Long-Term Miralax Use: Safe Or Not?

MiraLAX is a brand-name, over-the-counter powder used to treat constipation. It is also used for colonoscopy bowel preparation and is available in the U.S. without a prescription. While it is typically used for short-term treatment, it can be used long-term to treat chronic constipation. However, there are concerns about the safety of long-term use, particularly in children, due to potential side effects such as diarrhoea, flatulence, nausea, and neuropsychiatric events.

Is Miralax safe for pregnant women?

Constipation is a common issue during pregnancy, affecting 75% of people during their first trimester. While Miralax (polyethylene glycol 3350) is an over-the-counter medication that is considered safe for short-term use during pregnancy, it has not been tested for safety in pregnant women. It is always recommended to consult a doctor before taking any medication during pregnancy.

Miralax is often a first-choice medication for doctors to ease constipation during pregnancy. It is an osmotic laxative, which works by drawing water into the colon, softening the stool, and making it easier to pass. However, there are limited studies on the use of Miralax in pregnant women, and some doctors may suggest alternative treatments or medications with more research backing their use during pregnancy. These alternatives include stimulant laxatives such as bisacodyl (Dulcolax) and senna (Fletcher's Laxative).

While Miralax is generally considered safe and well-tolerated, it can cause side effects such as abdominal cramping, diarrhoea, and hives. It is important to note that stimulant laxatives, including Miralax, should only be used in the short term or occasionally to avoid dehydration or electrolyte imbalances in pregnant women.

Pregnant women should always try non-medication measures first to relieve constipation. These include increasing fluid and dietary fibre intake, as well as regular exercise. If these strategies are ineffective, Miralax can be considered under the guidance of a healthcare provider. It is crucial to consult a doctor before taking any medication during pregnancy, especially if other medications are also being taken.

What are the side effects of long-term use?

The side effects of long-term use of Miralax vary from mild to severe. The most common side effects are gastrointestinal complaints of diarrhoea, loose stool, flatulence, and nausea. These effects are generally mild or moderate in severity. Some people have also reported bloating, headaches, and weight gain while taking Miralax, although it is not clear if Miralax is the cause of these effects.

In rare cases, allergic reactions can be severe and include anaphylaxis. Symptoms of an allergic reaction can include difficulty breathing and swelling of the lips, tongue, or throat.

There have also been reports of unusual side effects in some children, such as tremors, tics, obsessive-compulsive behaviours, and aggression. However, these side effects have not occurred in clinical studies of Miralax in children, and it is not clear if they are caused by the medication or something else. The FDA is funding additional research to investigate these concerns.

Long-term use or overuse of Miralax may result in dependence on laxatives and chronic constipation. Overuse may also cause diarrhoea, dehydration, and mineral imbalance (such as low sodium). It is important to note that Miralax is intended for short-term use and should not be used for more than 7 days without consulting a doctor.

Is Miralax addictive?

Miralax (Polyethylene Glycol), an osmotic laxative, is a non-addictive oral laxative that is indicated for the relief of constipation. It is considered a first-line laxative in most situations as it is non-addictive and non-habit-forming. Clinical trials lasting as long as 6 months have shown that doses of 17 grams per day in adults produced few, if any, side effects.

Unlike other over-the-counter (OTC) laxatives such as bisacodyl, Miralax does not produce what is known as tachyphylaxis (a diminishing response to successive doses of a drug, making it less effective over time). In addition, when stimulant laxatives are taken for too long, patients may become dependent on them and find it difficult to produce a bowel movement without the aid of a laxative product. Miralax doesn't have this problem because it is considered a non-active drug that is not significantly absorbed into the body when taken orally. Nearly 100% of the dose stays in the GI tract and binds water, which in turn produces softer stools as water is retained within the stool.

Doses above 17 grams per day can sometimes cause bloating and diarrhea in patients, especially the elderly. If this occurs, it is often recommended to reduce the dosage or switch to a product that is better tolerated.

The active ingredient in Miralax, polyethylene glycol 3350 (PEG 3350), is a very large polymer that is too big to be absorbed by the intestine. When PEG 3350 is consumed, it stays in the gut and holds water, making the stool within the gut soft and easy to pass, gently relieving constipation. PEG 3350 does not work on the muscles or nerves of the gut, so it is not habit-forming, nor does it cause dependence on the product.

PEG 3350 has been extensively studied for effectiveness in chronic constipation. These studies have included the medication being used in various ages, different doses, and for many types of stooling problems. In addition, no significant effects from long-term use of the medication have been reported in pediatric gastroenterology literature.

However, it is important to note that the US Food and Drug Administration (FDA) has placed Miralax on its Adverse Event Reporting System (AERS) in connection with "neuropsychiatric events". This warning also applies to several other laxatives that contain PEG 3350 as their active ingredient. The term "neuropsychiatric events" refers to neurologic disorders of the central and peripheral nervous systems such as autism, dementia, depression, schizophrenia, multiple sclerosis, Alzheimer's and Parkinson's diseases, and similar others. These conditions result from PEG's direct (through cellular damage) and indirect (through malnutrition of essential micronutrients) neurotoxicity.

How does Miralax work?

MiraLAX (polyethylene glycol 3350) is a non-stimulant, osmotic laxative that is used to treat constipation. It works by drawing water into the colon, which softens the stool and may naturally stimulate the colon to contract. These actions help ease bowel movements.

MiraLAX is typically taken once a day and works within 1 to 3 days. It is important to drink enough water while taking MiraLAX as this will help it be more effective. The powder should be mixed with 4 to 8 ounces of water or another liquid such as juice or coffee. It can be taken with or without food.

MiraLAX is generally well-tolerated and does not usually cause harsh side effects. However, some people may experience mild side effects such as diarrhoea, loose stools, bloating, nausea, and headaches. More serious side effects are rare but may include dehydration, allergic reactions, and bowel obstruction.

MiraLAX is intended for short-term use, typically up to 7 days. However, in some cases, it may be used long-term to treat chronic constipation. It is important to speak to a doctor before using MiraLAX long-term.

What are the alternatives to Miralax?

While Miralax is approved by the FDA for adults, it is not approved for use in children. This has led many people, especially parents, to seek natural alternatives to the over-the-counter laxative.

The Boston Children's Hospital recommends lifestyle changes as the first form of treatment for constipation. This includes increased hydration, high-fibre diets, and regular exercise.

If lifestyle modifications are not enough, medication alternatives to Miralax include:

• Lactulose (a non-absorbable sugar)
• Magnesium hydroxide (Milk of Magnesia)
• Senna (an herbal extract that stimulates bowel motions)

Other natural alternatives to Miralax include:

• Sorbitol, found in many dried fruits, berries, apples, plums, pears, cherries, dates, avocados, peaches, apricots, and cherries
• Coconut oil, which can be consumed in teaspoons, mixed in a natural fruit juice, or used as a cooking oil
• Olive oil, which can be consumed in teaspoons, mixed in a natural fruit juice, or used as a cooking oil
• Lemon, which is recommended right after waking up in the morning or after a meal
• Dandelion, which can be added to regular food dishes or steeped as tea
• Probiotics, which can be found in cheese, fermented foods, live culture yoghurt, fermented vegetables, and miso soup
• Fish oil, which can also be consumed through dietary supplements
• Blackstrap molasses, which can be used in food and drink as a sweetener, taken in a teaspoon, or with water

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