page91
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 U
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 U
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 adminis-
tered 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 encephalo-
pathy
.
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 evacua-
tion is required. Sodium salts should be avoided as they
may give rise to sodium and water retention in suscep-
tible 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 obstruc-
tion
Pregnancy
not known to be harmful; see also
Pregnancy,
p.
67
Side-effects
nausea (can be reduced by administra-
tion 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 pack = £2.10, 500-mL pack = £2.59
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
Brands include
Duphalac
c
D,
Lactugal
c
,
Regulose
c
MACROGOLS
(Polyethylene glycols)
Indications
see preparations below
Cautions
discontinue if symptoms of fluid and
electrolyte disturbance;
see also preparations below
Contra-indications
intestinal perforation or obstruc-
tion,
paralytic ileus,
severe inflammatory conditions
of the intestinal tract (such as Crohn’s disease,
ulcer-
ative colitis,
and toxic megacolon),
see also prepara-
tions below
Pregnancy
manufacturers advice use only if essen-
tial—no information available
Breast-feeding
manufacturers advice use only if
essential—no information available
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,
sod-
ium chloride 350.7 mg,
potassium chloride 46.6 mg/
sachet,
net price 20-sachet pack = £4.45,
30-sachet
pack = £6.68.
Label:
13
Brands include
Laxido
c
Orange
,
Molaxole
c
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
(Norgine)
Oral powder
,
macrogol ‘3350’
(polyethylene glycol
‘3350’) 13.125 g,
sodium bicarbonate 178.5 mg,
sod-
ium 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
Note
Amount of
potassium chloride varies according to flavour
of
Movicol
c
as follows:
plain-flavour (sugar-free) = 50.2 mg/
sachet;
lime and lemon flavour = 46.6 mg/sachet;
BNF 61
1.6.4 Osmotic laxatives
71
1
Gastro-intestinal system