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Polyethylene Glycol-Electrolyte Solution and Bisacodyl

Pronunciation

(pol i ETH i leen GLY kol ee LEK troe lite soe LOO shun & bis a KOE dil)

Index Terms

  • Bisac/NaCl/Nahco3/KCl/Peg 3350
  • Bisacodyl and Polyethylene Glycol-Electrolyte Solution
  • Electrolyte Lavage Solution

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Kit [each kit contains]:

GaviLyte-H and Bisacodyl:

Powder for solution, oral (GaviLyte-H): PEG 3350 210 g, sodium bicarbonate 2.86 g, sodium chloride 5.6 g, potassium chloride 0.74 g (2000 mL) [contains 3 flavor packs: cherry, lemon, orange]

Tablet, delayed release, oral (Bisacodyl): 5 mg (1s)

HalfLytely and Bisacodyl [DSC]:

Powder for solution, oral (HalfLytely): PEG 3350 210 g, sodium bicarbonate 2.86 g, sodium chloride 5.6 g, potassium chloride 0.74 g (2000 mL) [contains 4 flavor packs: cherry, lemon-lime, orange, pineapple]

Tablet, delayed release, oral (Bisacodyl): 5 mg (1s)

PEG-Prep and Bisacodyl:

Powder for solution, oral (PEG-Prep): PEG 3350 210 g, sodium bicarbonate 2.86 g, sodium chloride 5.6 g, potassium chloride 0.74 g (2000 mL) [contains 3 flavor packs: cherry, lemon, orange]

Tablet, delayed release, oral (Bisacodyl): 5 mg (1s)

Brand Names: U.S.

  • GaviLyte-H and Bisacodyl
  • HalfLytely and Bisacodyl [DSC]
  • PEG-Prep and Bisacodyl

Pharmacologic Category

  • Laxative, Bowel Evacuant
  • Laxative, Stimulant

Pharmacology

Bisacodyl acts on the colonic mucosa to increase peristalsis throughout the large intestine. Polyethylene glycol-electrolyte solution induces catharsis through strong electrolyte and osmotic effects.

Use: Labeled Indications

Bowel cleansing prior to colonoscopy

Contraindications

Gastrointestinal obstruction; bowel perforation; toxic colitis; toxic megacolon; gastric retention; ileus

Dosing: Adult

Bowel cleansing: Oral:

Bisacodyl: 5 mg as a single dose. After bowel movement or 6 hours (whichever occurs first), initiate polyethylene glycol-electrolyte solution

Polyethylene glycol-electrolyte solution: 8 ounces every 10 minutes until 2 L are consumed

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling. Use with caution due to risks of fluid and electrolyte abnormalities.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling (has not been studied).

Reconstitution

Fill the container with water to the fill mark; may add flavor packet provided in kit to the solution; no other ingredients should be added to the solution. Shake well.

Administration

Administer bisacodyl tablet with water; do not chew or crush tablet. Do not take antacids within 1 hour of taking bisacodyl. Rapidly drinking the polyethylene glycol-electrolyte solution is preferred to drinking small amount continuously. If severe bloating, distention, or abdominal pain occurs, administration should be slowed or temporarily discontinued until symptoms resolve. Oral medications should not be administered within 1 hour of start of therapy.

Dietary Considerations

Drink only clear liquids the day of and during the bowel preparation; after consuming the solution, avoid drinking large quantities of clear liquids until colonoscopy.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). When polyethylene glycol-electrolyte solution is reconstituted, may refrigerate. Use within 48 hours.

Drug Interactions

Antacids: May diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Consider therapy modification

Adverse Reactions

>10%:

Central nervous system: Malaise (57%)

Gastrointestinal: Gastrointestinal fullness (40%), abdominal cramps (38%), nausea (34%)

1% to 10%: Gastrointestinal: Vomiting (10%)

<1% (Limited to important or life-threatening): Anaphylaxis, aspiration, asystole, dermatitis, dizziness, dyspnea, esophageal perforation, hypersensitivity reaction, ischemic colitis, Mallory-Weiss syndrome, pulmonary edema, rhinorrhea, seizure (using the 4 L preparation), syncope, urticaria

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmias: Serious arrhythmias have been reported (rarely) with the use of ionic osmotic laxative products. Use with caution in patients who may be at risk of cardiac arrhythmias (eg, patients with a history of prolonged QT, uncontrolled arrhythmias, recent MI, unstable angina, CHF, or cardiomyopathy). Consider pre-dose and post-colonoscopy ECGs in these patients.

• Fluid/electrolyte loss: Fluid and electrolyte disturbances can lead to arrhythmias, seizures, and renal impairment. Advise patients to maintain adequate hydration before, during, and after treatment. If patient becomes dehydrated or experiences significant vomiting after treatment, consider post-colonoscopy lab tests (electrolytes, creatinine, and BUN).

• Ischemic colitis: Cases of ischemic colitis have been reported; development of severe abdominal pain or rectal bleeding should prompt further evaluation.

• Seizures: Generalized tonic-clonic seizures have occurred in patients with no prior history of seizures when using the large volume (4 L) preparation. Seizures resolved with the correction of fluid and electrolyte abnormalities. Use caution in patients taking medications which increase the risk for electrolyte abnormalities (eg, diuretics) and/or patients with pre-existing electrolyte abnormalities. Evaluation of electrolytes pre- and post-colonoscopy is warranted in this population.

Disease-related concerns:

• Impaired gag reflex: Observe unconscious or semiconscious patients with impaired gag reflex or those who are otherwise prone to regurgitation or aspiration during administration.

• Renal impairment: Use with caution in patients with renal impairment and/or in patients taking medications that may adversely affect renal function (eg, diuretics, NSAIDs, ACE inhibitors). Patients with impaired renal function who develop severe vomiting should be closely monitored including measurement of electrolytes.

• Ulcerative colitis: Use with caution in patients with severe ulcerative colitis.

Other warnings/precautions:

• Appropriate use: Evaluate patients with symptoms of bowel obstruction or perforation prior to use. Correct electrolyte abnormalities in patients prior to use. No additional ingredients or flavors (other than the flavor packs provided) should be added to the polyethylene glycol-electrolyte solution.

Monitoring Parameters

Bowel movements; electrolytes, renal function

Pregnancy Risk Factor

C

Pregnancy Considerations

Reproductive studies have not been conducted with this combination.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience bloating, vomiting, or nausea. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or nausea or vomiting), severe dizziness, passing out, severe headache, severe abdominal pain, rectal bleeding, rectal pain, or vomiting blood (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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