III. Contraindications

IV. Mechanism

  1. Poorly absorbed, hyperosmolar agent

V. Medications

  1. Polyethylene Glycol 3350 (PEG, Miralax, Restoralax, GaviLax, GlycoLax)
    1. Available as 17 grams per capful or scoop
    2. Indicated for Constipation and available OTC
    3. No salty taste
  2. Polyethylene Glycol with Electrolytes (GoLytely, Colyte, NuLytely, Plenvu, MoviPrep)
    1. Indicated for Colonoscopy Preparation and requires prescription
    2. See Colonoscopy Bowel Preparation for dosing protocols

VI. Dosing: Polyethylene Glycol 3350 (PEG, Miralax)

  1. See Colonoscopy Bowel Preparation for dosing protocols
  2. Onset of action with 24-48 hours
  3. Preparation of Liquid 17 g in 8 ounces
    1. Use PEG powder 17 grams (one capful)
    2. Dissolve in 240 ml (8 ounces) water or juice
    3. May chill PEG solution or mix with flavoring (e.g. Crystal Light) to improve taste
      1. If for Colonoscopy prep, avoid colored flavoring that might interfere with visibility
  4. Individual Serving Dosing added to liquid (round to closest measurable dose)
    1. One quarter capful contains 4 g
    2. One heaping teaspoon contains 5.5 g
    3. One half capful contains 8.5 g
    4. Two heaping teaspoons contain 11 g
    5. Three quarters capful contains 13 g
    6. One capful contains 17 g
  5. Disimpaction Dose
    1. Use for 1 to 3 days until soft stool output
    2. Adult: 17 grams (1 capful or scoop) in 8 oz orally daily
    3. Child (over age 6 months)
      1. Start 1 to 1.5 g/kg/day (15 ml/kg/day) orally in liquid divided twice daily
      2. Adjust dose for two soft, painless stools per day
      3. Taper dose over time (see maintenance dosing below)
  6. Maintenance Dose
    1. Avoid daily use beyond 14 days
    2. Adult: 8.5 to 17 grams (1/2 to 1 capful) orally daily
    3. Child: 0.2 to to 0.8 g/kg/day (up to 1 g/kg/day)

VII. Efficacy

  1. Safe, well tolerated and effective for Constipation
  2. More effective and better tolerated than Lactulose

VIII. Adverse Effects

  1. Abdominal Pain
  2. Flatulence
  3. Neurotoxicity (case reports)
    1. In 2017, studies initiated to determine if young children absorb Ethylene Glycol with neurotoxicity based on case reports
    2. Rare case reports of tics, Tremors, OCD behavior
    3. No evidence at this point that this is a significant concern
    4. (2017) Presc Lett 24(4): 23

IX. Safety

  1. Appears safe in children and adults
  2. Pregnancy Category C
  3. Unknown Safety in Lactation (but not absorbed)

XI. References

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

polyethylene glycol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
POLYETHYLENE GLYCOL 3350 POWD Generic OTC $0.02 per gram
peg (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PEG 3350-ELECTROLYTE SOLUTION Generic $0.01 per ml
PEG-3350 AND ELECTROLYTES SOLN Generic $0.01 per ml
PEG3350-SOD SUL-NACL-KCL-ASCB-C 100-7.5-2.691-1.015-5.9-4.7G Generic $76.45 each

Ontology: Polyethylene Glycols (C0032483)

Definition (MSH) Polymers of ETHYLENE OXIDE and water, and their ethers. They vary in consistency from liquid to solid depending on the molecular weight indicated by a number following the name. They are used as SURFACTANTS, dispersing agents, solvents, ointment and suppository bases, vehicles, and tablet excipients. Some specific groups are NONOXYNOLS, OCTOXYNOLS, and POLOXAMERS.
Definition (NCI_NCI-GLOSS) A polymer made by joining molecules of ethylene oxide and water together in a repeating pattern. Polyethylene glycol can be a liquid or a waxy solid. In medicine, forms of polyethylene glycol can be used in ointments, in drugs or substances to make them stay in the body longer, or in laxatives.
Definition (CSP) an addition polymer of ethylene oxide and water.
Concepts Organic Chemical (T109) , Biomedical or Dental Material (T122) , Pharmacologic Substance (T121)
MSH D011092
SnomedCT 419116004, 8030004, 356076006
English Glycols, Polyethylene, Macrogols, Oxide, Polyethylene, Polyethylene Glycol, Polyethylene Glycols, Polyethylene Oxide, Polyethyleneoxide, Polyoxyethylenes, PEG, Polyethylene Glycols [Chemical/Ingredient], macrogol (medication), Oxides, Polyethylene, Polyoxyethylene, Polyethylene Oxides, Polyethyleneoxides, glycol polyethylene, macrogols, polyethylene oxide, polyoxyethylene, POLYETHYLENE GLYCOL, macrogol, polyethylene glycol, polyehtylene glycol, polythylene glycol, polyethylene glycols, Polyethylene glycols, POLYETHYLENE GLYCOLS, POLYETHYLENE GLYCOLs, Macrogol (substance), Glycol, polyethylene, Ethanol, 2,2'-(oxybis(2,1-ethanediyloxy)bis)-, PEG - Polyethylene glycol, Polyethylene glycol, Polyethylene glycol product, Macrogol, Polyethylene glycol (substance), Polyethylene glycol product (product), glycol, polyethylene, Polyethylene glycol, NOS, Polyethylene glycol product (substance), Glycol, Polyethylene, POLYOXYETHYLENE
Swedish Polyetylenglykoler
Czech polyethylenglykoly
Finnish Polytetyleeniglykolit
French Polyoxyéthylènes, Polyéthylène glycols, Macrogols, Polyéthylèneglycols
Russian TRITONY (KHIM), POLIOKSIETILENY, MAKROGOLY, POLIETILENGLIKOLI, МАКРОГОЛЫ, ПОЛИОКСИЭТИЛЕНЫ, ПОЛИЭТИЛЕНГЛИКОЛИ, ТРИТОНЫ (ХИМ)
Japanese マクロゴール, ポリエチレンオキシド, トリトン, ポリオキシエチレン, ポリエチレングリコール
Spanish polietilénglicol, producto (producto), polietilénglicol, producto, polietilenglicol (sustancia), macrogol (producto), polietilenglicol, macrogol, polietilénglicol, polietilénglicol (producto), macrogol (sustancia), Glicoles de Polietileno, Macrogoles, Polioxietilenos
Croatian POLIETILENGLIKOLI
Polish Glikole polietylenowe, Trytony-chemia
Norwegian Not Translated[Polyethylene Glycols]
Portuguese Triton X-100, Macrogóis, Polietilenoglicóis, Polioxietileno
German Makrogole, Polyethylenglycole, Polyoxyethylene
Italian Glicoli polietilenici

Ontology: Miralax (C0876088)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011092
English Miralax, Miralaxs, miralax, MiraLax, MiraLax (obsolete)