polyethylene glycol/electrolytes/sodium ascorbate/ascorbic acid

Action and Spectrum

Actions and Spectrum: 

polyethylene Glycol (PEG): 

Action: polyethylene glycol (PEG) is a water-soluble polymer with many applications. In medicine, PEG is commonly used as a laxative in the form of polyethylene glycol-electrolyte solution (PEG-ELS), which helps to treat constipation by increasing the water content in the stool, making it simple to pass. PEG can also be used as a binder, filler, or solubilizing agent in pharmaceutical formulations. 

Spectrum: The spectrum of action of PEG primarily involves its role as an osmotic agent. When PEG-ELS is ingested, it draws water into the intestines by osmosis, softening the stool and increasing the frequency of bowel movements. This osmotic effect helps relieve constipation. Additionally, PEG has a broad spectrum of solubility, making it helpful in enhancing the solubility and bioavailability of poorly soluble drugs. 

electrolytes: 

Action: electrolytes are minerals in the body that carry an electric charge. They are crucial in maintaining proper fluid balance, nerve function, and muscle contraction. In medicine, electrolyte solutions are commonly used for rehydration, especially in dehydration due to diarrhea, vomiting, or excessive sweating. electrolyte solutions contain a balanced combination of sodium, potassium, chloride, and other minerals to restore electrolyte balance. 

Spectrum: The spectrum of action of electrolytes involves their ability to restore and maintain proper electrolyte balance in the body. Sodium, potassium, and chloride are essential for regulating fluid balance, maintaining nerve function, and supporting muscle contraction. By replenishing these electrolytes, electrolyte solutions help restore hydration and support normal physiological processes. 

sodium Ascorbate/ascorbic Acid (Vitamin C): 

Action: sodium ascorbate and ascorbic acid are different forms of vitamin C, a water-soluble vitamin with antioxidant properties. Vitamin C is vital in various physiological processes, including collagen synthesis, immune function, and iron absorption, and also acts as an antioxidant, protecting cells from damage caused by free radicals. sodium ascorbate and ascorbic acid are used as dietary supplements to ensure adequate vitamin C intake. 

Spectrum: The spectrum of action of sodium ascorbate and ascorbic acid involves their role as antioxidants and cofactors in enzymatic reactions. As antioxidants, vitamin C helps neutralize free radicals, reducing oxidative stress in the body. This can benefit the immune system, cardiovascular health, and skin health. ascorbic acid, which is also involved in collagen synthesis, which is essential for maintaining healthy connective tissues, wound healing, and overall skin health.

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

Full dose 

Hunger (30.2%) 

Anal discomfort (51.5%) 

Rigors (33.7%) 

Abdominal pain (39.1%) 

Thirst, nausea (47.3%) 

Malaise (26.6%) 

Abdominal distension (59.8%) 

Split-dose 

Nausea (14-47%) 

Malaise (18-27%) 

Abdominal pain (13-39%) 

Vomiting (17-12%) 

1-10% 

Full dose 

Dizziness (6.5%) 

Vomiting (7.1%) 

Headache (1.8%) 

Split-dose 

Upper abdominal pain (5.6%) 

Vomiting (7.8%) 

Dyspepsia (2.8%) 

Frequency not defined 

Dermatitis 

Anaphylactic reaction 

Bloating 

Urticaria 

Rhinorrhea 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

polyethylene Glycol (PEG): 

• Known hypersensitivity or allergy: Individuals with known hypersensitivity or allergy to polyethylene glycol or any other formulation component should avoid its use. 
• Intestinal obstruction: PEG should not be used in individuals with suspected or known intestinal obstruction, as it may worsen the condition. 

electrolytes: 

• Severe kidney dysfunction: In individuals with severe kidney dysfunction, specific electrolyte solutions may be contraindicated, as they can further disrupt electrolyte balance. Specific precautions and adjustments may be necessary in such cases. 

sodium Ascorbate/ascorbic Acid (Vitamin C): 

• Known hypersensitivity or allergy: Individuals with known hypersensitivity or allergy to sodium ascorbate, ascorbic acid, or any other formulation component should avoid its use. 
• Certain medical conditions: While vitamin C is generally considered safe, there may be contraindications, such as kidney stones, glucose-6-phosphate dehydrogenase deficiency, and certain iron overload disorders. It is key to consult a healthcare professional for guidance. 

Caution 

polyethylene Glycol (PEG): 

• Dehydration: PEG-electrolyte solutions should be used cautiously in individuals at risk of dehydration or insufficient fluid intake. Adequate hydration should be maintained during and after the use of PEG solutions. 
• Gastrointestinal disorders: PEG should be used cautiously in individuals with certain gastrointestinal disorders, such as inflammatory bowel disease or diverticulitis. Close monitoring may be necessary in these cases. 

electrolytes: 

• Kidney dysfunction: electrolyte solutions should be used cautiously in individuals with kidney dysfunction. Close monitoring of electrolyte levels is essential in these cases. 
• Heart conditions: Some electrolyte solutions, mainly those containing potassium, should be used with caution in individuals with heart conditions, as imbalances in electrolyte levels can affect cardiac function. 

sodium Ascorbate/ascorbic Acid (Vitamin C): 

• Iron overload disorders: Individuals with iron overload disorders, such as hemochromatosis, should use vitamin C supplements cautiously. Excessive vitamin C intake may increase iron absorption, potentially worsening the condition. 
• Oxalate kidney stones: High-dose vitamin C supplementation may increase the risk of oxalate kidney stone formation in susceptible individuals.  
• Interactions with certain medications: Vitamin C can interact with certain drugs, such as anticoagulants (blood thinners) and specific cancer treatments. It is key to consult with a healthcare professional before starting vitamin C supplements if you are taking any medications. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not Known. 

Lactation:   

Excreted into human milk: Not known. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

polyethylene glycol (PEG) is a water-soluble polymer that acts as an osmotic agent when used as a laxative in PEG-electrolyte solutions, increasing water content in the stool and relieving constipation.  

electrolytes, such as sodium, potassium, and chloride, play vital roles in maintaining fluid balance, nerve function, and muscle contraction; electrolyte solutions help restore these balances in the body.  

sodium ascorbate and ascorbic acid, vitamin C forms act as antioxidants, neutralizing free radicals and reducing oxidative stress. They are also involved in collagen synthesis, supporting wound healing and maintaining healthy connective tissues while promoting immune function and aiding iron absorption from plant-based sources. 

Pharmacodynamics: 

Mechanism of action: The action for polyethylene glycol (PEG), electrolytes, sodium ascorbate, and ascorbic acid are as follows: 

polyethylene Glycol (PEG): 

Mechanism of Action: PEG acts as an osmotic agent when used as a laxative in PEG-electrolyte solutions. It works by increasing the water content in the stool through osmosis. This osmotic effect helps to soften the stool and promote bowel movements, relieving constipation. 

electrolytes: 

Mechanism of Action: electrolytes, such as sodium, potassium, and chloride, play essential roles in maintaining the balance of fluids and electrolytes in the body. They contribute to nerve function, muscle contraction, and the maintenance of pH levels. When electrolyte levels are imbalanced, electrolyte solutions help restore these balances by providing the necessary minerals. 

sodium Ascorbate/ascorbic Acid (Vitamin C): 

Mechanism of Action: sodium ascorbate and ascorbic acid function as vitamin C, a cofactor in several enzymatic reactions. ascorbic acid is an antioxidant, protecting cells from damage caused by free radicals. It neutralizes these reactive molecules and reduces oxidative stress. Additionally, vitamin C is involved in collagen synthesis, supporting wound healing and maintaining healthy connective tissues, and also plays a role in supporting immune function and aiding the absorption of non-heme iron from plant-based sources. 

Pharmacokinetics: 

Absorption 

PEG is not significantly absorbed from the gastrointestinal tract. It acts primarily as an osmotic agent within the intestines. 

electrolytes, like sodium, potassium, and chloride, are readily absorbed from the gastrointestinal tract. The specific absorption mechanisms vary for each electrolyte. 

sodium ascorbate and ascorbic acid are absorbed from the gastrointestinal tract (G.I.T), mainly in the small intestine, through active transport and passive diffusion. 

Distribution 

PEG does not distribute extensively within the body since it remains primarily within the gastrointestinal tract. 

electrolytes are distributed throughout the body, with sodium being the most abundant extracellular cation and potassium being the principal intracellular cation. 

ascorbic acid is distributed throughout the body, with higher concentrations found in organs such as the adrenal glands, pituitary glands, brain, and liver. 

Metabolism 

The body does not metabolize PEG and is generally considered inert. 

electrolytes are not metabolized to a significant extent. 

Vitamin C undergoes various metabolic processes, including reduction, oxidation, and recycling. It can be converted to its active form, dehydroascorbic acid, and metabolized to oxalic acid, which is then excreted in the urine. 

Elimination and Excretion 

PEG and its metabolites are primarily excreted unchanged in the feces. 

electrolytes are primarily excreted via the kidneys through urine, although small amounts may be excreted through feces and sweat. 

Vitamin C and its metabolites are primarily excreted in the urine. Higher doses of vitamin C can result in increased urinary excretion due to its water-soluble nature. 

Adminstartion

Administration: 

Oral administration 

polyethylene Glycol (PEG): 

• PEG as a laxative: PEG is commonly used in PEG-electrolyte solutions. These solutions are typically provided as a powder/liquid that needs to be mixed with water before administration. Follow the instructions the healthcare professional provides or the product label for the appropriate dosage and mixing instructions. It is usually taken orally. 

electrolytes: 

• electrolyte solutions: electrolyte solutions are available in various forms, including oral solutions, tablets, or powders that require reconstitution. These solutions are typically taken orally. It is essential to maintain proper hydration while using electrolyte solutions. 

sodium Ascorbate/ascorbic Acid (Vitamin C): 

• Dietary supplementation: sodium ascorbate and ascorbic acid are commonly available as dietary supplements in various forms, including tablets, capsules, chewable tablets, or powders. It is typically taken orally with water or food. 
• Intravenous administration: In specific medical settings, high-dose vitamin C may be administered intravenously under medical supervision. This is usually done in specialized healthcare facilities and requires healthcare professional guidance. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: polyethylene glycol/electrolytes/sodium ascorbate/ascorbic acid 

Why do we use polyethylene glycol/electrolytes/sodium ascorbate/ascorbic acid? 

polyethylene Glycol (PEG): 

• Laxative: PEG is commonly used as a laxative in the form of PEG-electrolyte solutions. It helps to relieve constipation by increasing the water content in the stool, making it simple to pass. 
• Pharmaceutical excipient: PEG is used as a binder, filler, or solubilizing agent in various pharmaceutical formulations to enhance drug solubility and bioavailability. 

electrolytes: 

• Rehydration: electrolyte solutions are used for rehydration in cases of dehydration due to diarrhea, vomiting, excessive sweating, or other fluid losses. They help restore the balance of electrolytes in the body and maintain proper fluid balance. 
• electrolyte imbalances: electrolyte solutions may be used to correct electrolyte imbalances, such as low levels of sodium, potassium, chloride, or other minerals in the body. 

sodium Ascorbate/ascorbic Acid (Vitamin C): 

• Dietary supplement: sodium ascorbate and ascorbic acid are commonly used as dietary supplements to ensure an adequate intake of vitamin C. Vitamin C is essential for various physiological processes, including collagen synthesis, immune function, and antioxidant protection. 
• Common cold and immune support: Vitamin C is often taken as a supplement to support immune health and may help reduce the duration and severity of common cold symptoms. 
• Antioxidant: Vitamin C acts as an antioxidant, protecting cells from damage caused by free radicals. It helps neutralize free radicals, reducing oxidative stress in the body. 
• Collagen synthesis: Vitamin C is necessary for synthesizing collagen, a protein crucial for maintaining healthy connective tissues, wound healing, and supporting skin health.