ABSTRACT OF THE WEEK

Journal of feline medicine and surgery
Volume 13 | Issue 10 (October 2011)

Safety and palatability of polyethylene glycol 3350 as an oral laxative in cats.

J Feline Med Surg. October 2011;13(10):694-7.

Fiona M Tam¹, Anthony P Carr, Sherry L Myers

¹ Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. fiona.tam@usask.ca

Abstract

Recurrent constipation is a common problem in cats. Laxatives often are the cornerstone for management of recurrent constipation; however, there is a paucity of published research on laxative use in cats. This study investigated the safety and palatability of polyethylene glycol (PEG3350) in normal cats. All cats consumed the PEG3350 laxative for 4 weeks without changes in weight or food intake. In all cats soft stools were achieved. Effective doses varied widely in experimental cats, so individualized dosing is important. Mild, non-clinical hyperkalemia was noted although the cause is unknown.

Companion Notes

Report on the safety and palatability of polyethylene glycol 3350 as an oral laxative in normal cats

Study design

- introduction on the treatment of constipation in cats

- laxatives commonly used as part of management

- polyethylene glycol (PEG3350) is a bulking and softening agent

- large molecular weight, water-soluble polymer

- in human medicine widely used as an osmotic laxative

- not metabolized by intestinal bacterial

- minimally absorbed

- each molecule hydrogen bonds with 100 molecules of water

- this results in high osmotic pressures in bowel lumen

- this acts against the absorption of water out of the lumen

- in multiple meta-analyses

- PEG3350 a more effective laxative than lactulose

- as well as many other oral laxatives

- adverse events are self-limiting and include the following:

- distended abdomen with pain

- nausea

- excessive diarrhea

- clinical hyponatremia not documented with daily low-dose use

- lactulose is a commonly used osmotic laxative

- in human medicine

- moderate evidence of efficacy and safety for chronic constipation

- in veterinary medicine: no evidence to support use

- soluble and insoluble dietary fibers

- in human medicine

- weak evidence of efficacy and safety for chronic constipation

- in feline medicine: no evidence to support use

- study population: 6 healthy cats from 1-4 years of age in a closed colony

- there was no history of diarrhea or constipation in the colony

- procedure:

- pilot trial on 2 of the cats to determine an effective initial dose

- treatment trial for 4 weeks

- PEG3350 with electrolytes (Colyte oral solution; Schwarz Pharma)

- 1.9 g per meal with the powder mixed with food

- cats were fed twice daily

(Iams, ProActive Adult formula, canned and dry)

- standard weight of canned and dry food offered each meal

- unconsumed amount weighed

- dosage titrated in each cat to achieve soft, formed stool (grade II-III)

- initial dose doubled if no effect seen within 48 hours

- assessment methods:

- fecal scores assessed daily; standardized fecal grading scale used

- grade I: over 66% of feces are liquid

- grade II: intermediate consistency between soft and liquid

- equal amounts of feces are soft and liquid

- grade III: over 66% of feces is soft

- firm enough to form a pile (no cylindrical appearance)

- grade IV: intermediate between firm and soft

- equal amounts of feces are firm and soft

- grade V: over 66% of feces in a defecation are firm

- cylindrical shape with little flattening

- CBC and chemistry before and 2 and 4 weeks after starting PEG3350

- palatability assessed by food intake and weight

- treatment stopped after 4 weeks

- cats monitored until stool consistency was normal for 2 defecations

Results

- grade I-III stool consistency achieved in all cats

- target consistency achieved in a median of 21.5 days

- median daily dose of powder to achieve target fecal grade: 3.0 ± 1.1 g

- median daily doses of the 6 cats to achieve target fecal grade

- 0.8, 1.5, 3.0, 3.0, 3.8 and 3.8 g

- dosage may be highly variable between cats

- diarrhea occasionally noted during treatment, 4 cats

- PEG3350 dosage decreased

- median time to return to normal consistency after stopping: 5.5 ± 3.4 days

- adverse event: no significant side effects noted in any cat

- sporadic vomiting, 1 cat during the treatment

- mild hyperkalemia, 3 cats at 5.6-6.0 mmol/l with reference at 3.9-5.5 mmol/l

- not associated with clinical signs in any of the cats

- food intake and body weight not significantly changed by PEG3350

“Our study demonstrated that PEG3350 with electrolytes is a safe and palatable oral laxative in healthy cats when used for 4 weeks. Potential side-effects include hyperkalemia; however, the changes we noted were not clinically or statistically significant.”

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