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Citramag
c
(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) = £17.20.
Label:
10,
patient information
leaflet,
13,
counselling,
see below
Electrolytes
Mg
2þ
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 m
2
Pregnancy
caution
Breast-feeding
caution
Side-effects
see notes above;
also chest pain, arrhy-
thmias,
asthenia,
and renal failure
Dose
. See preparations
OsmoPrep
c
(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,
Mg
2þ
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
c
(Casen-Fleet)
Oral solution
,
sugar-free,
sodium dihydrogen phos-
phate dihydrate 24.4 g,
disodium phosphate dodeca-
hydrate 10.8 g/45 mL. Net price 2 45-mL bottles =
£4.79.
Label:
10, patient information leaflet,
counsel-
ling
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) recom-
mended 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 fail-
ure
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;
also anal discomfort,
sleep disturbances,
fatigue,
and rash
Dose
. See preparations
CitraFleet
c
(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,
Mg
2þ
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
c
(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,
Mg
2þ
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
1.6.6
Peripheral opioid-
receptor antagonists
Methylnaltrexone is a peripherally acting opioid-recep-
tor
antagonist
that
is
licensed for
the treatment
of
opioid-induced constipation in patients receiving pallia-
tive care,
when response to other
laxatives is inade-
74
1.6.6 Peripheral opioid-receptor antagonists
BNF 61
1
Gastro-intestinal system