GoLYTELY - Drug Monograph

Introduction

GoLYTELY (polyethylene glycol 3350 with electrolytes) is a prescription osmotic laxative solution used for bowel cleansing prior to colonoscopy, barium enema X-ray examination, or other medical procedures requiring a clean colon. It is a polyethylene glycol-based bowel preparation that works through osmotic action without significant systemic absorption.

Mechanism of Action

GoLYTELY acts as an osmotic laxative that cleanses the entire colon without significant net absorption or secretion of ions and water. The polyethylene glycol 3350 component creates an osmotic gradient that draws water into the intestinal lumen, while the electrolyte composition (sodium sulfate, sodium chloride, sodium bicarbonate, and potassium chloride) helps maintain electrolyte balance and prevents significant fluid and electrolyte shifts.

Indications

• Bowel cleansing prior to colonoscopy
• Preparation for barium enema radiography
• Other diagnostic procedures requiring a clean colon
• Off-label: Treatment of chronic constipation (though other PEG formulations are typically preferred)

Dosage and Administration

• 4 liters administered orally the evening before the procedure
• Drink 240 mL (8 oz) every 10 minutes until the entire solution is consumed or rectal effluent is clear

• Refrigerate solution for improved palatability
• Consume only clear liquids during preparation period
• Complete consumption within 4 hours
• Do not add flavorings or other substances to solution

• Geriatric patients: Standard dosing with monitoring for dehydration
• Renal impairment: Use with caution; monitor electrolyte status
• Hepatic impairment: No dosage adjustment required
• Pediatric patients: Safety and effectiveness not established

Pharmacokinetics

Contraindications

• Known hypersensitivity to polyethylene glycol or any component
• Gastrointestinal obstruction
• Bowel perforation
• Toxic colitis or toxic megacolon
• Gastric retention
• Ileus

Warnings and Precautions

• Fluid and electrolyte imbalance: May cause dehydration, hypokalemia, hyponatremia
• Cardiac arrhythmias: Use caution in patients with cardiac history
• Seizures: Rare cases reported, typically associated with electrolyte disturbances
• Aspiration risk: Use caution in patients with impaired gag reflex
• Colonic mucosal inflammation: May cause aphthous ulcerations
• Ischemic colitis: Rare cases reported

Drug Interactions

• Oral medications: Reduced absorption of concomitantly administered drugs
• Diuretics: Increased risk of dehydration and electrolyte abnormalities
• ACE inhibitors/ARBs: Potential for hyperkalemia
• NSAIDs: Increased risk of renal impairment
• Other bowel preparations: Additive effects

Adverse Effects

• Abdominal bloating/cramping
• Nausea
• Vomiting
• Anal irritation

• Headache
• Dizziness
• Abdominal pain
• Hunger

• Allergic reactions
• Electrolyte abnormalities
• Seizures
• Ischemic colitis
• Aspiration pneumonia

Monitoring Parameters

• Hydration status (skin turgor, mucous membranes, urine output)
• Electrolyte levels (particularly in high-risk patients)
• Renal function (BUN, creatinine)
• Signs of hypovolemia (tachycardia, hypotension)
• Completion of bowel preparation (stool characteristics)
• Adverse effects (nausea, vomiting, abdominal pain)

Patient Education

• Preparation: Follow clear liquid diet starting the day before procedure
• Administration: Chill solution for better taste; drink steadily every 10 minutes
• Expectations: Multiple bowel movements beginning within 1 hour; continue until stool is clear
• Hydration: Drink clear fluids before, during, and after preparation to maintain hydration
• When to seek help: Severe abdominal pain, vomiting preventing completion, bloody stools, or signs of dehydration
• Medication timing: Hold all oral medications as directed by healthcare provider
• Procedure timing: Complete preparation at recommended time before procedure

References

1. American Society for Gastrointestinal Endoscopy. (2015). Bowel preparation before colonoscopy. Gastrointestinal Endoscopy, 81(4), 781-794. 2. Johnson, D. A., et al. (2014). Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 147(4), 903-924. 3. GoLYTELY prescribing information. Braintree Laboratories, Inc. 4. Belsey, J., et al. (2011). Systematic review: adverse event reports for polyethylene glycol 3350. Alimentary Pharmacology & Therapeutics, 33(12), 1310-1319. 5. Wexner, S. D., et al. (2006). A consensus document on bowel preparation before colonoscopy. Gastrointestinal Endoscopy, 63(7), 894-909.