The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a drug safety update on the use of polyethylene glycol (PEG)-based laxatives together with starch-based thickeners.
The MHRA has warned about a potentially harmful interaction between PEG-based laxatives and starch-based thickeners when mixed together. Mixing the two products together can attenuate the thickening action resulting in a thin watery liquid. Patients with dysphagia consuming such thin liquids are at risk of aspiration.
PEG-based laxatives are commonly used to treat constipation in adults. On the other hand, patients with dysphagia are often told to use a thickener in liquids to improve bolus control and lower the risk of aspiration. The elderly and people with disabilities are likely to use both products together as constipation and dysphagia often co-occur in such populations.
The risk was initially highlighted by the Institute for Safe Medication Practices (ISMP) Canada based on a fatal case possibly resulting from the concomitant use of PEG-3350 and a starch-based pre-thickened juice. Although the cause of death could not be established due to underlying comorbidities, aspiration could have been a contributing factor. No case reports of this potential interaction have been reported in the UK.
MHRA has urged manufacturers in the UK to update the Summary of Product Characteristics and the Patient Information Leaflet of PEG laxative products with information on the potential interaction with starch-based thickeners.
