example, some products may be split-dosed and administered partly on the evening prior and then partly on the morning of the procedure.
    Other formulations must be administered as a full one-time dose. In this case, one method is to schedule patients for the exam midmorning or later, allowing the patients 3 hours for drinking the full dose and an additional 1-hour period for complete bowel evacuation.
    Another method is to give the solution the evening before the examination, particularly if the patient is to have a barium enema.
    Reconstitute the specific product prescribed according to the package instructions with water only. 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.
    The solution is more palatable if chilled before administration. When reconstituted, keep solution refrigerated. Depending on the product, use within 24 to 48 hours of reconstitution. Discard unused portion.

    STORAGE

    Colyte:
    - Discard unused portion. Do not store for later use.
    - Store reconstituted product in refrigerator (36 to 46 degrees F)
    - Store unreconstituted product at 68 to 77 degrees F; excursions permitted to 59 to 86 degrees F
    - Use within 48 hours after mixing
    GaviLyte-C:
    - Discard unused portion. Do not store for later use.
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    - Store reconstituted product in refrigerator (36 to 46 degrees F)
    - Use within 48 hours after mixing
    GaviLyte-G:
    - Discard unused portion. Do not store for later use.
    - Reconstituted product may be refrigerated (36 to 46 degrees F) for use within 48 hours
    - Store unreconstituted product at 59 to 86 degrees F
    GaviLyte-N:
    - Discard unused portion. Do not store for later use.
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Store reconstituted product in refrigerator (36 to 46 degrees F)
    - Use within 48 hours after mixing
    GoLYTELY:
    - Discard unused portion. Do not store for later use.
    - Reconstituted product may be refrigerated (36 to 46 degrees F) for use within 48 hours
    - Store unreconstituted product at 59 to 86 degrees F
    NuLYTELY:
    - Discard unused portion. Do not store for later use.
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Store reconstituted product in refrigerator (36 to 46 degrees F)
    - Use within 48 hours after mixing
    Suclear:
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    TriLyte:
    - Discard unused portion. Do not store for later use.
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Store reconstituted product in refrigerator (36 to 46 degrees F)
    - Use within 48 hours after mixing

    CONTRAINDICATIONS / PRECAUTIONS

    General Information

    Polyethylene glycol; electrolytes solution is contraindicated for use in those with known polyethylene glycol hypersensitivity or with hypersensitivity to any of the components of the specific commercial products.

    Abdominal pain, acute abdomen, appendicitis, colitis, dehydration, GI obstruction, GI perforation, ileus, inflammatory bowel disease, toxic megacolon, ulcerative colitis, vomiting

    Polyethylene glycol; electrolytes 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 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 solution may lead to very rare instances of bowel perforation in such patients. Administration of PEG; electrolytes 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 and electrolyte abnormalities can lead to serious adverse events.

    Electrolyte imbalance, hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia, seizure disorder, seizures

    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 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 (see Interactions), taking concomitant medications that increase the risk of electrolyte abnormalities (see Interactions), 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.

    Children, infants, neonates

    In neonates, infants, and children < 2 years of age, the use of polyethylene glycol; electrolytes solution should be carefully monitored for occurrence of possible hypoglycemia, as this solution has no caloric substrate. Dehydration has been reported in 1 child and hypokalemia has been reported in 3 children. NuLytely, GaviLyte-N, and Trilyte have been approved for use in infants as young as 6 months of age.

    Pregnancy

    Polyethylene glycol; electrolytes solution (PEG-3350 with electrolytes) is classified in FDA pregnancy risk category C. Administer during pregnancy only if clearly needed and with caution. Animal reproduction studies have not been performed. While high-molecular weight polyethylene glycols are common food additives and are not significantly absorbed from the GI tract, it is not known whether this drug, when used as intended, can cause fetal harm when given during pregnancy or if the drug can affect reproductive capacity. Nevertheless, evidence appears to favor PEG-electrolyte solutions as preferred agents over bowel preparations like sodium phosphate (which might have a higher association with fluid and electrolyte abnormalities) when complete bowel evacuation is necessary during pregnancy.

    Breast-feeding

    The safest bowel evacuants for use in lactating women are those that are not systemically absorbed. Polyethylene glycol 3350 (PEG 3350) is a common food additive and is not significantly absorbed from the GI tract. Only 0.2% of an oral dose would be absorbed systemically by the lactating mother. It is not known if polyethylene glycol; electrolytes solution is distributed into breast-milk, but significant passage seems unlikely. Consensus documents indicate that PEG-containing bowel preparations represent a low risk when used during breast-feeding.

    Coma, dementia, dysphagia, esophageal stricture, gag reflex depression

    Due to the potential choking hazard, use polyethylene glycol; electrolytes 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 polyethylene glycol; electrolytes 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.

    Angina, cardiac arrhythmias, cardiomyopathy, heart failure, myocardial infarction, QT prolongation

    There have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Therefore, caution is warranted when polyethylene glycol; electrolytes are 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, or other cardiac disease 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.

    Renal impairment

    Bowel preparations containing polyethylene glycol; electrolytes 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.

    ADVERSE REACTIONS

    Severe

    anaphylactic shock / Rapid / Incidence not known
    angioedema / Rapid / Incidence not known
    anaphylactoid reactions / Rapid / Incidence not known
    renal failure (unspecified) / Delayed / Incidence not known
    seizures / Delayed / Incidence not known
    pulmonary edema / Early / Incidence not known
    GI bleeding / Delayed / Incidence not known
    GI perforation / Delayed / Incidence not known
    arrhythmia exacerbation / Early / Incidence not known
    atrial fibrillation / Early / Incidence not known
    pancreatitis / Delayed / Incidence not known

    Moderate

    fecal incontinence / Early / Incidence not known
    dyspnea / Early / Incidence not known
    fluid retention / Delayed / Incidence not known
    hypokalemia / Delayed / Incidence not known
    dehydration / Delayed / Incidence not known
    hypernatremia / Delayed / Incidence not known
    hypoglycemia / Early / Incidence not known
    hypocalcemia / Delayed / Incidence not known
    hypomagnesemia / Delayed / Incidence not known
    hyponatremia / Delayed / Incidence not known
    colitis / Delayed / Incidence not known
    peripheral edema / Delayed / Incidence not known
    hypertension / Early / Incidence not known
    sinus tachycardia / Rapid / Incidence not known
    palpitations / Early / Incidence not known

    Mild

    nausea / Early / 14.4-47.3
    polydipsia / Early / 47.3-47.3
    abdominal pain / Early / 5.6-39.1
    chills / Rapid / 33.7-33.7
    malaise / Early / 19.4-26.6
    vomiting / Early / 7.1-12.8
    dizziness / Early / 6.5-6.5
    dyspepsia / Early / 1.1-2.8
    headache / Early / 1.8-1.8
    diarrhea / Early / 1.0
    fecal urgency / Early / 1.0
    pruritus / Rapid / Incidence not known
    fever / Early / Incidence not known
    urticaria / Rapid / Incidence not known
    rhinorrhea / Early / Incidence not known
    rash / Early / Incidence not known
    syncope / Early / Incidence not known
    tremor / Early / Incidence not known

    DRUG INTERACTIONS

    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.
    Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    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.
    Aliskiren; 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.
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Bendroflumethiazide; Nadolol: (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) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    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.
    Brompheniramine; 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.
    Brompheniramine; 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.
    Bumetanide: (Moderate) There have been rare reports of generalized tonic-clonic seizures associated with electrolyte abnormalities in patients using polyethylene glycol colon preparation products. In addition, there have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Some of these events are associated with electrolyte imbalance. Therefore, polyethylene glycol; electrolytes preparations should be used with caution in patients using concomitant medications that increase the risk of electrolyte abnormalities such as loop diuretics. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Carbinoxamine; Hydrocodone; Phenylephrine: (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.
    Carbinoxamine; 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.
    Casanthranol; Docusate Sodium: (Major) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    Castor Oil: (Major) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    Chlorothiazide: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Chlorpheniramine; Guaifenesin; 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.
    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; Hydrocodone; Phenylephrine: (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; 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.
    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.
    Chlorthalidone; Clonidine: (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.
    Digoxin: (Major) 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; Hydrocodone; Phenylephrine: (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.
    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.
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Enalapril; Felodipine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (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) There have been rare reports of generalized tonic-clonic seizures associated with electrolyte abnormalities in patients using polyethylene glycol colon preparation products. In addition, there have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Some of these events are associated with electrolyte imbalance. Therefore, polyethylene glycol; electrolytes preparations should be used with caution in patients using concomitant medications that increase the risk of electrolyte abnormalities such as loop diuretics. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    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.
    Food: (Contraindicated) Foods, seasonings, or medicines containing high potassium or sodium content, such as dietary salt substitutes, 'low salt' milk products (which contain potassium), or tomato juice (which has high sodium content), could increase the risk of complications of hyperkalemia or sodium excess. Regularly monitor the serum potassium and/or sodium concentration in patients taking food or medications with high potassium and/or sodium content. Muscle weakness, chest pain, or an abnormal heart rhythm can indicate hyperkalemia. Abdominal pain, diarrhea, metabolic alkalosis, nausea, vomiting, and seizures can indicate sodium excess.
    Fosinopril: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Furosemide: (Moderate) There have been rare reports of generalized tonic-clonic seizures associated with electrolyte abnormalities in patients using polyethylene glycol colon preparation products. In addition, there have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Some of these events are associated with electrolyte imbalance. Therefore, polyethylene glycol; electrolytes preparations should be used with caution in patients using concomitant medications that increase the risk of electrolyte abnormalities such as loop diuretics. (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.
    Guaifenesin; 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.
    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.
    Hydralazine; 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: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Hydrochlorothiazide, HCTZ; Methyldopa: (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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (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: (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; Phenylephrine: (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; Potassium Guaiacolsulfonate: (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; Potassium Guaiacolsulfonate; 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.
    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.
    Indapamide: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    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.
    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.
    Lisinopril: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (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) There have been rare reports of generalized tonic-clonic seizures associated with electrolyte abnormalities in patients using polyethylene glycol colon preparation products. In addition, there have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Some of these events are associated with electrolyte imbalance. Therefore, polyethylene glycol; electrolytes preparations should be used with caution in patients using concomitant medications that increase the risk of electrolyte abnormalities such as loop diuretics.
    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.
    Methyclothiazide: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    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.
    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.
    Norfloxacin: (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.
    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.
    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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Perindopril; Amlodipine: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    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.
    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) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    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.
    Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Quinapril: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors). (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) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    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: (Major) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    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.
    Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Major) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    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: (Major) The use of stimulant laxatives should be avoided in combination with some polyethylene glycol bowel preparation products (e.g., Colyte, Golytely, Nulytely, Moviprep, Plenvu). Concurrent use may increase the risk of mucosal ulceration or ischemic colitis.
    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.
    Torsemide: (Moderate) There have been rare reports of generalized tonic-clonic seizures associated with electrolyte abnormalities in patients using polyethylene glycol colon preparation products. In addition, there have been rare reports of serious arrhythmias associated with the use of ionic osmotic laxative products for bowel preparation. Some of these events are associated with electrolyte imbalance. Therefore, polyethylene glycol; electrolytes preparations should be used with caution in patients using concomitant medications that increase the risk of electrolyte abnormalities such as loop diuretics. (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as diuretics.
    Trandolapril: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    Trandolapril; Verapamil: (Moderate) Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors (ACE inhibitors).
    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.

    PREGNANCY AND LACTATION

    Pregnancy

    Polyethylene glycol; electrolytes solution (PEG-3350 with electrolytes) is classified in FDA pregnancy risk category C. Administer during pregnancy only if clearly needed and with caution. Animal reproduction studies have not been performed. While high-molecular weight polyethylene glycols are common food additives and are not significantly absorbed from the GI tract, it is not known whether this drug, when used as intended, can cause fetal harm when given during pregnancy or if the drug can affect reproductive capacity. Nevertheless, evidence appears to favor PEG-electrolyte solutions as preferred agents over bowel preparations like sodium phosphate (which might have a higher association with fluid and electrolyte abnormalities) when complete bowel evacuation is necessary during pregnancy.

    The safest bowel evacuants for use in lactating women are those that are not systemically absorbed. Polyethylene glycol 3350 (PEG 3350) is a common food additive and is not significantly absorbed from the GI tract. Only 0.2% of an oral dose would be absorbed systemically by the lactating mother. It is not known if polyethylene glycol; electrolytes solution is distributed into breast-milk, but significant passage seems unlikely. Consensus documents indicate that PEG-containing bowel preparations represent a low risk when used during breast-feeding.

    MECHANISM OF ACTION

    Mechanism of Action: Polyethylene glycol; electrolytes solution contains polyethylene glycol 3350 (PEG 3350), 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 3350 contributes to the drug's effectiveness; tachyphylaxis does not normally occur with intermittent use. PEG 3350 softens stool consistency, increases stool frequency, and facilitates stool evacuation. PEG 3350 does not affect colonic transit time. A balance of electrolytes (e.g., sodium, chloride, potassium and bicarbonate) are added to the solution to counteract losses resulting from bowel evacuation. The concentration of electrolytes in the polyethylene glycol; electrolytes solution causes no net absorption or secretion of electrolytes; thus water and electrolyte balance are usually maintained even after administration of large volumes.

    PHARMACOKINETICS

    Polyethylene glycol; electrolytes solution is administered orally as a solution in water. Any systemically absorbed dose is quickly excreted in the urine.

    Oral Route

    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.