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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; contents
of each sachet dissolved in half a glass (approx. 125 mL) of water;
maintenance, 1–2 sachets daily
Faecal impaction, ADULT and CHILD over 12 years, 8 sachets daily
dissolved in 1 litre of water and drunk within 6 hours,
usually for
max.
3 days
After reconstitution the solution should be kept in a refrigerator
and discarded if unused after 6 hours
Movicol
c
-Half
(Norgine)
Oral powder
,
sugar-free,
macrogol ‘3350’ (polyethy-
lene glycol ‘3350’) 6.563 g,
sodium bicarbonate
89.3 mg,
sodium chloride 175.4 mg,
potassium chlor-
ide 23.3 mg/sachet,
net price 20-sachet pack (lime
and lemon flavour) = £2.67,
30-sachet pack = £4.01.
Label:
13
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; content
of each sachet dissolved in quarter of a glass (approx. 60–65 mL)
of water; maintenance, 2–4 sachets daily
Faecal impaction, ADULT and CHILD over 12 years, 16 sachets daily
dissolved in 1 litre of water and drunk within 6 hours, usually for
max.
3 days
After reconstitution the solution should be kept in a refrigerator
and discarded if unused after 6 hours
Movicol
c
Paediatric Plain
(Norgine) A
Oral powder
,
sugar-free,
macrogol ‘3350’ (polyethy-
lene glycol ‘3350’) 6.563 g,
sodium bicarbonate
89.3 mg,
sodium chloride 175.4 mg,
potassium chlor-
ide 25.1 mg/sachet, net price 30-sachet pack = £4.45.
Label:
13
Cautions
with high doses
,
impaired gag reflex,
reflux oeso-
phagitis,
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); content of each sachet dis-
solved 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 U
Oral emulsion
,
25% liquid paraffin in aqueous sus-
pension 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
c
D
Magnesium sulphate
Magnesium Sulphate
Label:
13,
23
Dose
rapid bowel evacuation (acts in 2–4 hours) 5–10 g in a glass
of water preferably before breakfast
Note
Magnesium sulphate is on sale to the public as Epsom Salts
Bowel cleansing preparations
Section 1.6.5
PHOSPHATES (RECTAL)
Indications
rectal use in constipation; bowel evacua-
tion before abdominal radiological procedures,
endo-
scopy,
and surgery
Cautions
elderly and debilitated;
with enema
,
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 enema with caution
Side-effects
local irritation;
with enema
,
electrolyte
disturbances
Dose
. See under preparations
Carbalax
c
(Chemidex)
Suppositories
,
sodium acid phosphate (anhydrous)
1.3 g, sodium bicarbonate 1.08 g, net price 12 = £2.01
Dose
constipation,
ADULT and CHILD over 12 years, 1 supposi-
tory,
inserted 30 minutes before evacuation required;
moisten
with water before use
Fleet
c
Ready-to-use Enema
(Casen-Fleet)
Enema
,
sodium acid phosphate 21.4 g,
sodium phos-
phate 9.4 g/118 mL,
net price 133-mL pack (delivers
118 mL dose) with standard tube = 57p
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 = £3.98
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
c
(Pinewood)
Enema
,
sodium citrate 450 mg,
sodium lauryl sul-
phoacetate 45 mg,
glycerol 625 mg,
together with
potassium sorbate and sorbitol in a viscous solution,
72
1.6.4 Osmotic laxatives
BNF 61
1
Gastro-intestinal system