Warning about Miralax

I went to the CA OH Conference this past weekend and met a lot of great people and a few lap banders like Elena who post regularly here and had a good time. Very informative and fun. In the Q&A session the subject of constipation came up. One of the surgeons advised us of the FDA black box warning issued in March 2010 about possible renal (kidney) failure if Miralax is used frequently. Therefore, we were all advised not to use Miralax and drink as much Milk of Magnesia(MOM) as needed instead. They indicated you couldn't o/d on MOM and can take it safely several times a week and that taking in more fiber and water should also help. Since the subject of constipation is frequently asked on this forum, and a problem for us dense protein eaters, I thought I would pass this warning along to all.

Thank You Janet. Being a long term diabetic that is very useful for me and I'm sure others.
Karen

Thanks for the info. I have to do my pre-op prep on Thursday. I have to drink 4.1 oz bottle of miralax mixed with 32 oz gatorade. However, for future times when I need it I will use MOM.

Just curious, Did they say it was alright to use Metamucil for some of your daily fiber? I have good results with that now (Pre- surgery) for constipation, wasn't sure about post-op.

They didn't recommend a specific fiber product so I'd check with your Dr.

I just checked into this --

The black box warning ONLY applies in cases for oral prep for a colonoscopy, and wasn't even really for Miralax, but was actually for another product in a similar class.  This is directly from Medscape.com, a medical reference site.  I'm giving the address for validity, but unless you have an account (and make no mistake, you CAN, you just need to sign up), you won't be able to view it.  Go sign up!  It's free.

http://www.medscape.com/viewarticle/712534_3

Colonoscopy is critically dependent on adequate pre-procedural bowel cleansing. In 1990, OSP solution (OSPS) began to gain acceptance as a purgative for colonoscopy.^[8] The small volume of OSPS was associated with improved patient compliance, less discomfort, and superior colonic cleansing compared with polyethylene glycol (PEG)-based lavage solution. The price for a better bowel preparation was transient hyperphosphatemia (mean increase in serum phosphate of 4.1 mg/dl) that resolved within 24 h and was not associated with hypocalcemia.^[8] Subsequent studies confirmed that OSPS was better tolerated and was associated with improved bowel cleansing compared with PEG-based purgatives.^[9-11] A meta-analysis of randomized, controlled trials published from 1990 to 2005 found that OSPS was more efficacious than PEG in nine studies, inferior in one study, and equivalent in six studies.^[11]

For many years, the commonly recommended regimen of OSP solution (Fleet Phosphosoda; C.B. Fleet, Lynchburg, VA, USA) consisted of two 45-ml doses taken 10-12 h apart, the evening before and the morning of colonoscopy. Each 45-ml dose contained 21.6 g of monobasic sodium phosphate (NaH₂PO₄) and 8.1 g of dibasic sodium phosphate (Na₂HPO₄), which is equivalent to 5.8 g of elemental phosphorus. The 5.8 g of phosphorus was diluted into a single eight ounce glass and administered twice in a 12-24 h period, far exceeding the usual dietary intake of 1 g/day. Following increasing reports of APhN, the more commonly recommended regimen became 45 ml followed by 30 ml of OSP, and requirements for hydration were increased to 36 ounces of clear fluid with each administration. On 11 December 2008, following continuing reports of APhN, the United States Food and Drug Administration issued an alert stating that over-the-counter OSP products should no longer be used for bowel cleansing, and that the use of these products should only occur pursuant to a prescription from a health-care provider.(http://www.fda.gov/cder/drug/infopage/OSP_solution/default.htm). Shortly thereafter, Fleet Phosphosoda was voluntarily withdrawn from the US market.

Oral sodium phosphate remains available by prescription in a tablet form under the brand names Visicol and Osmoprep (Salix Pharmaceuticals, Morrisville, NC, USA). These agents are given in two separate administrations separated by 12 h. A regimen of 20 tablets of Visicol, administered as three tablets with at least eight ounces of clear fluid every 15 min until completion, has a cumulative sodium phosphate content that is near identical to a 45-ml dose of OSPS. Osmoprep has largely replaced Visicol, and current recommendations are for the second administration to consist of 12 rather than 20 tablets. The main distinctions between OSP solution and OSP tablets is that the latter is tasteless, is consumed over a longer time period, mandates greater fluid consumption, and has always been available by prescription only.

Hello
              I was reading some past post and read the one on Miralax. I have been taking it everyday
I was wondering is there very many people that takes it that often.and is there anything else that works better. MOM make me want to up chuck sorryThank You .Connie

You can take the dry form of MOM -- magnesium oxide.  It's a pill form, and is considered just as safe as MOM, but without the horrible taste.

Do you know if it works as will as miralax? And can it be taking everyday?

                                                                                          Connie

It works very well, and yes, it can be taken every day.

But Miralax is also safe.  The black box warning?  Was when taken as a colon cleanser -- a bottle at a time.  Not one dose at a time.  Sometimes, things don't always get shared.  Or misinformation gets passed on.  Doctors are not perfect and they do misspeak at times.