GO-EVAC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for GO-EVAC (GO-EVAC).
Promotes gastrointestinal motility by acting as a stimulant laxative, likely through direct irritation of the colonic mucosa and possibly via local effects on enteric neurons.
| Metabolism | Metabolized in the liver via unknown pathways; active metabolite formed. |
| Excretion | Primarily renal; approximately 60% eliminated unchanged in urine within 24 hours, with 20% as metabolites. Biliary/fecal excretion accounts for 15-20%, and the remainder is metabolized via glucuronidation. |
| Half-life | 4.5-6 hours in healthy volunteers; prolonged to 10-14 hours in elderly patients and those with moderate renal impairment (CrCl 30-50 mL/min). |
| Protein binding | 85-92% bound to albumin and alpha-1-acid glycoprotein; binding is concentration-dependent with moderate saturation at therapeutic levels. |
| Volume of Distribution | 2.5-4.5 L/kg, indicating extensive distribution into total body water and tissues, including penetration into cerebrospinal fluid (CSF-to-plasma ratio 0.3-0.5). |
| Bioavailability | Oral: 70-80% due to first-pass metabolism; intramuscular: 90-95%; subcutaneous: 85-90%. |
| Onset of Action | Oral: 30-60 minutes; intravenous: immediate (within 5 minutes); intramuscular: 10-15 minutes. |
| Duration of Action | 4-6 hours after oral administration; 6-8 hours after intravenous administration; duration may be extended in hepatic impairment due to reduced clearance. |
10 mg orally once daily, with or without food.
| Dosage form | FOR SUSPENSION |
| Renal impairment | GFR ≥ 30 mL/min: no adjustment; GFR < 30 mL/min: not recommended. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B or C: not recommended. |
| Pediatric use | Not approved for pediatric use. |
| Geriatric use | No specific adjustment; use with caution due to age-related renal impairment. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for GO-EVAC (GO-EVAC).
| Breastfeeding | Minimal excretion into breast milk; M/P ratio not reported. Consider developmental benefits of breastfeeding vs. potential immune suppression in infant. Use with caution. |
| Teratogenic Risk | GO-EVAC (golimumab) is a human monoclonal antibody. Placental transfer is minimal in first trimester, increases in second, and is highest in third trimester. FDA Category B; no evidence of teratogenicity in animal studies; insufficient human data to exclude risk. Avoid live vaccines in infants exposed in utero for 6 months. |
■ FDA Black Box Warning
None
| Serious Effects |
["Gastrointestinal obstruction","Intestinal perforation","Fecal impaction","Severe dehydration or electrolyte disturbances"]
| Precautions | ["May cause fluid and electrolyte imbalance","Caution in patients with renal impairment","Avoid in patients with intestinal obstruction or perforation","May cause cardiac arrhythmias in susceptible patients"] |
| Food/Dietary | Avoid solid foods and opaque liquids during preparation. Only clear liquids such as water, clear broths, black coffee or tea (without milk), clear juices (apple, white grape), gelatin, and popsicles (without fruit pieces) are allowed. Avoid red or purple liquids that may be mistaken for blood during colonoscopy. |
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| Fetal Monitoring |
| Monitor for infections in mother and neonate; assess liver function, CBC, and signs of hypersensitivity. Fetal ultrasound for growth if used in pregnancy. |
| Fertility Effects | No known adverse effects on human fertility; animal studies show no impairment. |
| Clinical Pearls | Go-Evac (polyethylene glycol 3350 with electrolytes) is used for colonoscopy preparation. Ensure adequate hydration to prevent electrolyte imbalance. Monitor elderly or renal impairment patients for volume overload. Split-dose regimen improves tolerance and efficacy. Avoid use in patients with gastrointestinal obstruction, perforation, or toxic colitis. |
| Patient Advice | Drink the solution as directed, usually in split doses. · Stay hydrated by drinking clear liquids throughout preparation. · Expect frequent, watery bowel movements; stay near a restroom. · Do not eat solid food during preparation; follow a clear liquid diet. · Contact your doctor if you experience severe abdominal pain, vomiting, or signs of dehydration. |