Osmotic laxatives

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Refer to NICE guidance and patient information at www.nhsinform.co.uk.

MACROGOL 3350 WITH POTASSIUM CHLORIDE, SODIUM BICARBONATE AND SODIUM CHLORIDE (First Line)

Therapy notes

MHRA advice: Polyethylene glycol (PEG) laxatives and starch-based thickeners: potential interactive effect when mixed, leading to an increased risk of aspiration (April 2021) (www.gov.uk).

  • In adults, the lower volume Movicol-Half® may be useful if fluid volume is a problem, refer to SPC.  
  • In children, refer to Laxido Paediatric Plain® SPC or Movicol Paediatric Chocolate® SPC.
  • If prescribing the 6·563 gram sachets for children ensure that the brand selected is licensed for and contains appropriate dosing instructions for the age of the child.

Formulation and dosage details

Formulation:

Oral powder 13·125 grams/sachet (Laxido Orange®)

Dosage:

In adults:
Chronic constipation: 1 to 3 sachets daily in divided doses usually for up to 2 weeks; maintenance, 1 to 2 sachets daily
Faecal impaction: 8 sachets daily dissolved in 1 litre water and drunk within 6 hours, usually for maximum 3 days.
Dissolve each sachet in 125mL water. After reconstitution keep the solution in a fridge and discard if unused after 6 hours.

Formulation

Sachet 6·563 grams/sachet (Movicol-Half®, Laxido Paediatric Plain®, Movicol Paediatric Chocolate®)

LACTULOSE

Therapy notes

  • Lactulose is less effective than macrogol in the treatment of constipation; it takes 2 to 3 days to work,  is unsuitable on a ‘when required’ basis and frequently causes bloating.

Formulation and dosage details

Formulation:

Solution 3·1 to 3·7 grams/5mL

Dosage:

Hepatic encephalopathy: 30mL 3 times daily, subsequently adjusted to produce 2 to 3 soft stools daily.