Other drugs used for Bowel cleansingBisacodyl, p.59
.
Docusate sodium, p.58
.
Magnesium sulfate, p.963LAXATIVES
›
OSMOTIC LAXATIVESCitric acid with magnesium carbonate
(Formulated as a bowel cleansing preparation)
lINDICATIONS AND DOSE
Bowel evacuation for surgery, colonoscopy or radiological examination
▶BY MOUTH
▶Child 5–9 years:One-third of a sachet to be given at 8a.m. the day before the procedure and, one-third of a sachet to be given between2and4p.m. the day before the procedure
▶Child 10–17 years:0.5–1sachet, given at8a.m. the day before the procedure and0.5–1sachet, given between 2and4p.m. the day before the procedure
▶Adult:1sachet, given8a.m. the day before the procedure and1sachet, given between2and4p.m. the day before the procedure, use half the dose in frail elderly patients
lCONTRA-INDICATIONSAcute severe colitis
.
gastric retention.
gastro-intestinal obstruction.
gastro-intestinal perforation.
toxic megacolonlCAUTIONSChildren
.
colitis (avoid if acute severe colitis).
debilitated
.
elderly.
hypovolaemia (should be corrected before administration of bowel cleansing preparations).
impaired gag reflex or possibility of regurgitation or aspiration
.
patients withfluid and electrolyte disturbances48 Constipation and bowel cleansing
BNF74Gastro-intestinalsystem
1
CAUTIONS, FURTHER INFORMATION
Adequate hydration should be maintained during treatment.
lINTERACTIONS→Appendix1: bowel cleansing preparations
lSIDE-EFFECTS
▶Common or very commonAbdominal distention
.
abdominal pain
.
nausea.
vomiting▶UncommonDehydration
.
dizziness.
electrolyte disturbances.
headacheSIDE-EFFECTS, FURTHER INFORMATION
▶Abdominal painAbdominal pain is usually transient and can be reduced by taking preparation more slowly.
lPREGNANCYUse with caution.
lBREAST FEEDINGUse with caution.
lHEPATIC IMPAIRMENTAvoid in hepatic coma if risk of renal failure.
lRENAL IMPAIRMENT
▶In adultsAvoid if eGFR less than30mL/minute/1.73m2— risk of hypermagnesaemia.
▶In childrenAvoid if estimated glomerularfiltration rate less than30mL/minute/1.73m2—risk of hypermagnesaemia.
lMONITORING REQUIREMENTSRenal function should be measured before starting treatment in patients at risk of fluid and electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATIONOne sachet should be reconstituted with200mL of hot water; the solution should be allowed to cool for approx.30minutes before drinking.
lPRESCRIBING AND DISPENSING INFORMATION Reconstitution of one sachet containing11.57g magnesium carbonate and17.79g anhydrous citric acid produces a solution containing magnesium citrate with 118mmol Mg2+.
Flavours of oral powders may include lemon and lime.
lPATIENT AND CARER ADVICELow residue orfluid only diet (e.g. water, fruit squash, clear soup, black tea or coffee) recommended before procedure (according to prescriber’s advice) and copious intake of clearfluids recommended until procedure. Patient or carers should be given advice on how to administer oral powder.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Effervescent powder
CAUTIONARY AND ADVISORY LABELS13, 10 ELECTROLYTES:May contain Magnesium
▶Citramag(Sanochemia Diagnostics UK Ltd)
Magnesium carbonate heavy 11.57 gram, Citric acid anhydrous 17.79 gramCitramag effervescent powder sachets sugar-free|10 sachetp£18.92
Macrogol 3350 with anhydrous sodium sulfate, ascorbic acid,
potassium chloride, sodium ascorbate and sodium chloride
(Polyethylene glycols)
lINDICATIONS AND DOSE MOVIPREP®
Bowel evacuation for surgery, colonoscopy or radiological examination
▶BY MOUTH
▶Adult:1litre daily for2doses:first dose of reconstituted solution taken on the evening before procedure and the second dose on the morning of
procedure, alternatively2litres daily for1dose;
reconstituted solution to be taken on the evening before the procedure, treatment should be completed at least1hour before colonoscopy
lCONTRA-INDICATIONSAcute severe colitis
.
G6PD deficiency.
gastric retention.
gastro-intestinal obstruction.
gastro-intestinal perforation.
toxic megacolon lCAUTIONSColitis (avoid if acute severe colitis).
debilitatedpatients
.
elderly.
fluid and electrolyte disturbances.
heart failure.
hypovolaemia (should be corrected before administration of bowel cleansing preparations).
impaired gag reflex or possibility of regurgitation or aspiration lINTERACTIONS→Appendix1: bowel cleansingpreparations lSIDE-EFFECTS
▶Common or very commonAbdominal distention
.
abdominal pain
.
nausea.
vomiting▶UncommonDehydration
.
dizziness.
electrolyte disturbances.
headache▶Frequency not knownAnal discomfort
.
fatigue.
sleep disturbancesSIDE-EFFECTS, FURTHER INFORMATION
▶Abdominal painAbdominal pain is usually transient and can be reduced by taking preparation more slowly.
lPREGNANCYManufacturers advise use only if essential—
no information available.
lBREAST FEEDINGManufacturers advise use only if essential—no information available.
lRENAL IMPAIRMENTCaution if eGFR less than 30mL/minute/1.73m2.
lMONITORING REQUIREMENTSRenal function should be measured before starting treatment in patients at risk of fluid and electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATION
MOVIPREP®One pair of sachets (A and B) should be reconstituted in1litre of water and taken over1–2hours.
1litre of other clearfluid should also be taken during treatment.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of oral powder formulations may include lemon or orange.
MOVIPREP®1pair of sachets (A+B) when reconstituted with1litre of water provides Na+181.6mmol (Na+ 56.2mmol absorbable), K+14.2mmol, Cl–59.8mmol.
lPATIENT AND CARER ADVICEPatient information leaflet.
Solid food should not be taken during treatment until procedure completed. Treatment can be stopped if bowel motions become watery and clear.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Powder
CAUTIONARY AND ADVISORY LABELS10, 13 EXCIPIENTS:May contain Aspartame
ELECTROLYTES:May contain Chloride, potassium, sodium
▶Moviprep(Norgine Pharmaceuticals Ltd)
Moviprep oral powder sachets sugar-free|4sachetp£9.87
BNF74
Bowel cleansing 49
Gastro-intestinalsystem
1
Macrogol 3350 with anhydrous sodium sulfate, potassium chloride, sodium bicarbonate and sodium chloride
(Formulated as a bowel cleansing preparation)
lINDICATIONS AND DOSE
Bowel cleansing before radiological examination, colonoscopy, or surgery
▶INITIALLY BY MOUTH
▶Adult:Initially2litres daily for2doses:first dose of reconstituted solution taken on the evening before procedure and the second dose on the morning of procedure, alternatively (by mouth) initially250mL every10–15minutes, reconstituted solution to be administered, alternatively (by nasogastric tube) initially20–30mL/minute, starting on the day before procedure until4litres have been consumed lCONTRA-INDICATIONSAcute severe colitis
.
gastricretention
.
gastro-intestinal obstruction.
gastro-intestinal perforation.
toxic megacolonlCAUTIONSColitis (avoid if acute severe colitis)
.
debilitated patients.
elderly.
fluid and electrolyte disturbances.
heart failure.
hypovolaemia (should be corrected before administration of bowel cleansing preparations).
impaired gag reflex or possibility of regurgitation or aspiration lINTERACTIONS→Appendix1: bowel cleansingpreparations lSIDE-EFFECTS
▶Common or very commonAbdominal distention
.
abdominal pain
.
nausea.
vomiting▶UncommonAnal discomfort
.
dehydration.
dizziness.
electrolyte disturbances
.
fatigue.
headache.
sleep disturbancesSIDE-EFFECTS, FURTHER INFORMATION
▶Abdominal painAbdominal pain is usually transient and can be reduced by taking preparation more slowly.
lPREGNANCYManufacturers advise use only if essential—
no information available.
lBREAST FEEDINGManufacturers advise use only if essential—no information available.
lMONITORING REQUIREMENTSRenal function should be measured before starting treatment in patients at risk of fluid and electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATION1sachet should be reconstituted with1litre of water. Flavouring such as clear fruit cordials may be added if required. After
reconstitution the solution should be kept in a refrigerator and discarded if unused after24hours.
lPRESCRIBING AND DISPENSING INFORMATIONEach Klean-Prep®sachet provides Na+125mmol, K+10mmol, Cl -35mmol and HCO3-20mmol when reconstituted with 1litre of water.
lPATIENT AND CARER ADVICESolid food should not be taken for2hours before starting treatment. Adequate hydration should be maintained during treatment.
Treatment can be stopped if bowel motions become watery and clear.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Powder
CAUTIONARY AND ADVISORY LABELS10, 13 EXCIPIENTS:May contain Aspartame
ELECTROLYTES:May contain Bicarbonate, chloride, potassium, sodium
▶Klean-Prep(Norgine Pharmaceuticals Ltd)
Potassium chloride 742.5 mg, Sodium chloride 1.465 gram, Sodium bicarbonate 1.685 gram, Sodium sulfate anhydrous 5.685 gram, Polyethylene glycol 3350 59 gramKlean-Prep oral powder69g sachets sugar-free|4sachetp £9.98
LAXATIVES
›
STIMULANT LAXATIVESMagnesium citrate with sodium picosulfate
(Formulated as a bowel cleansing preparation)
lINDICATIONS AND DOSE CITRAFLEET®SACHETS
Bowel evacuation on day before radiological examination, endoscopy, or surgery
▶BY MOUTH
▶Adult:1sachet taken before8a.m, then1sachet after 6–8hours
PHARMACOKINETICS
ForCitraFleet®: Acts within3hours offirst dose.
PICOLAX®SACHETS
Bowel evacuation on day before radiological procedure, endoscopy, or surgery
▶BY MOUTH
▶Child 1 year:0.25sachet taken before8a.m, then 0.25sachet after6–8hours
▶Child 2–3 years: 0.5sachet taken before8a.m, then 0.5sachet after6–8hours
▶Child 4–8 years:1sachet taken before8a.m, then 0.5sachet after6–8hours
▶Child 9–17 years:1sachet taken before8a.m, then 1sachet after6–8hours
▶Adult:1sachet taken before8a.m, then1sachet after 6–8hours
PHARMACOKINETICS
ForPicolax®: Acts within3hours offirst dose.
lCONTRA-INDICATIONSAcute severe colitis
.
ascites.
congestive cardiac failure
.
gastric retention.
gastro-intestinal obstruction.
gastro-intestinal perforation.
gastro-intestinal ulceration
.
toxic megacolon lCAUTIONSCardiac disease (avoid in congestive cardiacfailure)
.
children.
colitis (avoid if acute severe colitis).
debilitated patients
.
elderly.
fluid and electrolyte disturbances.
hypovolaemia (should be corrected before administration).
impaired gag reflex or possibility of regurgitation or aspiration.
recent gastro-intestinal surgerylSIDE-EFFECTS
▶Common or very commonAbdominal distention
.
abdominal pain (usually transient—reduced by taking more slowly)
.
nausea.
vomiting▶UncommonDehydration
.
dizziness.
electrolyte disturbances.
headache▶Frequency not knownAnal discomfort
.
fatigue.
rash.
sleep disturbanceslPREGNANCYCaution.
lBREAST FEEDINGCaution.
lHEPATIC IMPAIRMENTAvoid in hepatic coma if risk of renal failure.
50 Constipation and bowel cleansing
BNF74Gastro-intestinalsystem
1
lRENAL IMPAIRMENT
▶In adultsAvoid if eGFR less than30mL/minute/1.73m2— risk of hypermagnesaemia.
▶In childrenAvoid if estimated glomerularfiltration rate less than30mL/minute/1.73m2—risk of hypermagnesaemia.
lDIRECTIONS FOR ADMINISTRATIONOne sachet of sodium picosulfate with magnesium citrate powder should be reconstituted with150mL (approx. half a glass) of cold water; patients should be warned that heat is generated during reconstitution and that the solution should be allowed to cool before drinking.
PICOLAX®SACHETSOne sachet should be reconstituted with150mL (approx. half a glass) of cold water.
CITRAFLEET®SACHETSOne sachet should be reconstituted with150mL (approx. half a glass) of cold water.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of oral powder formulations may include lemon.
PICOLAX®SACHETSOne reconstituted sachet contains K+ 5mmol and Mg2+87mmol.
CITRAFLEET®SACHETSOne reconstituted sachet contains K+5mmol and Mg2+86mmol.
lPATIENT AND CARER ADVICELow residue diet recommended on the day before procedure and copious intake of water or other clearfluids recommended during treatment. Patients or carers should be given advice on how to administer sodium picosulfate with magnesium citrate oral powder.
PICOLAX®SACHETS AND CITRAFLEET®SACHETSLow residue diet recommended on the day before procedure and copious intake of water or other clearfluids recommended during treatment.
Patients and carers should be given advice on how to administer oral powder; they should be warned that heat is generated during reconstitution and that the solution should be allowed to cool before drinking.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines containing the same drug.
Powder
CAUTIONARY AND ADVISORY LABELS10, 13 ELECTROLYTES:May contain Magnesium, potassium
▶CitraFleet(Casen Recordati S.L.)
Sodium picosulfate 10 mg, Magnesium oxide light 3.5 gram, Citric acid anhydrous 10.97 gramCitraFleet oral powder15.08g sachets sugar-free|2sachetp£3.25
▶Picolax(Ferring Pharmaceuticals Ltd)
Sodium picosulfate 10 mg, Magnesium oxide 3.5 gram, Citric acid anhydrous 12 gramPicolax oral powder16.1g sachets sugar-free| 20sachetP no price available