Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Irrigation:
Generic: 3% (3000 mL); 3.3% (2000 mL, 4000 mL)
Solution, Oral:
Generic: 70% (30 mL, 473 mL, 474 mL, 480 mL, 3840 mL)
Solution, Rectal:
Generic: 70% (473 mL)
Pharmacology
Mechanism of Action
A polyalcoholic sugar with osmotic cathartic actions
Pharmacokinetics/Pharmacodynamics
Absorption
Oral, rectal: Poor
Metabolism
Primarily hepatic to fructose
Onset of Action
Rectal: 0.25-1 hour
Use: Labeled Indications
Genitourinary irrigant in transurethral prostatic resection or other transurethral resection or other transurethral surgical procedures; diuretic; humectant; sweetening agent; hyperosmotic laxative; facilitate the passage of sodium polystyrene sulfonate through the intestinal tract
Contraindications
Anuria (for irrigation)
OTC labeling: When used for self-medication, do not use for longer than 7 days or when abdominal pain, nausea, or vomiting is present.
Dosage and Administration
Dosing: Adult
Hyperosmotic laxative (as single dose, at infrequent intervals):
Oral: 30 to 45 mL (as 70% solution)
Rectal enema: 120 mL as 25% to 30% solution
Adjunct to sodium polystyrene sulfonate: 15 mL as 70% solution orally until diarrhea occurs (10 to 20 mL/2 hours) or 20 to 100 mL as an oral vehicle for the sodium polystyrene sulfonate resin
Transurethral surgical procedures: Irrigation: Topical: 3% to 3.3% as transurethral surgical procedure irrigation
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Constipation:
Oral: 70% solution:
Manufacturer's labeling: Children ≥12 years and Adolescents: Usual dose: 30 to 45 mL once daily as needed; maximum dose: 60 mL/dose; higher daily doses (60 to 90 mL in divided doses) may be necessary in some patients. Note: Consult product-specific labeling for detailed information.
Alternate dosing: Limited data available: Infants, Children and Adolescents: 1 to 3 mL/kg/day in divided doses, once or twice daily (Wyllie 2011). Usual range in adolescents: 30 to 90 mL/day
Rectal enema: 25% to 30% solution:
Children 2 to <12 years: 30 to 60 mL once daily as needed
Children ≥12 years and Adolescents: 120 mL once daily as needed
Fecal disimpaction, slow disimpaction: Oral: 70% solution: Limited data available: Infants, Children, and Adolescents: 2 mL/kg twice daily for 7 days (Pashankar 2005; Wyllie 2011)
Toxic ingestion, adjunct with charcoal: Children and Adolescents: Oral: 35% solution: 4.3 mL/kg; Note: Current guidelines recommend limiting use to a single dose administered with the initial charcoal dose of 1 g/kg (AACT/EAPCCT 2004).
Storage
Irrigation solution: Avoid storage in temperatures >150°F; do not freeze.
Oral solution: Store at 15°C to 30°C (59°F to 86°F); do not freeze; below 15°C (59°F) cloudiness and thickening may occur; warming will restore clarity and fluidity without affecting product quality.
Drug Interactions
Calcium Polystyrene Sulfonate: Sorbitol may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of these agents may increase the risk for intestinal necrosis. Avoid combination
LamiVUDine: Sorbitol may decrease the serum concentration of LamiVUDine. Management: When possible, avoid chronic coadministration of sorbitol-containing solutions with lamivudine, but if this combination cannot be avoided, monitor patients more closely for possible therapeutic failure associated with decreased lamivudine exposure. Consider therapy modification
Sodium Polystyrene Sulfonate: Sorbitol may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of these agents may increase the risk for intestinal necrosis. Avoid combination
Adverse Reactions
Frequency not defined.
Cardiovascular: Edema
Endocrine & metabolic: Electrolyte depletion, hyperglycemia, hypovolemia, lactic acidosis
Gastrointestinal: Abdominal distress, diarrhea, nausea, vomiting, xerostomia
Warnings/Precautions
Concerns related to adverse effects:
- Fluid/electrolyte imbalance: Large volumes may result in fluid overload and/or electrolyte changes.
Disease-related concerns:
- Cardiopulmonary disease: Use with caution in patients with severe cardiopulmonary disease.
- Renal impairment: Use with caution in patients with renal impairment.
- Unable to metabolize sorbitol: Use with caution in patients unable to metabolize sorbitol.
Monitoring Parameters
Monitor for fluid overload and/or electrolyte disturbances following large volumes; GI distress (bloating, flatulence)
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience heartburn, abdominal cramps, passing gas, or rectal irritation. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, fast heartbeat, increased thirst, seizures, loss of strength and energy, lack of appetite, unable to pass urine or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting), signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit), severe diarrhea, shortness of breath, excessive weight gain, swelling of arms or legs, severe abdominal pain, nausea, vomiting, dizziness, weakness, chest pain, or blurred vision (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
