Version May 2024
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
There are no dosage adjustments provided in the manufacturer's labeling. Use with caution due to risks of fluid and electrolyte abnormalities.
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Central nervous system: Malaise (57%)
Gastrointestinal: Gastrointestinal fullness (40%), abdominal cramps (38%), nausea (34%)
1% to 10%: Gastrointestinal: Vomiting (10%)
<1%, postmarketing and/or case reports: 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
Gastrointestinal obstruction; bowel perforation; toxic colitis; toxic megacolon; gastric retention; ileus
Bi-Peglyte [Canadian product]: Hypersensitivity to bisacodyl, polyethylene glycol or any component of the formulation; ileus; gastric retention; GI obstruction; bowel perforation; toxic colitis; toxic megacolon; acute surgical abdomen; appendicitis; rectal bleeding; gastroenteritis; diverticulitis
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; do not combine with starch-based thickeners due to potential for choking or aspiration.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
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)
No
Kit (PEG-Prep Oral)
5-210 mg-g (per each): $94.67
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit [each kit contains]:
Bi-Peglyte Bowel Prep Kit:
PEG 3350 59.55 g, sodium bicarbonate 1.69 g, sodium chloride 1.46 g, sodium sulfate 5.74 g, potassium chloride 0.76 g (1000 mL ) [contains 2 sachets: fruit flavor] [contains saccharin sodium]
Tablet, delayed release, oral (Bisacodyl): 5 mg (3s)
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; do not add any other ingredients (including starch-based thickeners) except flavor packets to the solution. 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.
An FDA-approved patient medication guide, which is available with the product information and at http://www.fda.gov/downloads/Drugs/DrugSafety/UCM220644.pdf, must be dispensed with this medication.
Bowel cleansing: Bowel cleansing prior to colonoscopy.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Agents With Seizure Threshold Lowering Potential: May enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of seizure may be increased. Risk C: Monitor therapy
Angiotensin II Receptor Blockers: May enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: May enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy
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. Management: Antacids should not be used within 1 hour before bisacodyl administration. Risk D: Consider therapy modification
ChlorproMAZINE: May enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of seizure may be increased. Polyethylene Glycol-Electrolyte Solution may decrease the absorption of ChlorproMAZINE. Management: Give oral chlorpromazine at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Monitor for seizures. Risk D: Consider therapy modification
Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy
Digoxin: Polyethylene Glycol-Electrolyte Solution may decrease the absorption of Digoxin. Management: Give oral digoxin at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider therapy modification
Diuretics: May enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy
Iron Preparations: Polyethylene Glycol-Electrolyte Solution may decrease the absorption of Iron Preparations. Management: Give oral iron products at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider therapy modification
Laxatives (Stimulant): May enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of colonic mucosal aphthous ulcerations may be increased. Management: Consider avoiding this combination due to a potential for increased risk of colonic mucosal aphthous ulcerations. Risk D: Consider therapy modification
Nonsteroidal Anti-Inflammatory Agents: May enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy
PenicillAMINE: Polyethylene Glycol-Electrolyte Solution may decrease the absorption of PenicillAMINE. Management: Give penicillamine at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider therapy modification
Polyethylene Glycol-Electrolyte Solution: Laxatives (Stimulant) may enhance the adverse/toxic effect of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of colonic mucosal aphthous ulcerations may be increased. Management: Consider avoiding this combination due to a potential for increased risk of colonic mucosal aphthous ulcerations. Risk D: Consider therapy modification
Quinolones: Polyethylene Glycol-Electrolyte Solution may decrease the absorption of Quinolones. Management: Give oral quinolones at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider therapy modification
Sodium Sulfate: Laxatives (Stimulant) may enhance the adverse/toxic effect of Sodium Sulfate. Specifically, the risk of mucosal ulceration or ischemic colitis may be increased. Risk X: Avoid combination
Tetracyclines: Polyethylene Glycol-Electrolyte Solution may decrease the absorption of Tetracyclines. Management: Give oral tetracyclines at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider therapy modification
Animal reproduction studies have not been conducted with this combination. Refer to individual monographs for additional information.
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.
Bowel movements; electrolytes, renal function
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.
See individual agents.
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