Polyethylene glycol-electrolyte solution (PEG-ES)

WHY is this medicine prescribed?

Polyethylene glycol-electrolyte solution (PEG-ES) is used to empty the colon (large intestine, bowel) before a colonoscopy (examination of the inside of the colon to check for colon cancer and other abnormalities) or barium enema (a test in which the colon is filled with a fluid and then x-rays are taken) so that the doctor will have a clear view of the walls of the colon. PEG-ES is in a class of medications called osmotic laxatives. It works by causing watery diarrhea so that the stool can be emptied from the colon. The medication also contains electrolytes to prevent dehydration and other serious side effects that may be caused by fluid loss as the colon is emptied.

HOW should this medicine be used?

Polyethylene glycol-electrolyte solution (PEG-ES) comes as a powder to mix with water and take by mouth. Certain PEG-ES products may also be given through a nasogastric tube (NG tube; a tube that is used to carry liquid nutrition and medication through the nose to the stomach for people who cannot eat enough food by mouth). It is usually taken the evening before and/or the morning of the procedure. Your doctor will tell you when you should begin taking PEG-ES, and whether you should take all of the medication at one time or take it as two separate doses. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take PEG-ES exactly as directed. Do not take more or less of it than prescribed by your doctor.

You may not eat any solid foods or drink milk before and during your treatment with PEG-ES. You should only have clear liquids. Your doctor will tell you when to begin the clear liquid diet and can answer any question about which liquids are allowed. Examples of clear liquids are water, light colored fruit juice without pulp, clear broth, coffee or tea without milk, flavored gelatin, popsicles, and soft drinks. Do not drink any liquid that is red or purple. You will need to drink a certain amount of clear liquids during your treatment to decrease the chance that you will become dehydrated as your colon is emptied. Tell your doctor if you have trouble drinking enough clear liquids during your treatment.

You will need to mix your medication with lukewarm water so that it will be ready to drink. Read the directions that come with your medication to see how much water you should add to the powder and whether you should mix it in the container it came in or in another container. Follow these directions carefully and be sure to shake or stir the mixture so that the medication is mixed evenly. If your medication comes with flavor packets, you may add the contents of one packet to the medication to improve the taste, but you should not add any other flavorings to the medication. Do not mix your medication with any liquid other than water, and do not try to swallow the medication powder without mixing it with water. After you mix your medication, you may chill it in the refrigerator to make it easier to drink. However, if you will be giving the medication to an infant, you should not chill it.

Your doctor will tell you exactly how to take PEG-ES. You will probably be told to drink one 8 ounce (240 mL) glass of PEG-ES every 10 or 15 minutes, and to continue drinking until your liquid bowel movements are clear and free of solid material. It is best to drink each glass of medication quickly instead of sipping it slowly. Dispose of any leftover medication that you use for this treatment.

You will have many bowel movements during your treatment with PEG-ES. Be sure to stay close to a toilet from the time you take your first dose of the medication until the time of your colonoscopy appointment. Ask your doctor about other things you can do to stay comfortable during this time.

You may experience stomach pain and bloating while you are taking your medication. If these symptoms become severe, drink each glass of medication slowly or allow more time between drinking glasses of medication. Call your doctor if these symptoms do not go away.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) if it is available for the brand of PEG-ES you are taking when you begin treatment with this medication. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

What SPECIAL PRECAUTIONS should I follow?

Before taking PEG-ES,

• tell your doctor and pharmacist if you are allergic to PEG-ES, any other medications, or any of the ingredients in the PEG-ES product you are taking. Ask your pharmacist or check the manufacturer's information for the patient for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking PEG-ES. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. .

• the following nonprescription products may interact with PEG-ES: aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen (Motrin) and naproxen (Aleve, Naprosyn). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking PEG-ES. Do not start any of these medications while taking PEG-ES without discussing with your healthcare provider.

• do not take any other laxatives during your treatment with PEG-ES.

• if you are taking any other medications by mouth, take them at least 1 hour before you begin your treatment with PEG-ES.

• tell your doctor if you have a blockage in your intestine, a hole in the lining of your stomach or intestine, toxic megacolon (a serious or life-threatening widening of the intestine), or any condition that causes problems with the emptying of your stomach or intestine. Your doctor will probably tell you not to take PEG-ES.

• tell your doctor if you have or have ever had an irregular heartbeat, a prolonged QT interval (an inherited condition that may cause irregular heartbeat, fainting, or sudden death), a recent heart attack, chest pain, heart failure, an enlarged heart, seizures, acid reflux, difficulty swallowing, inflammatory bowel disease (conditions that causes swelling of the lining of the intestine) such as ulcerative colitis (a condition which causes swelling and sores in the lining of the colon [large intestine] and rectum), G6-PD deficiency (an inherited blood disease), low levels of sodium, magnesium, potassium, or calcium in your blood, any condition that increases the risk that you will choke or inhale food to your lungs, or kidney disease. If you will be using Moviprep^® or Plenvu^® brand PEG-ES, also tell your doctor if you have phenylketonuria (PKU; an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability).

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

What SPECIAL DIETARY instructions should I follow?

Your doctor will tell you what you may eat and drink before, during, and after your treatment with PEG-ES. Follow these directions carefully.

What should I do IF I FORGET to take a dose?

Call your doctor if you forget or are unable to take this medication exactly as directed.

What SIDE EFFECTS can this medicine cause?

PEG-ES may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• stomach pain, cramps, or fullness
• bloating
• rectal irritation
• weakness
• heartburn
• thirst
• hunger
• chills

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical help:

• rash
• hives
• itching
• swelling of the eyes, face, mouth, lips, tongue, arms, hands, feet, ankles, or lower legs
• difficulty breathing or swallowing
• vomiting
• dizziness
• headache
• decreased urination
• irregular heartbeat
• seizures
• bleeding from rectum

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the mixed solution in the refrigerator. If you are using Colyte^®, Nulytely^®, or Trilyte^® brand solutions, use it within 48 hours after mixing. If you are using Moviprep^® brand solution, use it within 24 hours after mixing. If you are using Plenvu^® brand solution, use it within 6 hours after mixing.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain laboratory tests to check your body's response to PEG-ES.

Do not let anyone else take your medication.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

^¶ This branded product is no longer on the market. Generic alternatives may be available.