(Boehringer Ingelheim) is used for bisacodyl tablets, net price 10-tab pack = 74p; suppositories (10 mg), 10 = £1.57; paediatric suppositories (5 mg), 5 = 94p
The brand name Dulcolax® Pico Liquid is used for sodium picosulfate elixir
DANTRON
(Danthron)
Indications only for constipation in terminally ill patients of all ages
Cautions see notes above; rodent studies indicate potential carcinogenic risk; avoid prolonged contact with skin (as in incontinent patients or infants wearing nappies) — risk of irritation and excoriation
Contra-indications See notes above
Pregnancy manufacturers of co-danthramer and co-danthrusate advise avoid — no information available
Breast-feeding manufacturers of co-danthramer and co-danthrusate advise avoid — limited information available
Side-effects see notes above; urine may be coloured red
Dose
See under preparations
With poloxamer ‘188’ (as co-danthramer)
Note Co-danthramer suspension 5 mL = one co-danthramer capsule, but strong co-danthramer suspension 5 mL = two strong co-danthramer capsules
Co-danthramer (Non-proprietary) 
Capsules, co-danthramer 25/200 (dantron 25 mg, poloxamer ‘188’ 200 mg). Net price 60-cap pack = £12.86. Label: 14, (urine red)
Dose 1–2 capsules at bedtime; CHILD 1 capsule at bedtime (restricted indications, see notes above)
Strong capsules, co-danthramer 37.5/500 (dantron 37.5 mg, poloxamer ‘188’ 500 mg). Net price 60-cap pack = £15.55. Label: 14, (urine red)
Dose ADULT and CHILD over 12 years, 1–2 capsules at bedtime (restricted indications, see notes above)
Suspension, co-danthramer 25/200 in 5 mL (dantron 25 mg, poloxamer ‘188’ 200 mg/5 mL). Net price 300 mL = £109.15. Label: 14, (urine red)
Note Sugar-free versions are available and can be ordered by specifying ‘sugar-free’ on the prescription
Brands include Danlax®
Dose 5–10 mL at night; CHILD 2.5–5 mL (restricted indications, see notes above)
Strong suspension, co-danthramer 75/1000 in 5 mL (dantron 75 mg, poloxamer ‘188’ 1 g/5 mL). Net price 300 mL = £266.08. Label: 14, (urine red)
Note Sugar-free versions are available and can be ordered by specifying ‘sugar-free’ on the prescription
Dose ADULT and CHILD over 12 years, 5 mL at night (restricted indications, see notes above)
With docusate sodium (as co-danthrusate)
Co-danthrusate (Non-proprietary) 
Capsules, co-danthrusate 50/60 (dantron 50 mg, docusate sodium 60 mg). Net price 63-cap pack = £42.50. Label: 14, (urine red)
Brands include Normax®
Dose 1–3 capsules at night; CHILD 6–12 years 1 capsule at night (restricted indications, see notes above)
Suspension, yellow, co-danthrusate 50/60 (dantron 50 mg, docusate sodium 60 mg/5 mL). Net price 200 mL = £89.92. Label: 14, (urine red)
Brands include Normax®
Dose 5–15 mL at night; CHILD 6–12 years 5 mL at night (restricted indications, see notes above)
DOCUSATE SODIUM
(Dioctyl sodium sulphosuccinate)
Indications constipation, adjunct in abdominal radiological procedures
Cautions see notes above; do not give with liquid paraffin; rectal preparations not indicated if haemorrhoids or anal fissure
Contra-indications see notes above
Pregnancy not known to be harmful — manufacturer advises caution
Breast-feeding present in milk following oral administration — manufacturer advises caution; rectal administration not known to be harmful
Side-effects see notes above; also rash
Dose
By mouth, chronic constipation, up to 500 mg daily in divided doses; CHILD (but see section 1.6) 6 months–2 years 12.5 mg 3 times daily, adjusted according to response (use paediatric solution); 2–12 years 12.5–25 mg 3 times daily, adjusted according to response (use paediatric oral solution)
Note Oral preparations act within 1–2 days
With barium meal, ADULT and CHILD over 12 years, 400 mg
Dioctyl® (UCB Pharma)
Capsules, yellow/white, docusate sodium 100 mg, net price 30-cap pack = £2.09, 100-cap pack = £6.98
Docusol® (Typharm)
Adult oral solution, sugar-free, docusate sodium 50 mg/5 mL, net price 300 mL = £5.49
Paediatric oral solution, sugar-free, docusate sodium 12.5 mg/5 mL, net price 300 mL = £5.29
Rectal preparations
Norgalax Micro-enema® (Norgine)
Enema, docusate sodium 120 mg in 10-g single-dose disposable packs. Net price 10-g unit = 66p
Dose ADULT and CHILD (but see section 1.6) over 12 years, 10-g unit
GLYCEROL
(Glycerin)
Indications constipation
Dose
See below
Glycerol Suppositories, BP
(Glycerin Suppositories)
Suppositories, gelatin 140 mg, glycerol 700 mg, purified water to 1 g, net price 12 = 88p (1 g), £1.08 (2 g), £1.72 (4 g)
Dose 1 suppository moistened with water before use, when required. The usual sizes are for INFANT under 1 year, small (1-g mould), CHILD 1–12 years medium (2-g mould), ADULT and CHILD over 12 years, large (4-g mould)
SENNA
Indications constipation
Cautions see notes above
Contra-indications see notes above
Pregnancy see Pregnancy
Breast-feeding not known to be harmful
Side-effects see notes above
Dose
See under preparations
Note Acts in 8–12 hours
Senna (Non-proprietary)
Tablets, total sennosides (calculated as sennoside B) 7.5 mg. Net price 60 = £7.12
Brands include Senokot® 
Dose 2–4 tablets, usually at night; initial dose should be low then gradually increased; CHILD (but see section 1.6) 2–6 years see BNF for Children; 6–18 years 1–4 tablets once daily, adjusted according to response
Note Lower dose on packs on sale to the public
Manevac® (HFA Healthcare)
Granules, coated, senna fruit 12.4%, ispaghula 54.2%, net price 400 g = £9.25. Label: 25, counselling, administration
Excipients include sucrose 800 mg per level 5-mL spoonful of granules
Dose ADULT and CHILD over 12 years, 1–2 level 5-mL spoonfuls at night with at least 150 mL water, fruit juice, milk or warm drink
Counselling Preparations that swell in contact with liquid should always be carefully swallowed with water or appropriate fluid and should not be taken immediately before going to bed
Senokot® (Reckitt Benckiser)
Tablets 
, see above
Syrup, sugar-free, brown, total sennosides (calculated as sennoside B) 7.5 mg/5 mL, net price 500 mL = £2.69
Dose 10–20 mL, usually at bedtime; CHILD (but see section 1.6) 1 month–2 years see BNF for Children, 2–4 years 2.5–10 mL once daily, adjusted according to response; 4–18 years 2.5–20 mL once daily, adjusted according to response
Note Lower dose on packs on sale to the public
SODIUM PICOSULFATE
(Sodium picosulphate)
Indications constipation; bowel evacuation before abdominal radiological and endoscopic procedures on the colon, and surgery (section 1.6.5); acts within 6–12 hours
Cautions see notes above; active inflammatory bowel disease (avoid if fulminant)
Contra-indications see notes above; severe dehydration
Pregnancy see Pregnancy
Breast-feeding not known to be present in milk but manufacturer advises avoid unless potential benefit outweighs risk
Side-effects see notes above; also nausea and vomiting
Dose
5–10 mg at night; CHILD (but see section 1.6) 1 month–4 years 2.5–10 mg once daily, adjusted according to response; 4–18 years 2.5–20 mg once daily, adjusted according to response
Note Sodium picosulfate doses in BNF may differ from those in product literature
Sodium Picosulfate (Non-proprietary)
Elixir, sodium picosulfate 5 mg/5 mL, net price 100 mL = £2.14
Note The brand name Dulcolax® Pico Liquid (Boehringer Ingelheim) is used for sodium picosulfate elixir 5 mg/5 mL
Other stimulant laxatives
Unstandardised preparations of cascara, frangula, rhubarb, and senna should be avoided as their laxative action is unpredictable. Aloes, colocynth, and jalap should be avoided as they have a drastic purgative action.
1.6.3 Faecal softeners
Liquid paraffin, the traditional lubricant, has disadvantages (see below). Bulk laxatives (section 1.6.1) and non-ionic surfactant ‘wetting’ agents e.g. docusate sodium (section 1.6.2) also have softening properties. Such drugs are useful for oral administration in the management of haemorrhoids and anal fissure; glycerol (section 1.6.2) is useful for rectal use.
Enemas containing arachis oil (ground-nut oil, peanut oil) lubricate and soften impacted faeces and promote a bowel movement.
ARACHIS OIL
Indications see notes above
Dose
See below
Arachis Oil Enema (Non-proprietary)
Enema, arachis (peanut) oil in 130-mL single-dose disposable packs. Net price 130 mL = £7.98
Dose to soften impacted faeces, 130 mL; the enema should be warmed before use; CHILD (but see section 1.6) under 3 years not recommended; over 3 years reduce adult dose in proportion to body-weight (medical supervision only), see BNF for Children
LIQUID PARAFFIN 
Indications constipation
Cautions avoid prolonged use; contra-indicated in children under 3 years
Side-effects anal seepage of paraffin and consequent anal irritation after prolonged use, granulomatous reactions caused by absorption of small quantities of liquid paraffin (especially from the emulsion), lipoid pneumonia, and interference with the absorption of fat-soluble vitamins
Dose
See under preparation
Liquid Paraffin Oral Emulsion, BP 
Oral emulsion, liquid paraffin 5 mL, vanillin 5 mg, chloroform 0.025 mL, benzoic acid solution 0.2 mL, methylcellulose-20 200 mg, saccharin sodium 500 micrograms, water to 10 mL
Dose ADULT over 18 years, 10–30 mL at night when required
Counselling Should not be taken immediately before going to bed
1.6.4 Osmotic laxatives
Osmotic laxatives increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with.
Lactulose is a semi-synthetic disaccharide which is not absorbed from the gastro-intestinal tract. It produces an osmotic diarrhoea of low faecal pH, and discourages the proliferation of ammonia-producing organisms. It is therefore useful in the treatment of hepatic encephalopathy.
Macrogols are inert polymers of ethylene glycol which sequester fluid in the bowel; giving fluid with macrogols may reduce the dehydrating effect sometimes seen with osmotic laxatives.
Saline purgatives such as magnesium hydroxide are commonly abused but are satisfactory for occasional use; adequate fluid intake should be maintained. Magnesium salts are useful where rapid bowel evacuation is required. Sodium salts should be avoided as they may give rise to sodium and water retention in susceptible individuals. Phosphate enemas are useful in bowel clearance before radiology, endoscopy, and surgery.
LACTULOSE
Indications constipation (may take up to 48 hours to act), hepatic encephalopathy (portal systemic encephalopathy)
Cautions lactose intolerance; interactions: Appendix 1 (lactulose)
Contra-indications galactosaemia, intestinal obstruction
Pregnancy not known to be harmful; see also Pregnancy
Side-effects nausea (can be reduced by administration with water, fruit juice or with meals), vomiting, flatulence, cramps, and abdominal discomfort
Dose
See under preparations below
Lactulose (Non-proprietary)
Solution, lactulose 3.1–3.7 g/5 mL with other ketoses. Net price 300-mL = £1.95, 500-mL = £3.25, 10 × 15 mL sachet pack = £2.50
Brands include Duphalac® 
, Lactugal®, Laevolac®
Dose constipation, initially 15 mL twice daily, adjusted according to response; CHILD (but see section 1.6) under 1 year 2.5 mL twice daily, adjusted according to response; 1–5 years 2.5–10 mL twice daily, adjusted according to response; 5–18 years 5–20 mL twice daily, adjusted according to response
Hepatic encephalopathy, 30–50 mL 3 times daily, subsequently adjusted to produce 2–3 soft stools daily; CHILD 12–18 years see BNF for Children
Note Lactulose doses in BNF may differ from those in product literature
MACROGOLS
(Polyethylene glycols)
Indications see preparations below
Cautions discontinue if symptoms of fluid and electrolyte disturbance; see also preparations below; interactions: Appendix 1 (macrogols)
Contra-indications intestinal perforation or obstruction, paralytic ileus, severe inflammatory conditions of the intestinal tract (such as Crohn’s disease, ulcerative colitis, and toxic megacolon), see also preparations below
Pregnancy limited data, but manufacturer advises that it can be used
Breast-feeding manufacturer advises that it can be used
Side-effects abdominal distension and pain, nausea, flatulence
Dose
See preparations below
Macrogol Oral Powder, Compound (Non-proprietary)
Oral powder, macrogol ‘3350’ (polyethylene glycol ‘3350’) 13.125 g, sodium bicarbonate 178.5 mg, sodium chloride 350.7 mg, potassium chloride 46.6 mg/sachet, net price 20-sachet pack = £4.45, 30-sachet pack = £8.87. Label: 13, counselling, administration
Brands include Laxido® Orange, Molaxole®
Cautions patients with cardiovascular impairment should not take more than 2 sachets in any 1 hour
Dose chronic constipation, ADULT and CHILD over 12 years, 1–3 sachets daily in divided doses usually for up to 2 weeks; maintenance, 1–2 sachets daily
Faecal impaction, ADULT and CHILD over 12 years, 4 sachets on first day, then increased in steps of 2 sachets daily to max. 8 sachets daily; total daily dose to be drunk within a 6 hour period. After disimpaction, switch to maintenance laxative therapy if required
Counselling Contents of each sachet to be dissolved in half a glass (approx. 125 mL) of water; after reconstitution the solution should be kept in a refrigerator and discarded if unused after 6 hours
Movicol® (Norgine)
Oral powder, macrogol ‘3350’ (polyethylene glycol ‘3350’) 13.125 g, sodium bicarbonate 178.5 mg, sodium chloride 350.7 mg, potassium chloride 46.6 mg/sachet, net price 20-sachet pack (lime and lemon flavour) = £4.45, 30-sachet pack (lime- and lemon- or chocolate- or plain-flavoured) = £6.68, 50–sachet pack (lime- and lemon- or plain-flavoured) = £11.13. Label: 13, counselling, administration
Note Amount of potassium chloride varies according to flavour of Movicol® as follows: plain-flavour (sugar-free) = 50.2 mg/sachet; lime and lemon flavour = 46.6 mg/sachet; chocolate flavour = 31.7 mg/sachet. 1 sachet when reconstituted with 125 mL water provides K+ 5.4 mmol/litre
Cautions patients with cardiovascular impairment should not take more than 2 sachets in any 1 hour
Dose chronic constipation, ADULT and CHILD over 12 years, 1–3 sachets daily in divided doses usually for up to 2 weeks; maintenance, 1–2 sachets daily
Faecal impaction, ADULT and CHILD over 12 years, 4 sachets on first day, then increased in steps of 2 sachets daily to max. 8 sachets daily; total daily dose to be drunk within a 6 hour period. After disimpaction, switch to maintenance laxative therapy if required
Counselling Contents of each sachet to be dissolved in half a glass (approx. 125 mL) of water; after reconstitution the solution should be kept in a refrigerator and discarded if unused after 6 hours
Oral concentrate, macrogol ‘3350’ (polyethylene glycol ‘3350’) 13.125 g, sodium bicarbonate 178.5 mg, sodium chloride 350.7 mg, potassium chloride 46.6 mg/25 mL, net price 500 mL (orange-flavoured) = £4.45. Label: 13, counselling, administration
Note 25 mL of oral concentrate when diluted with 100 mL water provides K+ 5.4 mmol/litre
Dose chronic constipation, ADULT and CHILD over 12 years, 25 mL 1–3 times daily usually for up to 2 weeks; maintenance, 25 mL 1–2 times daily
Counselling 25 mL of oral concentrate to be diluted with half a glass (approx. 100 mL of water). After dilution the solution should be discarded if unused after 24 hours
Movicol®-Half (Norgine)
Oral powder, sugar-free, macrogol ‘3350’ (polyethylene glycol ‘3350’) 6.563 g, sodium bicarbonate 89.3 mg, sodium chloride 175.4 mg, potassium chloride 23.3 mg/sachet, net price 20-sachet pack (lime and lemon flavour) = £2.92, 30-sachet pack = £4.38. Label: 13, counselling, administration
Cautions patients with cardiovascular impairment should not take more than 4 sachets in any 1 hour
Dose chronic constipation, ADULT and CHILD over 12 years, 2–6 sachets daily in divided doses usually for up to 2 weeks; maintenance, 2–4 sachets daily
Faecal impaction, ADULT and CHILD over 12 years, 8 sachets on first day, then increased in steps of 4 sachets daily to max. 16 sachets daily; total daily dose to be drunk within a 6 hour period. After disimpaction, switch to maintenance laxative therapy if required
Counselling Contents of each sachet to be dissolved in quarter of a glass (approx. 60–65 mL) of water; after reconstitution the solution should be kept in a refrigerator and discarded if unused after 6 hours
Movicol® Paediatric (Norgine) 
Oral powder, macrogol ‘3350’ (polyethylene glycol ‘3350’) 6.563 g, sodium bicarbonate 89.3 mg, sodium chloride 175.4 mg, potassium chloride 25.1 mg/sachet, net price 30-sachet pack (chocolate- or plain-flavoured) = £4.38. Label: 13, counselling, administration
Note Amount of potassium chloride varies according to flavour of Movicol® Paediatric as follows: chocolate flavour = 15.9 mg/sachet; plain flavour (sugar-free) = 25.1 mg/sachet. 1 sachet when reconstituted with 62.5 mL water provides K+ 5.4 mmol/litre
Cautions with high doses, impaired gag reflex, reflux oesophagitis, impaired consciousness
Contra-indications cardiovascular impairment; renal impairment
Dose chronic constipation and prevention of faecal impaction, CHILD under 2 years see BNF for Children; 2–6 years 1 sachet daily, adjusted according to response (max. 4 sachets daily); 6–12 years 2 sachets daily, adjusted according to response (max. 4 sachets daily)
Faecal impaction, CHILD under 5 years see BNF for Children; 5–12 years 4 sachets on first day then increased in steps of 2 sachets daily to 12 sachets daily (taken in divided doses over 12 hours each day until impaction resolves). After disimpaction, switch to maintenance laxative therapy
Counselling Contents of each sachet to be dissolved in quarter of a glass (approx. 60–65 mL) of water; after reconstitution the solution should be kept in a refrigerator and discarded if unused after 24 hours
MAGNESIUM SALTS
Indications see under preparations below
Cautions elderly and debilitated; see also notes above; interactions: Appendix 1 (antacids)
Contra-indications acute gastro-intestinal conditions
Hepatic impairment avoid in hepatic coma if risk of renal failure
Renal impairment avoid or reduce dose; increased risk of toxicity
Side-effects colic
Dose
See preparations
Magnesium hydroxide
Magnesium Hydroxide Mixture, BP
Aqueous suspension containing about 8% hydrated magnesium oxide. Do not store in cold place
Dose constipation, 30–45 mL with water at bedtime when required; CHILD 3–12 years, 5–10 mL with water at bedtime when required
Magnesium hydroxide with liquid paraffin
Liquid Paraffin and Magnesium Hydroxide Oral Emulsion, BP 
Oral emulsion, 25% liquid paraffin in aqueous suspension containing 6% hydrated magnesium oxide
Dose constipation, 5–20 mL when required
Note Liquid paraffin and magnesium hydroxide preparations on sale to the public include: Milpar® 
Magnesium sulfate
Magnesium Sulfate
Dose rapid bowel evacuation (acts in 2–4 hours) 5–10 g in a glass of water preferably before breakfast
Note Magnesium sulfate is on sale to the public as Epsom Salts
PHOSPHATES (RECTAL)
Indications rectal use in constipation; bowel evacuation before abdominal radiological procedures, endoscopy, and surgery
Cautions elderly and debilitated, electrolyte disturbances, congestive heart failure, ascites, uncontrolled hypertension, maintain adequate hydration
Contra-indications acute gastro-intestinal conditions (including gastro-intestinal obstruction, inflammatory bowel disease, and conditions associated with increased colonic absorption)
Renal impairment use with caution
Side-effects local irritation, electrolyte disturbances
Dose
See under preparations
Fleet® Ready-to-use Enema (Casen-Fleet)
Enema, sodium acid phosphate 21.4 g, sodium phosphate 9.4 g/118 mL, net price 133-mL pack (delivers 118 mL dose) with standard tube = 68p
Dose ADULT and CHILD (but see section 1.6) over 12 years, 118 mL; CHILD 3–12 years, on doctor’s advice only (under 3 years not recommended)
Phosphates Enema BP Formula B
Enema, sodium dihydrogen phosphate dihydrate 12.8 g, disodium phosphate dodecahydrate 10.24 g, purified water, freshly boiled and cooled, to 128 mL. Net price 128 mL with standard tube = £2.98, with long rectal tube = £17.93
Dose 128 mL; CHILD (but see section 1.6) over 3 years, reduced according to body weight see BNF for Children
SODIUM CITRATE (RECTAL)
Indications rectal use in constipation
Cautions elderly and debilitated; see also notes above
Contra-indications acute gastro-intestinal conditions
Dose
See under preparations
Micolette Micro-enema® (Pinewood)
Enema, sodium citrate 450 mg, sodium lauryl sulfoacetate 45 mg, glycerol 625 mg, together with potassium sorbate and sorbitol in a viscous solution, in 5-mL single-dose disposable packs with nozzle. Net price 5 mL = 41p
Dose ADULT and CHILD over 3 years, 5–10 mL (but see section 1.6)
Micralax Micro-enema® (RPH)
Enema, sodium citrate 450 mg, sodium alkylsulfoacetate 45 mg, sorbic acid 5 mg, together with glycerol and sorbitol in a viscous solution in 5-mL single-dose disposable packs with nozzle. Net price 5 mL = 41p
Dose ADULT and CHILD over 3 years, 5 mL (but see section 1.6)
Relaxit Micro-enema® (Crawford)
Enema, sodium citrate 450 mg, sodium lauryl sulfate 75 mg, sorbic acid 5 mg, together with glycerol and sorbitol in a viscous solution in 5-mL single-dose disposable packs with nozzle. Net price 5 mL = 43p
Dose ADULT and CHILD (but see section 1.6) 5 mL (insert only half nozzle length in child under 3 years)
1.6.5 Bowel cleansing preparations
Bowel cleansing preparations are used before colonic surgery, colonoscopy, or radiological examination to ensure the bowel is free of solid contents. They are not treatments for constipation.
Cautions Bowel cleansing preparations should be used with caution in patients with fluid and electrolyte disturbances. Renal function should be measured before starting treatment in patients at risk of fluid and electrolyte disturbances. Hypovolaemia should be corrected before administration of bowel cleansing preparations. Adequate hydration should be maintained during treatment. Bowel cleansing preparations should be used with caution in colitis (avoid if acute severe colitis), in children, in the elderly, or in those who are debilitated. They should also be used with caution in patients with an impaired gag reflex or possibility of regurgitation or aspiration.
Other oral drugs should not be taken one hour before or after administration of bowel cleansing preparations because absorption may be impaired. Consider withholding ACE inhibitors, angiotensin-II receptor antagonists, and NSAIDs on the day that bowel cleansing preparations are given and for up to 72 hours after the procedure. Also consider withholding diuretics on the day that bowel cleansing preparations are given. See also Combined Hormonal Contraceptives (section 7.3.1) and Oral Progestogen-only Contraceptives (section 7.3.2.1).
Contra-indications Bowel cleansing preparations are contra-indicated in patients with gastro-intestinal obstruction or perforation, gastric retention, acute severe colitis, or toxic megacolon.
Side-effects Side-effects of bowel cleansing preparations include nausea, vomiting, abdominal pain (usually transient — reduced by taking more slowly), and abdominal distention. Less frequent side-effects include headache, dizziness, dehydration, and electrolyte disturbances.
MACROGOLS
Indications see notes above
Cautions see notes above; also heart failure; interactions: Appendix 1 (macrogols)
Contra-indications see notes above
Pregnancy manufacturers advise use only if essential — no information available
Breast-feeding manufacturers advise use only if essential — no information available
Side-effects see notes above; also fatigue, sleep disturbances, and anal discomfort
Dose
See preparations
Klean-Prep® (Norgine)
Oral powder, sugar-free, macrogol ‘3350’ (polyethylene glycol ‘3350’) 59 g, anhydrous sodium sulfate 5.685 g, sodium bicarbonate 1.685 g, sodium chloride 1.465 g, potassium chloride 743 mg/sachet, net price 4 sachets = £9.07. Label: 10, patient information leaflet, 13, counselling
Excipients include aspartame (section 9.4.1)
Electrolytes 1 sachet when reconstituted with 1 litre of water provides Na+ 125 mmol, K+ 10 mmol, Cl– 35 mmol, HCO3– 20 mmol
Dose bowel evacuation before surgery, colonoscopy, or radiological examination, 2 litres of reconstituted solution on the evening before procedure and 2 litres of reconstituted solution on the morning of procedure; alternatively, a glass (approx. 250 mL) of reconstituted solution every 10–15 minutes, or by nasogastric tube 20–30 mL/minute, starting on the day before procedure until 4 litres have been consumed. Treatment can be stopped if bowel motions become watery and clear; CHILD 12–18 years see BNF for Children
Counselling 1 sachet should be reconstituted with 1 litre of water. Flavouring such as clear fruit cordials may be added if required. Solid food should not be taken for at least 2 hours before starting treatment. After reconstitution the solution should be kept in a refrigerator and discarded if unused after 24 hours
Moviprep® (Norgine)
Oral powder, lemon- or orange-flavoured, Sachet A (containing macrogol ‘3350’ (polyethylene glycol ‘3350’) 100 g, anhydrous sodium sulphate 7.5 g, sodium chloride 2.691 g, potassium chloride 1.015 g) and Sachet B (containing ascorbic acid 4.7 g, sodium ascorbate 5.9 g), net price 4-sachet pack (2 each of sachet A and B) = £9.87. Label: 10, patient information leaflet, 13, counselling, see below
Excipients include aspartame (section 9.4.1)
Electrolytes 1 pair of sachets (A+B) when reconstituted with 1 litre of water provides Na+ 181.6 mmol (Na+ 56.2 mmol absorbable), K+ 14.2 mmol, Cl– 59.8 mmol
Contra-indications G6PD deficiency
Renal impairment caution if eGFR less than 30 mL/minute/1.73 m2
Dose bowel evacuation for surgery, colonoscopy or radiological examination, ADULT over 18 years, 1 litre of reconstituted solution on the evening before procedure and 1 litre of reconstituted solution early on the morning of procedure; alternatively, 2 litres of reconstituted solution on the evening before procedure; treatment should be completed at least 1 hour before colonoscopy
Counselling One pair of sachets (A and B) should be reconstituted in 1 litre of water and taken over 1–2 hours. Solid food should not be taken during treatment until procedure completed. 1 litre of other clear fluid should also be taken during treatment. Treatment can be stopped if bowel motions become watery and clear
MAGNESIUM CITRATE
Reconstitution of a sachet containing 11.57 g magnesium carbonate and 17.79 g anhydrous citric acid produces a solution containing magnesium citrate
Indications see preparations
Cautions see notes above
Contra-indications see notes above
Hepatic impairment avoid in hepatic coma if risk of renal failure
Renal impairment avoid if eGFR less than 30 mL/minute/1.73 m2 — risk of hypermagnesaemia
Pregnancy caution
Breast-feeding caution
Side-effects see notes above
Dose
See preparations
Citramag® (Sanochemia)
Oral powder, sugar-free, effervescent, magnesium carbonate 11.57 g, anhydrous citric acid 17.79 g/sachet, net price 10-sachet pack (lemon and lime flavour) = £18.92. Label: 10, patient information leaflet, 13, counselling, see below
Electrolytes Mg2+ 118 mmol/sachet
Dose bowel evacuation for surgery, colonoscopy or radiological examination, on day before procedure, 1 sachet at 8 a.m. and 1 sachet between 2 and 4 p.m.; CHILD 5–10 years one-third adult dose; over 10 years and frail ELDERLY one-half adult dose
Counselling One sachet should be reconstituted with 200 mL of hot water; the solution should be allowed to cool for approx. 30 minutes before drinking. Low residue or fluid 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 clear fluids recommended until procedure
PHOSPHATES (ORAL)
Indications see preparations
Cautions see notes above; also cardiac disease (avoid in congestive cardiac failure)
Contra-indications see notes above; also ascites; congestive cardiac failure
Hepatic impairment use with caution in cirrhosis; avoid in ascites
Renal impairment avoid if eGFR less than 60 mL/minute/1.73 m2
Pregnancy caution
Breast-feeding caution
Side-effects see notes above; also chest pain, arrhythmias, asthenia, and renal failure
Dose
See preparations
OsmoPrep® (TMC)
Tablets, monobasic sodium phosphate monohydrate 1.102 g, disodium phosphate 398 mg, net price 32-tab pack = £8.50. Label: 10, patient information leaflet, counselling, see below
Electrolytes Na+ 13.6 mmol, Mg2+ 0.34 mmol, phosphate 10.8 mmol/tablet
Dose bowel evacuation before diagnostic procedure, ADULT over 18 years, 4 tablets every 15 minutes until a total of 20 tablets have been consumed on the evening before procedure, then on the next day (starting 3–5 hours before procedure) 4 tablets every 15 minutes until a total of 12 tablets have been consumed; do not repeat course within 7 days
Counselling On the day before procedure, a light, low-fibre breakfast may be consumed in the morning, clear liquid diet recommended after 12 noon. Each dose of 4 tablets to be taken with 250 mL clear liquid. Copious intake of water or other clear liquids recommended during treatment
Fleet Phospho-soda® (Casen-Fleet)
Oral solution, sugar-free, sodium dihydrogen phosphate dihydrate 24.4 g, disodium phosphate dodecahydrate 10.8 g/45 mL. Net price 2 × 45-mL bottles = £4.79. Label: 10, patient information leaflet, counselling
Electrolytes Na+ 217 mmol, phosphate 186 mmol/45 mL
Dose bowel evacuation before colonic surgery, colonoscopy or radiological examination, ADULT over 18 years, 45 mL diluted with half a glass (120 mL) of cold water, followed by one full glass (240 mL) of cold water
Timing of doses is dependent on the time of the procedure
For morning procedure, first dose should be taken at 7 a.m. and second at 7 p.m. on day before the procedure
For afternoon procedure, first dose should be taken at 7 p.m. on day before and second dose at 7 a.m. on day of the procedure
Acts within half to 6 hours of first dose
Counselling Intake of solid food should be stopped for at least 6 hours before starting treatment and until procedure completed. Copious intake of water or other clear fluids (e.g. clear soup, strained fruit juice without pulp, black tea or coffee) recommended until midnight before morning procedure and until 8 a.m. before afternoon procedure. At least one glass (approx 240 mL) of water or other clear fluid should also be taken immediately before each dose
SODIUM PICOSULFATE WITH MAGNESIUM CITRATE
Indications see preparations
Cautions see notes above; also recent gastro-intestinal surgery; cardiac disease (avoid in congestive cardiac failure)
Contra-indications see notes above; also gastro-intestinal ulceration; ascites; congestive cardiac failure
Hepatic impairment avoid in hepatic coma if risk of renal failure
Renal impairment avoid if eGFR less than 30 mL/minute/1.73 m2 — risk of hypermagnesaemia
Pregnancy caution
Breast-feeding caution
Side-effects see notes above; also anal discomfort, sleep disturbances, fatigue, and rash
Dose
See preparations
CitraFleet® (Casen-Fleet)
Oral powder, sodium picosulfate 10 mg/sachet, with magnesium citrate, net price 2-sachet pack (lemon-flavoured) = £3.25. Label: 10, patient information leaflet, 13, counselling, see below
Electrolytes K+ 5 mmol, Mg2+ 86 mmol/sachet
Dose bowel evacuation on day before radiological examination, endoscopy, or surgery, ADULT over 18 years, 1 sachet before 8 a.m. then 1 sachet 6–8 hours later
Acts within 3 hours of first dose
Counselling One sachet should be reconstituted with 150 mL (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. Low residue diet recommended on the day before procedure and copious intake of water or other clear fluids recommended during treatment
Picolax® (Ferring)
Oral powder, sugar-free, sodium picosulfate 10 mg/sachet, with magnesium citrate, net price 20-sachet pack = £33.90. Label: 10, patient information leaflet, 13, counselling, see below
Electrolytes K+ 5 mmol, Mg2+ 87 mmol/sachet
Dose bowel evacuation on day before radiological procedure, endoscopy, or surgery, ADULT and CHILD over 9 years, 1 sachet before 8 a.m. then 1 sachet 6–8 hours later; CHILD 1–2 years, quarter sachet before 8 a.m. then quarter sachet 6–8 hours later; 2–4 years, half sachet before 8 a.m. then half sachet 6–8 hours later; 4–9 years, 1 sachet before 8 a.m. then half sachet 6–8 hours later
Acts within 3 hours of first dose
Counselling One sachet should be reconstituted with 150 mL (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. Low residue diet recommended on the day before procedure and copious intake of water or other clear fluids recommended during treatment
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