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  5. NDC Package Code: 52268-100-01 Golytely

NDC Package 52268-100-01 Golytely

Polyethylene Glycol 3350,Sodium Sulfate Anhydrous,Sodium Bicarbonate,Sodium - View Billable Units, 11-Digit Format, RxNorm

Table of Contents

    1. Package Information
    2. Frequently Asked Questions

Package Information

Find all the important details about this NDC Package code, including the 11-Digit NDC Billing number, billing units, wholesale price, RxNorm crosswalk, active ingredients, pharmacologic clasess, etc.

NDC Package Code:
52268-100-01
Package Description:
4 L in 1 BOTTLE, PLASTIC
Product Code:
52268-100
Proprietary Name:
Golytely
Non-Proprietary Name:
Polyethylene Glycol 3350, Sodium Sulfate Anhydrous, Sodium Bicarbonate, Sodium Chloride, Potassium Chloride
Substance Name:
Polyethylene Glycol 3350; Potassium Chloride; Sodium Bicarbonate; Sodium Chloride; Sodium Sulfate Anhydrous
Usage Information:
PEG (polyethylene glycol) with electrolyte is used to clean out the intestines before certain bowel exam procedures such as colonoscopy or barium enema X-rays. It is a laxative that works by drawing large amounts of water into the colon. This effect results in watery bowel movements. Clearing stool from the intestines helps your doctor to better examine the intestines during your procedure.
11-Digit NDC Billing Format:
52268010001
Billing Unit:
ML - Billing unit of "milliliter" is used when a product is measured by its liquid volume.
NDC to RxNorm Crosswalk:
4000 ML
NDC to RxNorm Crosswalk:
  • RxCUI: 1870431 - polyethylene glycol 3350 227.1 GM / potassium chloride 2.82 GM / sodium bicarbonate 6.36 GM / sodium chloride 5.53 GM / sodium sulfate 21.5 GM Powder for Oral Solution
  • RxCUI: 1870431 - polyethylene glycol 3350 227100 MG / potassium chloride 2820 MG / sodium bicarbonate 6360 MG / sodium chloride 5530 MG / sodium sulfate 21500 MG Powder for Oral Solution
  • RxCUI: 1870431 - POLYETHYLENE GLYCOL 3350 227100 MG / K+ Chloride 2820 MG / NaHCO3 6360 MG / NaCl 5530 MG / sodium sulfate 21500 MG Powder for Oral Solution
  • RxCUI: 1870431 - POLYETHYLENE GLYCOL 3350 227100 MG / Pot Chloride 2820 MG / NaHCO3 6360 MG / NaCl 5530 MG / sodium sulfate 21500 MG Powder for Oral Solution
  • RxCUI: 966916 - GoLYTELY Packet Powder for Oral Solution
    • Product Type:
    Human Prescription Drug
    Labeler Name:
    Braintree Laboratories, Inc.
    Dosage Form:
    Powder, For Solution - An intimate mixture of dry, finely divided drugs and/or chemicals, which, upon the addition of suitable vehicles, yields a solution.
    Administration Route(s):
  • Oral - Administration to or by way of the mouth.
    • Active Ingredient(s):
  • POLYETHYLENE GLYCOL 3350 236 g/4L
  • POTASSIUM CHLORIDE 2.97 g/4L
  • SODIUM BICARBONATE 6.74 g/4L
  • SODIUM CHLORIDE 5.86 g/4L
  • SODIUM SULFATE ANHYDROUS 22.74 g/4L
    • Pharmacologic Class(es):
  • Increased Large Intestinal Motility - [PE] (Physiologic Effect)
  • Increased Large Intestinal Motility - [PE] (Physiologic Effect)
  • Inhibition Large Intestine Fluid/Electrolyte Absorption - [PE] (Physiologic Effect)
  • Osmotic Activity - [MoA] (Mechanism of Action)
  • Osmotic Laxative - [EPC] (Established Pharmacologic Class)
  • Potassium Compounds - [CS]
  • Potassium Salt - [EPC] (Established Pharmacologic Class)
  • Stimulation Large Intestine Fluid/Electrolyte Secretion - [PE] (Physiologic Effect)
    • Sample Package:
    No
    FDA Application Number:
    NDA019011
    Marketing Category:
    NDA - A product marketed under an approved New Drug Application.
    Start Marketing Date:
    07-13-1984
    Listing Expiration Date:
    12-31-2024
    Exclude Flag:
    N
    Code Structure:

    The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

    * Please review the disclaimer below.

    Frequently Asked Questions

    What is NDC 52268-100-01?

    The NDC Packaged Code 52268-100-01 is assigned to a package of 4 l in 1 bottle, plastic of Golytely, a human prescription drug labeled by Braintree Laboratories, Inc.. The product's dosage form is powder, for solution and is administered via oral form.

    Is NDC 52268-100 included in the NDC Directory?

    Yes, Golytely with product code 52268-100 is active and included in the NDC Directory. The product was first marketed by Braintree Laboratories, Inc. on July 13, 1984 and its listing in the NDC Directory is set to expire on December 31, 2024 if the product is not updated or renewed by the manufacturer.

    What is the NDC billing unit for package 52268-100-01?

    The contents of this package are billed per "ml or milliliter", products billed per milliliter are usually products measured by liquid volume. The calculated billable units for this package is 4000.

    What is the 11-digit format for NDC 52268-100-01?

    The 11-digit format is 52268010001. The 11-digit billing format might be required by the Centers for Medicare & Medicaid Services (CMS) and other payers in billing claim forms.

    This package code is originally configured in a 5-3-2 segment 10-digit format and by adding a zero within the original NDC package code we can obtain the converted 11-digit format in a 5-4-2 segment configuration. The table below shows the 11-digit code conversion:

    10-Digit Format10-Digit Original Code11-Digit Format11-Digit Code
    5-3-252268-100-015-4-252268-0100-01