Macropeg (Sodium Hydrogen Carbonate, Potassium Chloride, Sodium Chloride, Macrogol 3350)

Macropeg, containing macrogol and electrolytes, is used to manage conditions involving bowel transit and electrolyte balance.

• Constipation: provides osmotic water retention in the intestinal lumen to soften stool and promote regular bowel movements.
• Bowel preparation for colonoscopy: facilitates cleansing of the colon by inducing controlled diarrhea while maintaining electrolyte homeostasis.
• Mild dehydration with electrolyte loss: supplies sodium, potassium and chloride to help restore normal plasma electrolyte concentrations.

• Macrogol 3350, a high‑molecular‑weight polyethylene glycol, remains largely unabsorbed in the gastrointestinal tract and creates an osmotic gradient that draws water into the intestinal lumen. This increases stool water content, softens feces, and stimulates peristalsis. The accompanying sodium hydrogen carbonate, potassium chloride and sodium chloride maintain electrolyte equilibrium, reducing the risk of significant shifts in serum sodium or potassium during the laxative effect.

Macropeg may cause a range of adverse reactions, most of which are related to its osmotic activity and electrolyte content.

Common Side Effects

• Abdominal bloating: sensation of fullness or swelling in the abdomen.
• Flatulence: increased intestinal gas leading to discomfort.
• Nausea: feeling of unease or urge to vomit.
• Diarrhea: loose, watery stools occurring more frequently.
• Abdominal cramps: painful muscle contractions in the gut.
• Headache: mild to moderate head pain.

Serious or Rare Side Effects

• Severe dehydration: marked loss of body fluids requiring medical intervention.
• Electrolyte imbalance: abnormal serum sodium or potassium levels that may affect cardiac or neuromuscular function.
• Allergic reaction: rash, itching, swelling, or anaphylaxis.
• Intestinal obstruction worsening: exacerbation of a pre‑existing blockage.
• Severe abdominal pain: persistent, intense pain indicating possible complications.
• Blood in stool: presence of visible blood indicating mucosal injury.

When using Macropeg, several precautions should be observed to ensure safety and effectiveness.

• Renal function assessment: evaluate kidney function before initiating therapy, especially in patients with chronic kidney disease.
• Electrolyte monitoring: check serum sodium, potassium and chloride levels during treatment.
• Adequate fluid intake: ensure sufficient water consumption to prevent excessive dehydration.
• Contraindication in intestinal obstruction: avoid use in patients with known bowel blockage.
• Allergy screening: discontinue if hypersensitivity to any component is observed.
• Store at ambient temperature: keep in original packaging, protect from moisture and heat.

Macropeg can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Concurrent osmotic laxatives: may cause excessive fluid loss and electrolyte disturbances.
• Loop diuretics: increase risk of potassium depletion and dehydration.
• High‑dose potassium supplements: can lead to hyperkalemia when combined with potassium chloride.

Moderate Interactions (Monitor Closely)

• Antacids containing sodium or potassium: may affect the balance of electrolytes provided by Macropeg.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): increase risk of gastrointestinal irritation.
• ACE inhibitors or ARBs: require monitoring of potassium levels to avoid hyperkalemia.