sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol

Action and Spectrum

Actions and Spectrum: 

Action:  

sodium sulfate is a white, crystalline compound commonly used as a laxative to relieve constipation. It generally works by drawing water into the intestines, softening the stool, and promoting bowel movements. sodium sulfate is also used in some medications, detergents and as a filler in various products. 

potassium chloride is an essential mineral and electrolyte vital in various bodily functions, including maintaining heart and muscle function, regulating fluid balance, and supporting nerve transmission. 

magnesium sulfate, commonly known as Epsom salt, has several uses. It can be used as a laxative to relieve occasional constipation or as a soak for soothing sore muscles and reducing inflammation. polyethylene glycol (PEG) is a polymer compound often used as a laxative to treat constipation.  

Spectrum:  

sodium sulfate is primarily used for its laxative properties and is generally safe for short-term use. The body does not absorb it, and it passes through the digestive system without significant systemic effects. However, prolonged or excessive use of sodium sulfate as a laxative can lead to electrolyte imbalances and dehydration. 

potassium chloride is primarily used for its replenishing properties in cases of potassium deficiency. It is available in different forms, including oral tablets, solutions, and intravenous preparations. 

magnesium sulfate has different applications depending on the method of administration. As a laxative, it draws water into the intestines, softening the stool and promoting bowel movements. When used topically or in a bath, it may help relax muscles and reduce inflammation. 

polyethylene glycol laxatives are considered safe and effective for short-term use in relieving constipation. They are generally well-tolerated and do not cause significant systemic effects. 

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

Nausea (7-13%) 

1-10% 

Abdominal pain (3%) 

Abdominal distension (1-6%) 

Headache (2-3%) 

Vomiting (4-6%) 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

sodium sulfate: 

• Allergy or hypersensitivity to sodium sulfate or any of its components. 
• Intestinal blockage or obstruction. 
• Severe dehydration. 
• Inflammatory bowel disease. 
• Kidney disease or impairment. 
• Heart disease or congestive heart failure. 
• Use caution during pregnancy and breastfeeding, as safety has not been established. 

potassium chloride: 

• Allergy or hypersensitivity to potassium chloride or any of its components. 
• Hyperkalemia (high potassium levels). 
• Severe kidney disease or impaired kidney function. 
• Addison’s disease. 
• Certain medications or conditions that can increase the risk of hyperkalemia, such as certain diuretics (e.g., potassium-sparing diuretics), ACE inhibitors, angiotensin receptor blockers (ARBs), or certain types of renal dysfunction. 
• Use caution in patients with heart disease, as potassium chloride can affect heart rhythm. 

magnesium sulfate: 

• Allergy or hypersensitivity to magnesium sulfate or any of its components. 
• Heart block or myocardial damage. 
• Kidney disease or impaired kidney function. 
• Low heart rate or bradycardia. 
• Myasthenia gravis. 

polyethylene glycol: 

• Allergy or hypersensitivity to polyethylene glycol or any of its components. 
• Intestinal blockage or obstruction. 
• Severe inflammatory bowel disease (Crohn’s disease or ulcerative colitis). 
• Severe gastrointestinal conditions (e.g., toxic colitis, toxic megacolon). 
• Severe dehydration. 
• Kidney disease or impaired kidney function. 
• Heart failure or certain cardiac conditions. 

Caution 

sodium sulfate: 

• Use caution in individuals with electrolyte imbalances or disturbances. 
• People with renal (kidney) impairment should use sodium sulfate laxatives cautiously and under medical supervision. 
• Long-term or excessive use of sodium sulfate laxatives may lead to dependency or chronic laxative overuse. 
• Use caution in individuals with heart conditions, as sodium sulfate can cause fluid retention. 

potassium chloride: 

• Use caution in individuals with renal impairment or reduced kidney function, as potassium chloride is primarily excreted through the kidneys. 
• People with certain medical conditions, such as Addison’s disease or conditions associated with hyperkalemia, should use potassium chloride supplements with caution. 
• It is crucial to monitor potassium levels regularly during potassium chloride supplementation, especially in individuals taking medications that can affect potassium levels or individuals with renal dysfunction. 
• Use caution in patients with heart disease, as potassium chloride can affect heart rhythm. 

magnesium sulfate: 

• Use caution in individuals with renal impairment or reduced kidney function, as magnesium is primarily excreted through the kidneys. 
• People with heart block or myocardial damage should use magnesium sulfate cautiously. 
• High doses of magnesium sulfate administered intravenously can lead to respiratory depression, particularly in individuals with impaired respiratory function. 
• Careful monitoring of magnesium levels and renal function is necessary during the intravenous use of magnesium sulfate. 

polyethylene glycol: 

• Use caution in individuals with a history of intestinal blockage or obstruction, as polyethylene glycol laxatives may not be suitable. 
• People with severe inflammatory bowel disease should use polyethylene glycol laxatives cautiously, as they may require alternative treatment approaches. 
• Use caution in individuals with severe dehydration, as rehydration may be necessary before initiating polyethylene glycol laxative use. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not assigned. 

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: 

The pharmacology of sodium sulfate involves its mechanism as an osmotic laxative, drawing water into the intestines to soften the stool and promote bowel movements. potassium chloride acts as a potassium supplement, replenishing low potassium levels and supporting proper heart, muscle, and nerve function.

magnesium sulfate is a laxative, muscle relaxant, and anticonvulsant when administered intravenously, relieving constipation and muscle tension and preventing seizures in specific medical conditions. polyethylene glycol acts as an osmotic laxative, increasing water content in the stool, thereby facilitating its passage and relieving constipation. 

Pharmacodynamics: 

Mechanism of action: 

sodium sulfate: 

• sodium sulfate acts as an osmotic laxative. When taken orally, it increases the water content in the intestines, which leads to stool softening and promoting bowel movements. It achieves this by drawing water into the gastrointestinal tract through osmosis, stimulating bowel motility. 

potassium chloride: 

• potassium chloride functions as a potassium supplement. potassium is an key electrolyte that plays a crucial role in various physiological processes, including proper nerve conduction, muscle contraction (including the heart), and maintenance of fluid balance. potassium chloride replenishes low potassium levels in the body, helping to restore normal cellular function and electrolyte balance. 

magnesium sulfate: 

The action of magnesium sulfate depends on its route of administration: 

• As a laxative: magnesium sulfate increases the intestines’ water content, stimulating bowel movements. It attracts water into the intestines through osmosis, softening the stool and promoting its elimination. 
• Intravenous (IV) use: magnesium sulfate administered intravenously acts as a muscle relaxant and anticonvulsant. It works by blocking calcium channels and reducing the release of acetylcholine, resulting in muscle relaxation and suppressing neuronal activity. 

polyethylene glycol: 

• polyethylene glycol is an osmotic laxative. When taken orally, it increases the stool’s water content. It forms a non-absorbable solution that retains water in the intestinal lumen, leading to an osmotic effect. This increased water content in the stool softens it, facilitates movement through the intestines, and promotes bowel movements. 

Pharmacokinetics: 

Absorption 

sodium sulfate is not significantly absorbed by the body when taken orally as a laxative.  

potassium chloride is readily absorbed from the gastrointestinal tract after oral administration. 

magnesium sulfate can be absorbed through the gastrointestinal tract when taken orally or through the skin when used topically or as a bath soak. 

polyethylene glycol laxatives are minimally absorbed from the gastrointestinal tract. Most of the absorbed polyethylene glycol is eliminated in the urine. 

Distribution 

It does not distribute to specific body tissues or organs. 

potassium ions are distributed throughout the body, mainly found intracellularly. 

magnesium ions are distributed throughout the body, storing a significant portion of bones and muscles. 

polyethylene glycol is not extensively distributed to specific tissues or organs. 

Metabolism 

sodium sulfate does not undergo any significant metabolic processes in the body. 

potassium chloride does not undergo significant metabolism in the body. 

magnesium sulfate does not undergo substantial metabolism in the body. 

polyethylene glycol undergoes minimal metabolism in the body. 

Elimination and Excretion 

sodium sulfate is excreted unchanged in the feces. 

potassium ions are primarily excreted through the kidneys in urine, with a small amount excreted in feces and sweat. 

magnesium ions are excreted primarily through the kidneys in urine. 

Most polyethylene glycol is excreted unchanged in the urine, with a small amount eliminated in the feces. 

Adminstartion

Administration: 

Oral administration 

sodium sulfate: 

• sodium sulfate is primarily administered orally as a laxative. It is available in different forms, such as tablets, powders, or solutions. 
• Follow the instructions the manufacturer or healthcare professional provides regarding the dosage and administration. 
• sodium sulfate laxatives are usually dissolved in a glass of water and taken by mouth. 
• It is vital to drink an additional glass of water after taking the medication to help facilitate its action. 

potassium chloride: 

• potassium chloride is available in various forms, including oral tablets, extended-release tablets, and oral solutions. 
• It is typically taken orally with a glass of water and should be swallowed whole without crushing or chewing. 
• Extended-release formulations should be swallowed whole, not broken, crushed, or chewed. 

magnesium sulfate: 

• magnesium sulfate can be administered through different routes depending on the intended purpose. 
• For constipation relief, magnesium sulfate is typically taken orally. It is available in powder or tablet form, dissolved in water, and taken by mouth. 
• When used for muscle relaxation or as a soak, magnesium sulfate can be added to warm bathwater or used topically as a paste or gel. 
• For medical conditions such as eclampsia or preterm labor, magnesium sulfate is administered intravenously by healthcare professionals. 

polyethylene glycol: 

• polyethylene glycol laxatives are commonly administered orally. 
• They are available in various forms, including powders, liquids, or capsules. 
• polyethylene glycol powders or liquids are typically mixed with a specific amount of water or another beverage as directed. 
• It is essential to drink additional fluids while using polyethylene glycol laxatives to help prevent dehydration. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol 

Why do we use sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol? 

sodium sulfate: 

• sodium sulfate is primarily used as a laxative to relieve occasional constipation. It generally works by drawing water into the intestines, softening the stool, and promoting bowel movements. 
• It may also be used as an ingredient in certain medications, detergents, and personal care products. 
• In the industrial sector, sodium sulfate finds applications in manufacturing processes such as glass production, paper making, and textile dyeing. 

potassium chloride: 

• potassium chloride is commonly used as a potassium supplement to treat/prevent low levels of potassium (hypokalemia) in the body. 
• It is prescribed to individuals with conditions such as potassium depletion due to diuretic use, certain kidney disorders, or other medical conditions that can cause potassium deficiency. 
• potassium chloride is also used in intravenous fluids for hydration and electrolyte balance. 

magnesium sulfate: 

• magnesium sulfate, commonly known as Epsom salt, has various uses. It can be used as a laxative to relieve occasional constipation. 
• In the medical field, magnesium sulfate is administered intravenously to prevent seizures in conditions such as eclampsia (during pregnancy) and slow down preterm labor. 
• It is also topically or added to bathwater for its potential muscle relaxant properties and to soothe minor aches and pains. 

polyethylene glycol: 

• polyethylene glycol (PEG) is an osmotic laxative to relieve constipation. It works by increasing the water content in the stool, making it softer and also easier to pass. 
• PEG laxatives are available for oral administration in various formulations, including powders, liquids, or capsules. 
• In addition to its laxative properties, polyethylene glycol is used in various other industries, including pharmaceuticals, cosmetics, and food production.