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"I jumped on board with IDDSI because I’ve always believed it would reduce errors in the food served to people."

John Holahan

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Is It Safe to Thicken PEG3350 Laxatives?

Updated: Jan 20, 2020

Polyethylene Glycol 3350 (PEG3350) is a commonly used osmotic laxative in every care setting. Common brand names in the US and Canada include MiraLax, GlycoLax, Lax-A-Day and RestoraLAX.

Starch thickeners and PEG3350 are NOT compatible. When mixed together, the starch stops thickening and the beverage thins. This is one of those “common knowledge” situations that “everyone” knows about. Well, almost everyone...

All thickeners have situations where they work, where they don’t work so well, and where they don’t work at all. The information on these situations is not always well known. A recent warning from the Institute for Safe Medication Practices Canada as noted here

highlights the risk of not clearly communicating these situations to customers.

When a hospital patient that was already taking PEG3350 was switched to a thickened diet, the healthcare provider added the PEG3350 to a starch based prethickened juice. The beverage thinned. To make matters worse, “the healthcare provider preparing and administering the mixture was unfamiliar with the appearance of different types of thickened liquids. In particular, the change in consistency after the PEG laxative was added, from thickened to thin and watery, went unnoticed.” And the patient was served the thinned PEG3350 and juice mixture. There were apparent signs of aspiration – the patient was noted to be very “gurgly”. The warning notes, “The patient passed away a couple of hours later, following suspected aspiration during repositioning. As the patient had multiple comorbidities and a guarded prognosis, it is difficult to determine the cause of death, however, aspiration may have been a contributing factor.”

Although the inability of starch thickeners to thicken PEG3350 laxatives is “well-known” or “common knowledge”, no one at this particular institution was aware of it. And the computerized order system did not have any warnings about the interaction. And no one at the facility was trained with the simple IDDSI flow test.

Watch as the water thickened with a starch based product immediately thins once the PEG3350 is added.

Xanthan gum, the thickener used in SimplyThick® EasyMix™, has great compatibility with PEG3350. However, many people have been trained that “nothing thickens PEG3350”. I have watched the stunned faces of countless healthcare providers when we perform a live demonstration at tradeshows. See for yourself below.

Furthermore, the PEG3350 Laxative thickened with SimplyThick will remain

stable over time. See the data below.

PEG3350 Laxative Water thickened with SimplyThick EasyMix is tested every 15 minutes using the IDDSI Flow Test.
IDDSI Flow Test Results: PEG3350 Water Thickened with SimplyThick

Xanthan gum is compatible with and performs more consistently in a wider range of beverages than starches. This is exactly why I chose to bring xanthan gum to the dysphagia market back in 2001.

SimplyThick EasyMix works in most situations and many situations where starches will not. We don’t ever try to hide where our product doesn’t work. The consequences can be too great.



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