From the FDA Drug Label
CONTRAINDICATIONS Polyethylene Glycol 3350 NF is contraindicated in patients with known or suspected bowel obstruction and patients known to be allergic to polyethylene glycol. The contraindications to Miralax use are:
- Known or suspected bowel obstruction
- Known allergy to polyethylene glycol 1
From the Research
Miralax (polyethylene glycol 3350) should not be used in patients with known or suspected bowel obstruction, intestinal perforation, or hypersensitivity to the medication, as it can exacerbate these conditions and lead to severe morbidity and mortality. It is also contraindicated in those with toxic colitis, toxic megacolon, ileus, or gastric retention, as it can worsen these conditions and impact quality of life. Patients with symptoms of appendicitis should avoid Miralax until medical evaluation is completed, as it can mask symptoms and delay diagnosis. While generally considered safe during pregnancy and breastfeeding, consultation with a healthcare provider is recommended before use, as the evidence is limited and caution is advised. Caution is advised in patients with kidney disease, as electrolyte imbalances may occur, and Miralax can affect renal function, particularly in those with pre-existing kidney disease 2.
Key Considerations
- Miralax works by drawing water into the intestinal tract, softening stool and increasing bowel movements, which can be beneficial for patients with constipation, but may be harmful in certain conditions.
- The standard adult dose is 17 grams (about 1 heaping tablespoon) dissolved in 8 ounces of water once daily, but this may need to be adjusted in patients with kidney disease or other comorbidities.
- Patients should maintain adequate fluid intake while using Miralax to prevent dehydration and discontinue use if severe abdominal pain, nausea, or vomiting occurs, as these can be signs of underlying conditions that may be exacerbated by Miralax.
- The most recent study on the use of high-dose polyethylene glycol-3350 and Gatorade solutions for patients with previous inadequate bowel preparations for colonoscopy found that it is safe and effective, but this may not be generalizable to all patients, particularly those with certain comorbidities or conditions 2.
Important Warnings
- Miralax can cause severe abdominal pain, nausea, and vomiting in some patients, which can impact quality of life and lead to morbidity and mortality if not addressed promptly.
- Patients with a history of bowel obstruction, intestinal perforation, or hypersensitivity to the medication shouldn't use Miralax, as it can lead to severe complications and impact morbidity and mortality.
- Caution is advised in patients with kidney disease, as electrolyte imbalances may occur, and Miralax can affect renal function, particularly in those with pre-existing kidney disease 2.
Recommendations
- Miralax should be used with caution in patients with certain comorbidities or conditions, and the benefits and risks should be carefully weighed before initiating treatment.
- Patients should be closely monitored for signs of adverse effects, such as severe abdominal pain, nausea, and vomiting, and Miralax should be discontinued if these occur.
- The standard adult dose of Miralax should be adjusted in patients with kidney disease or other comorbidities, and patients should maintain adequate fluid intake while using Miralax to prevent dehydration.