Miralax (polyethylene glycol 3350)
Hypertonic Laxatives Oral Powder (GRAM)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Glycerin (glycerol), polyethylene glycol (PEG), and sorbitol are hyperosmotic laxatives.
USES: This medication is used to treat occasional constipation. It works by holding water in the stool to soften the stool and increases the number of bowel movements. It is known as an osmotic-type laxative.
This medication is also available without a prescription. If you are taking this medication for self-treatment, it is important to read the manufacturer's package instructions carefully so you know when to consult your doctor or pharmacist. (See also Precautions.)
Generic name: polyethylene glycol 3350
Pronunciation: (paw-lee-ETH-ih-leen GLY-coll)
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 Miralax
Indications
The following indications are listed for Miralax:
- Constipation
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.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Laxatives/Trofinetide
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Trofinetide commonly causes diarrhea of mild to moderate severity. Laxatives may increase the incidence or severity of diarrhea.(1)
CLINICAL EFFECTS: Concurrent use of laxatives with trofinetide may increase the risk of severe diarrhea.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Patients should stop laxatives before starting trofinetide. If diarrhea occurs, consider anti-diarrheal treatment and monitor hydration status. If severe diarrhea or dehydration occurs, interrupt, reduce dose, or discontinue trofinetide.(1)
DISCUSSION: In clinical trials, 85% of patients on trofinetide developed diarrhea. Concurrent use of laxatives may increase this risk.(1)
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)
There are no moderate interactions for this drug.
Contraindications
There is no enhanced messaging for this drug.
- Gastrointestinal obstruction
- Gastrointestinal perforation
- Toxic colitis
- Toxic megacolon
- Irritable bowel syndrome
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Severe vomiting
There are no moderate contraindications for this drug.
Adverse reactions
There is no enhanced messaging for this drug.
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
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
ICD codes
| Code | Type | Description |
|---|---|---|
| Constipation | ||
| K59.0 | ICD10CM | Constipation |
| K59.00 | ICD10CM | Constipation, unspecified |
| K59.01 | ICD10CM | Slow transit constipation |
| K59.03 | ICD10CM | Drug induced constipation |
| K59.04 | ICD10CM | Chronic idiopathic constipation |
| K59.09 | ICD10CM | Other constipation |
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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