page93
in 5-mL single-dose disposable packs with nozzle. Net
price 5 mL = 38p
Dose
ADULT and CHILD over 3 years, 5–10 mL (but see section
1.6)
Micralax Micro-enema
c
(UCB Pharma)
Enema
,
sodium citrate 450 mg,
sodium alkylsul-
phoacetate 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
c
(Crawford)
Enema
,
sodium citrate 450 mg,
sodium lauryl sul-
phate 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 = 32p
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
Renal
function should be measured before
starting treatment. Bowel cleansing preparations should
be used with caution in patients with fluid and electro-
lyte disturbances.
Hypovolaemia should be corrected
before administration of
bowel
cleansing preparations.
Adequate hydration should be maintained during treat-
ment. Bowel cleansing preparations should be used with
caution in colitis (avoid if acute severe colitis),
in chil-
dren, in the elderly, or in those who are debilitated. They
should also be used with caution in patients with an
impaired gag reflex, reduced levels of consciousness, 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.
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 prepara-
tions include nausea, vomiting, abdominal pain (usually
transient—reduced by taking more slowly),
and abdo-
minal
distention.
Less
frequent
side-effects
include
headache, dizziness, dehydration, and electrolyte distur-
bances.
MACROGOLS
Indications
see notes above
Cautions
see notes above; also heart failure;
acute
inflammatory bowel disease
Contra-indications
see notes above
Pregnancy
manufacturers advise use only if essen-
tial—no information available
Breast-feeding
manufacturers advise use only if
essential—no information available
Side-effects
see notes above;
also fatigue,
sleep dis-
turbances,
and anal discomfort
Dose
. See preparations
Klean-Prep
c
(Norgine)
Oral powder
,
sugar-free,
macrogol ‘3350’ (polyethy-
lene glycol ‘3350’) 59 g,
anhydrous sodium sulphate
5.685 g,
sodium bicarbonate 1.685 g, sodium chloride
1.465 g,
potassium chloride 743 mg/sachet,
net price
4 sachets = £8.23.
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
ÿ
35 mmol,
HCO
3
ÿ
20 mmol
Dose
bowel evacuation before surgery,
colonoscopy,
or radi-
ological examination,
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; alternatively, administration may be divided into
two (2 litres of reconstituted solution taken on the evening before
procedure and 2 litres of reconstituted solution taken on the
morning of procedure).
Treatment can be stopped if bowel
motions become watery and clear. To facilitate gastric emptying,
domperidone or metoclopramide may be given 30 minutes before
starting;
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
c
(Norgine)
Oral powder
,
lemon- or orange-flavoured,
Sachet A
(containing macrogol ‘3350’
(polyethylene glycol
‘3350’) 100 g,
anhydrous sodium sulphate 7.5 g,
sod-
ium 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 informa-
tion 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
ÿ
59.8 mmol
Contra-indications
G6PD deficiency
Renal impairment
caution if eGFR less than 30 mL/minute/
1.73 m
2
Dose
bowel evacuation for surgery, colonoscopy or radiological
examination,
ADULT over 18 years,
2 litres of reconstituted solu-
tion on the evening before procedure
or
1 litre of reconstituted
solution on the evening before procedure and 1 litre of reconsti-
tuted solution early on the morning of 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 solu-
tion 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 m
2
—risk of hypermagnesaemia
Pregnancy
caution
Breast-feeding
caution
Side-effects
see notes above
Dose
. See preparations
BNF 61
1.6.5 Bowel cleansing preparations
73
1
Gastro-intestinal system