NuLYTELY

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NuLYTELY

Classes

Bowel Prep Combinations

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.

Adverse Reactions
Severe

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

Moderate

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

Mild

nausea / Early / 7.0-47.3
polydipsia / Early / 47.3-47.3
abdominal pain / Early / 3.0-39.1
chills / Rapid / 33.7-33.7
malaise / Early / 19.4-26.6
vomiting / Early / 4.0-12.8
dizziness / Early / 6.5-6.5
headache / Early / 1.8-3.0
dyspepsia / Early / 1.1-2.8
diarrhea / Early / 1.0
fecal urgency / Early / 1.0
pruritus / Rapid / Incidence not known
rhinorrhea / Early / Incidence not known
urticaria / Rapid / Incidence not known
fever / Early / Incidence not known
rash / Early / Incidence not known
syncope / Early / Incidence not known
tremor / Early / Incidence not known

Common Brand Names

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

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

Dosage And 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

Have patient fast for at least 3 to 4 hours before administration, with no solid foods consumed within 2 hours before administration. Give 240 mL (approximately 8 ounces) 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.

Oral dosage (Suflave) Adults

Administer the first dose (i.e., 1 bottle with flavor enhancing packet) the evening before colonoscopy and the second dose (i.e., 1 bottle with flavor enhancing packet) approximately 5 to 8 hours before the colonoscopy, but no sooner than 4 hours from starting Dose 1. Each dose is administered by drinking 240 mL (8 ounces) of solution every 15 minutes until the bottle is empty. If nausea, bloating, or abdominal cramping occurs, pause or slow the rate for drinking the solution, and drink additional water until symptoms diminish. Drink an additional 480 mL (16 ounces) of water during the evening and morning before the colonoscopy. Stop drinking liquids at least 2 hours before the colonoscopy.

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

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

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).

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; 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; 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.
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.
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.
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: (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.
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.
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.
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; 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) 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: (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.
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.
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) 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.
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.
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.
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.
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) 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.
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) 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.

How Supplied

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/SUFLAVE/TriLyte Oral Pwd F/Recon
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

Maximum Dosage
Adults

4 liters per 24 hours PO; 2 liters per 24 hours PO for Suflave.

Geriatric

4 liters per 24 hours PO; 2 liters per 24 hours PO for Suflave.

Adolescents

4 liters per 24 hours PO for most products; some products are not approved for use in patients less than 18 years of age.

Children

25 mL/kg/hour PO (NuLytely, GaviLyte-N, and Trilyte only). Some products are not approved for use in pediatric patients.

Infants

6 to 11 months: 25 mL/kg/hour PO (NuLytely, GaviLyte-N, and Trilyte only). Some products are not approved for pediatric patients.
1 to 5 months: Safety and efficacy have not been established.

Neonates

Safety and efficacy have not been established.

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.

Pregnancy And Lactation
Pregnancy

Administer polyethylene glycol; electrolytes solution (PEG-3350 with electrolytes) for bowel preparation 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 these bowel preparation products, when used as intended, can cause fetal harm when given during pregnancy. 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.

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.