From the Guidelines
Yes, RestoraLAX (polyethylene glycol 3350 or PEG) can be used safely in elderly patients with chronic constipation at a half dose (8g) daily on an ongoing basis, as it is often appropriate for elderly individuals who may be more sensitive to medications or have decreased kidney function 1. PEG works by drawing water into the intestines to soften stool and increase bowel movements without being absorbed into the bloodstream, making it generally safe for long-term use.
Key Considerations
- When starting treatment, ensure adequate fluid intake (at least 8 glasses of water daily) to maximize effectiveness and prevent dehydration.
- The powder should be fully dissolved in 4-8 ounces of any beverage before consumption.
- If constipation persists after 7 days of use, consult a healthcare provider.
- Side effects are typically mild and may include bloating, gas, or nausea.
Preference for PEG in Elderly Patients
PEG is preferred in elderly patients because it doesn't cause dependency, significant electrolyte disturbances, or interact with most medications, making it safer than stimulant laxatives for ongoing use 2. Additionally, PEG (17 g/day) offers an efficacious and tolerable solution for elderly patients with a good safety profile 2.
Monitoring and Precautions
Regular monitoring of chronic kidney/heart failure is necessary when a concomitant treatment with diuretics or cardiac glycosides is prescribed, due to the risk of dehydration and electrolyte imbalances 2. Laxatives must be individualized and targeted to the older person’s medical history, drug interactions, and adverse effects 2.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: The recommended dose for adults is 4 liters of PEG-3350 and Electrolytes for Oral Solution solution The FDA drug label does not answer the question.
From the Research
Treatment of Chronic Constipation in the Elderly
- Chronic constipation is a common disorder in the elderly population, affecting 15%-30% of individuals aged >60 years 3.
- The treatment of chronic idiopathic constipation is empiric, based on a stepwise approach, including lifestyle advice, adjustment of chronic medications, and prescription of laxatives 3.
- Osmotic laxatives, such as polyethylene glycol (PEG), are commonly used to treat constipation in the elderly 4, 5, 6.
Use of Polyethylene Glycol (PEG) in the Elderly
- PEG is an effective and safe treatment for chronic constipation in the elderly 4, 6.
- The usual dose of PEG is 17g daily, but a half dose (8g) may be considered for ongoing use in the elderly, depending on the individual patient's response and tolerance 4, 6.
- However, there is limited specific guidance on the use of a half dose (8g) of PEG daily in the elderly population, and the decision to use this dose should be based on individual patient factors and clinical judgment 3, 5, 7.
Considerations for Treatment of Constipation in the Elderly
- Treatment of constipation in the elderly should be individualized, taking into account the patient's overall clinical status, capabilities, and underlying etiology of constipation 7.
- Healthcare providers should proactively identify older constipated patients who are self-medicating or not receiving treatment, and increase awareness of constipation, its complications, and treatment options among healthcare providers, patients, and carers 5.