evening before procedure and the second dose on the
morning of procedure, alternatively (by mouth)
initially 250 mL every 10 – 15 minutes, reconstituted
solution to be administered, alternatively (by
nasogastric tube) initially 20 – 30 mL/minute, starting
on the day before procedure until 4 litres have been
consumed
Distal intestinal obstruction syndrome
▶BY MOUTH, OR BY NASOGASTRIC TUBE, OR BY GASTROSTOMY
TUBE
▶Child 1–17 years: 10 mL/kilogram/hour for 30 minutes,
then increased to 20 mL/kilogram/hour for 30 minutes,
then increased if tolerated to 25 mL/kilogram/hour,
max. 100 mL/kg (or 4 litres) over 4 hours, repeat 4 hour
treatment if necessarylUNLICENSED USEKlean-Prep®not licensed for use in
children.
lCONTRA-INDICATIONSAcute severe colitis.gastric
retention.gastro-intestinal obstruction.gastro-intestinal
perforation.gastro-intestinal ulceration.toxic megacolon
lCAUTIONSChildren.colitis (avoid if acute severe colitis).
debilitated patients.fluid and electrolyte disturbances.
heart failure.hypovolaemia (should be corrected before
administration of bowel cleansing preparations).impaired
gag reflex or possibility of regurgitation or aspiration
lINTERACTIONS→Appendix 1 : bowel cleansing
preparations
lSIDE-EFFECTSAngioedema.arrhythmia.chills.confusion
.dehydration.dizziness.dyspnoea.electrolyte imbalance
.fever.flatulence.gastrointestinal discomfort.headache.
malaise.nausea.palpitations.seizure.skin reactions.
thirst.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONAbdominal pain is
usually transient and can be reduced by taking preparation
more slowly.
lPREGNANCYManufacturers advise use only if essential—
no information available.
lBREAST FEEDINGManufacturers advise use only if
essential—no information available.
lMONITORING REQUIREMENTSRenal function should be
measured before starting treatment in patients at risk of
fluid and electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATION 1 sachet should be
reconstituted with 1 litre of water. Flavouring such as clear
fruit cordials may be added if required. After
reconstitution the solution should be kept in a refrigerator
and discarded if unused after 24 hours.
lPRESCRIBING AND DISPENSING INFORMATIONEachKlean-
Prep®sachet provides Na+ 125 mmol, K+ 10 mmol, Cl-
35 mmol and HCO^3 - 20 mmol when reconstituted with
1 litre of water.
lPATIENT AND CARER ADVICESolid food should not be
taken for 2 hours before starting treatment. Adequate
hydration should be maintained during treatment.
Treatment can be stopped if bowel motions become watery
and clear.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder
CAUTIONARY AND ADVISORY LABELS10, 13
EXCIPIENTS:May contain Aspartame
ELECTROLYTES:May contain Bicarbonate, chloride, potassium, sodium
▶Klean-Prep(Norgine Pharmaceuticals Ltd)
Potassium chloride 742.5 mg, Sodium chloride 1.465 gram,
Sodium bicarbonate 1.685 gram, Sodium sulfate anhydrous
5.685 gram, Polyethylene glycol 3350 59 gramKlean-Prep oral
powder 69 g sachets sugar-free| 4 sachetp£ 10. 48LAXATIVES›STIMULANT LAXATIVES
Magnesium citrate with sodium
picosulfate
(Formulated as a bowel cleansing preparation)
lINDICATIONS AND DOSE
PICOLAX®SACHETS
Bowel evacuation on day before radiological procedure,
endoscopy, or surgery
▶BY MOUTH
▶Child 1 year: 0. 25 sachet taken before 8 a.m, then
0. 25 sachet after 6 – 8 hours
▶Child 2–3 years: 0. 5 sachet taken before 8 a.m, then
0. 5 sachet after 6 – 8 hours
▶Child 4–8 years: 1 sachet taken before 8 a.m, then
0. 5 sachet after 6 – 8 hours
▶Child 9–17 years: 1 sachet taken before 8 a.m, then
1 sachet after 6 – 8 hours
PHARMACOKINETICS
▶Acts within 3 hours offirst dose.lCONTRA-INDICATIONSAcute severe colitis.ascites.
congestive cardiac failure.gastric retention.gastro-
intestinal obstruction.gastro-intestinal perforation.
gastro-intestinal ulceration.toxic megacolon
lCAUTIONSCardiac disease (avoid in congestive cardiac
failure).children.colitis (avoid if acute severe colitis).
debilitated patients.fluid and electrolyte disturbances.
hypovolaemia (should be corrected before administration)
.impaired gag reflex or possibility of regurgitation or
aspiration.recent gastro-intestinal surgery
lSIDE-EFFECTS
▶Common or very commonGastrointestinal discomfort.
headache.nausea
▶UncommonConfusion.electrolyte imbalance.
gastrointestinal disorders.seizures.skin reactions.
vomiting
lPREGNANCYCaution.
lBREAST FEEDINGCaution.
lHEPATIC IMPAIRMENTAvoid in hepatic coma if risk of
renal failure.
lRENAL IMPAIRMENTAvoid if estimated glomerular
filtration rate less than 30 mL/minute/ 1. 73 m^2 —risk of
hypermagnesaemia.
lDIRECTIONS FOR ADMINISTRATIONOne sachet of sodium
picosulfate with magnesium citrate powder 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.
PICOLAX®SACHETSOne sachet should be reconstituted
with 150 mL (approx. half a glass) of cold water.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral powder formulations may include lemon.
PICOLAX®SACHETSOne reconstituted sachet contains K+
5 mmol and Mg^2 + 87 mmol.
lPATIENT AND CARER ADVICELow residue diet
recommended on the day before procedure and copious
intake of water or other clearfluids recommended during
treatment. Patients or carers should be given advice on
how to administer sodium picosulfate with magnesium
citrate oral powder.
PICOLAX®SACHETSLow residue diet recommended on the
day before procedure and copious intake of water or other
clearfluids recommended during treatment.
Patients and carers should be given advice on how to
administer oral powder; they should be warned that heat is38 Constipation and bowel cleansing BNFC 2018 – 2019
Gastro-intestinal system1