What is the best way to increase Polyethylene Glycol (PEG) for treating constipation?

From the Guidelines

To increase polyethylene glycol (PEG) for constipation, start with the recommended dose on the package (typically 17g of powder mixed in 8 ounces of water once daily) and gradually increase if needed, as supported by the American Gastroenterological Association-American College of Gastroenterology clinical practice guideline 1.

Key Considerations

• The guideline recommends the use of PEG compared with management without PEG, with a strong recommendation and moderate certainty of evidence 1.
• PEG works by drawing water into the intestines to soften stool and increase bowel movements without being absorbed into the bloodstream, making it safe for most people.
• You can safely increase to twice daily dosing, and some patients may require up to 34g (2 doses) twice daily in severe cases.
• Always mix the powder completely in water or another beverage before drinking.
• Begin the increase by adding an extra half dose for 2-3 days, then move to a full second dose if constipation persists.
• Drink plenty of water throughout the day while taking PEG, as adequate hydration helps the medication work effectively.
• If you don't see improvement after increasing to the maximum dose for several days, or if you experience new symptoms like abdominal pain or vomiting, consult your healthcare provider as another approach may be needed.

Potential Side Effects

• Common side effects of PEG include bloating, abdominal distension, loose stool, flatulence, and nausea, as noted in the guideline 1.
• These effects are consistent with and expected from laxative therapy, and most of these events were mild or moderate.

Comparison with Other Treatments

• The guideline also discusses the use of other medications, such as fiber, magnesium oxide, lactulose, bisacodyl, and picosulfate, but PEG is recommended as a first-line treatment for chronic idiopathic constipation due to its efficacy and safety profile 1.

From the FDA Drug Label

USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days The best way to increase PEG for constipation is to take polyethylene glycol (PO) as it relieves occasional constipation and generally produces a bowel movement in 1 to 3 days 2.

• The active ingredient is Polyethylene Glycol 3350, with a dose of 17 g 2.

From the Research

Increasing PEG for Constipation

To increase PEG (Polyethylene Glycol) for constipation, several studies have investigated the efficacy and optimal dose of PEG in children and adults.

• The optimal dose of PEG 3350 for children with chronic constipation was found to be around 0.8 g/kg/day 3.
• In adults with severe constipation and faecal impaction, a dose of up to eight 13.8 g sachets of PEG+E (polyethylene glycol + electrolyte solution) per day was effective 4.
• A study on colonic lavage solution (PEG-ELS) found that a dose of 16 oz per day was superior to 8 oz per day in terms of mean stool frequency and consistency 5.
• Another study found that polyethylene glycol 3350 17 g once daily was effective in treating chronic idiopathic constipation in adults 6.
• Long-term efficacy of polyethylene glycol 3350 was also assessed in children with and without encopresis, with an average effective dose of 0.7 g/kg/day 7.

Key Findings

• PEG 3350 is an effective treatment for constipation in both children and adults.
• The optimal dose of PEG 3350 varies depending on the population and severity of constipation.
• PEG+E solution is also effective in treating severe constipation and faecal impaction in adults.
• Long-term PEG therapy is effective for the treatment of chronic constipation with and without encopresis in children.

Dosage Considerations

• The dose of PEG 3350 should be adjusted based on individual response and tolerance.
• The dose range for children is around 0.7-0.8 g/kg/day, while adults may require up to 17 g once daily.
• PEG+E solution may be administered at a dose of up to eight 13.8 g sachets per day.