What is the recommended regimen for Pericolace and Miralax in treating constipation?

Pericolace BID and Miralax Daily for Constipation Management

For constipation management, the recommended regimen is polyethylene glycol (Miralax) 17g daily as the primary treatment, with Pericolace (docusate sodium + senna) twice daily as an adjunctive therapy when needed for more severe or persistent constipation. 1

First-Line Treatment Approach

Polyethylene Glycol (Miralax)

• Dosage: 17g daily mixed in 8oz of water
• Mechanism: Osmotic laxative that draws water into the intestinal lumen
• Efficacy: Shown to be effective for both short-term and long-term constipation management
• Advantages:
  • No maximum dose limit 1
  • Durable response over 6 months 1
  • Safe for extended use
  • Minimal drug interactions

Pericolace (Docusate Sodium + Senna)

• Dosage: 1 tablet twice daily
• Mechanism: Combination of stool softener (docusate) and stimulant laxative (senna)
• Role: Adjunctive therapy when Miralax alone is insufficient
• Caution: Long-term safety of stimulant laxatives is not well established 1

Treatment Algorithm Based on Constipation Severity

Mild Constipation

1. Start with Miralax 17g daily alone
2. Ensure adequate hydration (essential for Miralax efficacy)
3. Monitor for response within 24-72 hours

Moderate Constipation

1. Miralax 17g daily
2. Add Pericolace once daily if inadequate response after 3 days
3. Increase to Pericolace twice daily if needed

Severe Constipation

1. Miralax 17g daily
2. Pericolace twice daily
3. Consider increasing Miralax dose (no clear maximum dose) 1
4. Goal: 1 non-forced bowel movement every 1-2 days 1

Special Considerations

For Opioid-Induced Constipation

• Continue Miralax and Pericolace as above
• If inadequate response, consider adding methylnaltrexone 0.15 mg/kg subcutaneously every other day 1
• Contraindicated in post-operative ileus and mechanical bowel obstruction 1

For Fecal Impaction

• Rule out impaction if constipation persists despite treatment
• May require glycerine suppository or manual disimpaction 1
• After disimpaction, resume Miralax daily and Pericolace BID

Monitoring and Adjustments

• Target outcome: One non-forced bowel movement every 1-2 days 1
• Assessment timeframe: Evaluate response after 1 week of treatment
• Duration of therapy: Can be used long-term, though periodic reassessment is recommended

Common Pitfalls to Avoid

1. Inadequate fluid intake: Miralax requires adequate hydration to work effectively
2. Abrupt discontinuation: May lead to recurrence of constipation (61.7% of patients required additional treatment within 30 days of stopping Miralax) 2
3. Overreliance on stimulant laxatives: Long-term use of stimulant components in Pericolace may lead to dependency
4. Failure to rule out underlying causes: Always consider other causes of constipation (e.g., hypercalcemia, hypothyroidism, medications) 1

This regimen provides an effective approach to managing constipation while minimizing side effects and maintaining quality of life. The combination allows for titration based on individual response, with Miralax providing consistent osmotic action and Pericolace offering additional stimulant effects when needed.