BNF for Children (BNFC) 2018-2019

regimen depending on symptoms and response. If

disimpaction does not occur after 2 weeks, a stimulant

laxative can be added or if stools are hard, used in

combination with an osmotic laxative such as lactulose.

Long-term regular use of laxatives is essential to maintain

well-formed stools and prevent recurrence of faecal

impaction; intermittent use may provoke relapses.

Suppositories and enemas should not be used in primary

care unless all oral medications have failed and preferably

only then following specialist advice. If the impacted mass is

not expelled following treatment with macrogols and a

stimulant laxative, a sodium citrate enema p. 44 can be

administered. Although rectal administration of laxatives

may be effective, this route is frequently distressing for the

child and may lead to persistence of withholding. A sodium

acid phosphate with sodium phosphate enema may be

administered under specialist supervision if disimpaction

does not occur after a sodium citrate enema. Manual

evacuation under anaesthetic may be necessary if

disimpaction does not occur after oral and rectal treatment,

or if the child is afraid. Children undergoing disimpaction

should be reviewed within one week. Maintenance treatment

should be started as soon as the bowel is disimpacted.h

Useful Resources

Constipation in children and young People: Diagnosis and

management of idiopathic childhood constipation in

primary and secondary care. National Institute for Health

and Care Excellence. Clinical guideline 99. May 2010.

http://www.nice.org.uk/guidance/cg 99

LAXATIVES›BULK-FORMING LAXATIVES

Ispaghula husk 24-Feb-2016

lDRUG ACTIONBulk-forming laxatives relieve constipation

by increasing faecal mass which stimulates peristalsis.

lINDICATIONS AND DOSE

Constipation

▶BY MOUTH

▶Child 1 month–5 years: 2. 5 – 5 mL twice daily, dose to be

taken only when prescribed by a doctor, as half or

whole level spoonful in water, preferably after meals,

morning and evening

▶Child 6–11 years: 2. 5 – 5 mL twice daily, dose to be given

as a half or whole level spoonful in water, preferably

after meals, morning and evening

▶Child 12–17 years: 1 sachet twice daily, dose to be given

in water preferably after meals, morning and evening

DOSE EQUIVALENCE AND CONVERSION

▶ 1 sachet equivalent to 2 level 5 ml spoonsful.

lCONTRA-INDICATIONSColonic atony.faecal impaction.

intestinal obstruction.reduced gut motility

lCAUTIONSAdequatefluid intake should be maintained to

avoid intestinal obstruction

lSIDE-EFFECTSAbdominal distension.bronchospasm.

conjunctivitis.gastrointestinal disorders.hypersensitivity

.rhinitis.skin reactions

lDIRECTIONS FOR ADMINISTRATIONDose to be taken with

at least 150 mL liquid.

lPRESCRIBING AND DISPENSING INFORMATIONFlavours of

soluble granules formulations may include plain, lemon,

or orange.

lHANDLING AND STORAGEIspaghula husk contains potent

allergens. Individuals exposed to the product (including

those handling the product) can develop hypersensitivity

reactions such as rhinitis, conjunctivitis, bronchospasm

and in some cases, anaphylaxis.

lPATIENT AND CARER ADVICEManufacturer advises that

preparations that swell in contact with liquid should

always be carefully swallowed with water and should not

be taken immediately before going to bed. Patients and

their carers should be advised that the full effect may take

some days to develop and should be given advice on how

to administer ispaghula husk.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Effervescent granules

CAUTIONARY AND ADVISORY LABELS 13

EXCIPIENTS:May contain Aspartame

▶Ispaghula husk (Non-proprietary)

Ispaghula husk 3.5 gramIspaghula husk 3. 5 g effervescent granules

sachets gluten free sugar free| 30 sachetpsDT = £ 2. 72

Granules

CAUTIONARY AND ADVISORY LABELS 13

EXCIPIENTS:May contain Aspartame

▶Ispaghula husk (Non-proprietary)

Ispaghula husk 3.5 gramIspaghula husk 3. 5 g granules sachets

gluten free| 30 sachetG£ 2. 72

Combinations available:Senna with ispaghula husk,p. 47

Methylcellulose

lDRUG ACTIONBulk-forming laxatives relieve constipation

by increasing faecal mass which stimulates peristalsis.

lINDICATIONS AND DOSE

Constipation|Diarrhoea

▶BY MOUTH USING TABLETS

▶Child 7–11 years: 2 tablets twice daily

▶Child 12–17 years: 3 – 6 tablets twice daily

lUNLICENSED USENo age limit specified by manufacturer.

lCONTRA-INDICATIONSColonic atony.difficulty in

swallowing.faecal impaction.infective bowel disease.

intestinal obstruction

lCAUTIONSAdequatefluid intake should be maintained to

avoid intestinal obstruction

lSIDE-EFFECTSAbdominal distension.gastrointestinal

disorders

lDIRECTIONS FOR ADMINISTRATIONIn constipation the

dose should be taken with at least 300 mL liquid. In

diarrhoea, ileostomy, and colostomy control, avoid liquid

intake for 30 minutes before and after dose.

lPATIENT AND CARER ADVICEPatients and their carers

should be advised that the full effect may take some days

to develop. Preparations that swell in contact with liquid

should always be carefully swallowed with water and

should not be taken immediately before going to bed.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Tablet

▶Celevac(AMCo)

Methylcellulose "450" 500 mgCelevac 500 mg tablets|

112 tabletG£ 5. 31 DT = £ 5. 31

40 Constipation and bowel cleansing BNFC 2018 – 2019

Gastro-intestinal system

1