Moviprep (peg 3350/sodium sulfate/sod chloride/KCl/ascorbate sod/vit C)
Hypertonic Laxatives Oral Powder In Packet (EA)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Glycerin (glycerol), polyethylene glycol (PEG), and sorbitol are hyperosmotic laxatives.
USES: PEG (polyethylene glycol) with electrolyte is used to clean out the intestines before certain bowel exam procedures such as colonoscopy or barium enema X-rays. It is a laxative that works by drawing large amounts of water into the colon. This effect results in watery bowel movements.
Clearing stool from the intestines helps your doctor to better examine the intestines during your procedure.
Generic name: peg 3350/sodium sulfate/sod chloride/KCl/ascorbate sod/vit C
Pronunciation: (PEG/ih-LECK-troh-lite)
Drug class: Hypertonic Laxatives
Therapeutic class: Gastrointestinal Therapy Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Moviprep
Indications
The following indications are listed for Moviprep:
- Bowel Evacuation
Dosing
Prior to bowel cleansing, a copy of the patient information (containing careful instructions on the proper methods of reconstitution and administration of the laxatives) provided by the manufacturer should be given to the patient.
No dosing information is available for this tab.
| Drug label | Dosing type | Instructions |
|---|---|---|
| Moviprep Powder Packet | Maintenance | Take by oral route as directed per package instructions. |
| Drug label | Dosing type | Instructions |
|---|---|---|
| Peg3350 100-7.5-2.691-1.01-5.9 | Maintenance | Take by oral route as directed per package instructions. |
Drug interactions
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There are no contraindication interactions for this drug.
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Ascorbic Acid (VITAMIN C)/Bortezomib
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Vitamin C can form a complex with the boronic acid moiety of the bortezomib molecule, preventing its absorption into cells.(1-4) This may protect normal tissue in the body, which may have higher levels of Vitamin C.(5)
CLINICAL EFFECTS: Concurrent administration of Vitamin C may result in decreased bortezomib activity.(1-4)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Instruct patients receiving bortezomib therapy not to begin taking vitamin C supplements without consulting their oncologist first. Patients who are instructed to take vitamin C should follow their oncologist's instructions on how to separate dosages and should be carefully monitored for bortezomib efficacy.
DISCUSSION: An in vitro study with human plasma and multiple myeloma cells found that high levels of vitamin C (following 1 gram/day of ascorbic acid for 4 days) decreased bortezomib effectiveness by 26%. An in vivo study in mice found that vitamin C administration with bortezomib completely blocked the response of bortezomib.(6) An in vitro study in rat Schwann cells and myeloma cells(4) and an in vivo study in mice(7) found that delayed administration of vitamin C had no effect on bortezomib effects. In an in vivo study in multiple myeloma patients, concurrent ascorbic acid, arsenic trioxide, bortezomib, and high-dose melphalan in which ascorbic acid was administered close to bortezomib, the combination was safe and well tolerated, but produced no changes in response rates.(8) In another in vivo study in multiple myeloma patients, a regimen of ascorbic acid, bortezomib, and melphalan in which bortezomib was administered in the morning and ascorbic acid in the evening was found to be safe and efficacious, with 74% of patients responding to therapy.(9)
Laxatives; Stool Softeners/Tenapanor
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Tenapanor commonly causes diarrhea of mild to moderate severity. Laxatives and stool softeners may increase the incidence or severity of diarrhea.(1)
CLINICAL EFFECTS: Concurrent use of laxatives or stool softeners with tenapanor may increase the risk of severe diarrhea.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer of tenapanor states that patients should be instructed to avoid stool softeners and laxatives with tenapanor. If severe diarrhea occurs, tenapanor should be discontinued.(1)
DISCUSSION: In clinical trials, 43-53% of CKD patients on dialysis treated with tenapanor developed diarrhea. Diarrhea usually occurred soon after treatment initiation and was severe in 5% of patients.(1)
Polyethylene Glycol/Starch-Based Thickeners
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Polyethylene glycol when mixed in a starch-thickened liquid may cause an isothermal rotational rheology reaction to occur and may cause the starch-thickened liquid to become near-water consistency.(1,2)
CLINICAL EFFECTS: Mixing polyethylene glycol in a starch-thickened liquid may result in near-water consistency liquids. Patients receiving starch-thickened liquids due to dysphagia may be at risk when consuming near-water consistency liquids, including aspiration of the liquid upon consumption.(1,2)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Polyethylene glycol should not be mixed together in starch-thickened liquids. Literature suggests polyethylene glycol with xanthan gum based thickeners is compatible. Consider mixing polyethylene glycol in liquid thickened with xanthan gum based thickeners only.(1)
DISCUSSION: A case report details a patient on a nectar-thickened liquid diet with constipation who was prescribed polyethylene glycol. The polyethylene glycol was mixed in thickened apple juice and the liquid immediately thinned to near-water consistency. Results of near-water consistency were also observed when polyethylene glycol was mixed with thickened water and coffee.(2) A case report details a complex patient who received polyethylene glycol (PEG) 3350 for constipation mixed in starch-based prethickened juice and on the second day of administration was noted to be "gurgly" after swallowing the dose. The patient was suspected to have aspirated during repositioning and passed away a couple hours later. Cause of death was unknown, however aspiration was noted to be a contributing factor.(1)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Ascorbic Acid (VITAMIN C)/Deferoxamine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: It is believed that ascorbic acid increases the iron available for chelation from an labile intracellular iron pool. Ascorbic acid may then facilitate iron-induced oxidative tissue damage.(1)
CLINICAL EFFECTS: Dietary ascorbic acid may increase the absorption of dietary iron. Supplemental ascorbic acid therapy given during chelation therapy may improve iron output;(1-9) however, excessive dosages may result in cardiac toxicity from iron-induced oxidative tissue damage.(1,2,11-13)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Ascorbic acid intake is often restricted in patients with iron overload; however, it has been used in conjunction with deferoxamine to increase iron excretion.(2) Supplemental ascorbic acid therapy should only be initiated after one month of deferoxamine therapy. Ascorbic acid therapy should only be given in patients receiving deferoxamine regularly and the dose should be given after the infusion has started. The dosage of ascorbic acid should be limited to 50 mg daily in children under 10 years of age; 100 mg daily in older children; and 200 mg daily, in divided doses, in adults.(2) Cardiac function should be monitored in patients receiving concurrent therapy. Discontinue ascorbic acid therapy in patients who develop cardiac dysfunction.(2)
DISCUSSION: Supplemental ascorbic acid therapy given during chelation therapy has been shown to improve iron output,(1-9) possibly by increasing iron available for chelation from an labile intracellular iron pool.(1) However, dosages in excess of 500 mg daily have been associated with cardiac dysfunction.(1,2,11-13)
Contraindications
There is no enhanced messaging for this drug.
- Familial hyperkalemic periodic paralysis
- Gastrointestinal obstruction
- Gastrointestinal perforation
- Hemolytic anemia from pyruvate kinase and g6PD deficiencies
- Hyperkalemia
- Ileus
- Toxic colitis
- Toxic megacolon
- Anuria
- Calcium oxalate renal calculi
- Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
- Chronic kidney disease stage 5 (failure) GFr<15 ml/min
- Complete atrioventricular block
- Dehydration
- Gastric retention
- Gastrointestinal ulcer
- Glucose-6-phosphate dehydrogenase (g6Pd) deficiency
- Hyperchloremia
- Hyperoxaluria
- Hypokalemia
- Hyponatremia
- Hyporeninemic hypoaldosteronism
- Myotonia congenita - autosomal dominant form
- Predisposition to aspiration
- Seizure disorder
- Severe burns
- Severe heart block
- Hemochromatosis
- Hypocalcemia
- Kidney disease with likely reduction in glomerular filtration rate (GFr)
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Severe ulcerative colitis
- Severe vomiting
- Sickle cell disease
Adverse reactions
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Less Frequent
- Acidosis
- Hypercalcemia
- Hyperkalemia
- Hypernatremia
- Hyperuricemia
- Hypocalcemia
- Hypokalemia
- Hypomagnesemia
- Hyponatremia
- Hypophosphatemia
- Urticaria
Rare or Very Rare
- Abnormal hepatic function tests
- Acute pulmonary edema
- Anaphylaxis
- Angioedema
- Asystole
- Atrial fibrillation
- Cardiac arrhythmia
- Dyspnea
- Esophageal perforation
- Facial edema
- Gastritis
- Hypertension
- Ischemic colitis
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Lip swelling
- Peripheral edema
- Pulmonary edema
- Seizure disorder
- Skin rash
- Syncope
- Tachycardia
- Throat constriction
- Tongue swelling
- Tremor
- Ulceration of colon
- Upper GI bleed
More Frequent
- Abdominal distension
- Abdominal pain with cramps
- Acute abdominal pain
- Dehydration
- Malaise
- Nausea
- Polydipsia
- Rectal irritation
- Sleep disorder
- Upper abdominal pain
- Vomiting
Less Frequent
- Dizziness
- Dyspepsia
- Headache disorder
- Rhinorrhea
Rare or Very Rare
- Chest tightness
- Chills
- Fever
- Fluid volume disorder
- Palpitations
- Pruritus of skin
- Skin inflammation
Precautions
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No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
ICD codes
| Code | Type | Description |
|---|---|---|
| Bowel evacuation | ||
| 3E1H78Z | ICD10PCS | Irrigation of lower GI using irrigating substance, via natural or artificial opening |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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