Suclear (Polyethylene glycol electrolyte solution and sulfate solution) is a bowel cleansing agent that is used prior to colonoscopy.

Suclear (Polyethylene glycol electrolyte solution and sulfate solution) Uses:

• For bowel cleansing before colonoscopy

Suclear (Polyethylene glycol electrolyte solution and sulfate solution) Dose in Adults

Suclear (Polyethylene glycol electrolyte solution and sulfate solution) Dose in the treatment of Bowel cleansing prior to colonoscopy:

• Oral: May be administered as a single dose in one day or maybe divided over two days.
• Split-dose (2-day) regimen:
  • The total volume that may be required: Approximately 3500 mL.
• Dose 1:
  • The evening before colonoscopy (10-12 hours before Dose 2):   
    • Add 10 ounces of water to 6oz of oral solution, take orally within 20 minutes.
    • Again fill the container to 16oz volume, consume within 2 hours, again add 16 oz, and drink before sleeping at night.
    • The total volume of liquid Dose 1: 48 oz.
• Dose 2:
  • Morning of the colonoscopy (beginning at least 3.5 hours before a colonoscopy):
    • Dilute the powder in 2 L drink as follows:
      • Using the provided container of 500ml volume, drink at a rate of 500 mL every 20 minutes 4 times over the next 2 hours.
      • Complete at least 2 hours before the colonoscopy.
      • The total volume of liquid consumed: 2000 mL
• Day-before (1-day) regimen:
  • The total volume of liquid consumed over the course of treatment: 3500 mL
  • Dose 1:
    • The evening before colonoscopy starting at least 3.5 hours before bedtime:
      • Dilute the oral solution to the total volume of ~500ml drink within 20 minutes, drink another 500 ml over next 2 volum hours.
      • The total volume of liquid consumed ~1 L
  • Dose 2:
    • The evening before colonoscopy dilute in 2L of water, consume ~500ml every 20 minutes 4 times, drink ~500 ml before sleeping at night.
    • The total volume of liquid consumed ~2500ml.

Use in Children:

Not indicated.   

Pregnancy Risk Factor C

• No animal reproduction studies.

Polyethylene glycol electrolyte solution and sulfate solution use during breastfeeding:

• No data available use carefully.

Dose in Kidney Disease:

No dose adjustment. However use adequate hydration in patients with impaired renal function.   

Dose in Liver disease:

No dose adjustment needed.   

Common Side Effects of Suclear (Polyethylene glycol electrolyte solution and sulfate solution):

• Central Nervous System:
  • Malaise
• Gastrointestinal:
  • Abdominal Distension
  • Nausea
  • Abdominal Pain
  • Vomiting
• Hepatic:
  • Increased Serum Bilirubin
• Renal:
  • Renal Insufficiency

Less Common Side Effects Of Suclear (Polyethylene glycol electrolyte solution and sulfate solution):

• Central Nervous System:
  • Headache
• Endocrine & Metabolic:
  • Acidosis
  • Hypercalcemia
  • Increased Serum Glucose
  • Hyperuricemia
  • Hypokalemia
  • Decreased Serum Bicarbonate
  • Increased Urine Osmolality
  • Hypophosphatemia
  • Hypochloremia
  • Hyponatremia
  • Decreased Serum Magnesium
• Neuromuscular & Skeletal:
  • Increased Creatine Phosphokinase
• Renal:
  • Increased Serum Creatinine

Contraindications to Suclear (Polyethylene glycol electrolyte solution and sulfate solution):

• Hypersensitivity to sodium, potassium, magnesium, and any other component of the formulation
• Gastric perforation, GI obstruction, bowel perforation and gastric retention are all possible.

Warnings and precautions

• Arrhythmias:
  • Arrhythmias may occur in patients with uncontrolled arrhythmias or recent MI.
• Atypical electrolyte and fluid conditions:
  • Fluid and electrolyte impairment can cause renal injury, arrhythmias and seizures. Hydrate the patient prior to or following the procedure.
  • Patients who are dehydrated after the procedure may require RFTs or electrolyte levels.
• GI effects
  • Osmotic laxatives can cause colonic mucosal and aphthous ulcerations.
  • Patients with inflammatory bowel disease (or suspected) should be cautious when reading colonoscopy results.
• Seizures:
  • Patients with an underlying seizure disorder, electrolyte imbalance or concomitant medications (lower seizure threshold, withdrawal of alcohol, benzodiazepines) may experience seizures.
• Gout
  • Patients with gout may experience a temporary increase in uric Acid.
• Gagging reflex in the impaired
  • Patients with impaired consciousness or missing swallow reflexes require careful administration
• Renal impairment
  • Careful monitoring while using in renal dysfunction especially if using nephrotoxic drugs (eg, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, NSAIDs).
  • Before you have a colonoscopy, make sure that your baseline creatinine and electrolyte levels are at their highest
• Ulcerative colitis
  • It may worsen ulcerative colitis. Be careful.

Monitoring parameters:

• Pre-procedure urea, creatinine in patients at risk for renal dysfunction, seizure, or who have a history of electrolyte abnormality.
• Post-procedure electrolytes, creatinine, and BUN are recommended in patients' ECG (prior to therapy and post-colonoscopy) in patients with risks for prolonged QT or arrhythmias.

How to administer Suclear (Polyethylene glycol electrolyte solution and sulfate solution)?

Oral:

• Use as directed with the specified hydration.
• Clear liquids should be consumed no later than 2 hours after the initial dose.
• On the day preceding and day following the colonoscopy, do not eat solid foods, red or purple liquids, or drink alcoholic beverages.
• You can take oral medications up to an hour before you start therapy.   

Mechanism of action of Suclear (Polyethylene glycol electrolyte solution and sulfate solution):

• Unabsorbed sulfate salts in the GI tract and polyethylene glycol, (PEG), act as an osmotic bowel laxative.
• Sulfate salts supply sulfate aniions. PEG, which is primarily not absorbed, causes water retention, leading to watery diarrhea.

Notice:

• Moderate renal impairment (CrCl 30-49 mL/minute), resulted in a 43% greater C-max and 16% lower urinary serum sulfates clearance than healthy patients.

Absorption:

• PEG 3350: Minimal;
• Sulfates: Poor; ~20% absorbed systemically

Half-life elimination:

• Serum sulfate: 8.5 hours

Time to peak:

• Serum sulfate: ~5.5 hours

Excretion:

• feces (unabsorbed sulfates and PEG);
• urine (absorbed sulfates and PEG)

International Brand Names of Polyethylene glycol electrolyte solution and sulfate solution:

• Suclear™

Polyethylene glycol electrolyte solution and sulfate solution kit Brands Names in Pakistan:

No Brands Available in Pakistan.