lUNLICENSED USENot licensed for use in distal intestinal
obstruction syndrome.
lCONTRA-INDICATIONSHyperthyroidism
lCAUTIONSAsthma.benign nodular goitre.dehydration.
electrolyte disturbance (correctfirst).enteritis.history of
allergy.in children with oesophagealfistulae (aspiration
may lead to pulmonary oedema).latent hyperthyroidism.
risk of anaphylactoid reactions increased by concomitant
administration of beta-blockers
lSIDE-EFFECTS
GENERAL SIDE-EFFECTSAbdominal pain.cardiac arrest.
consciousness impaired.diarrhoea.dizziness.dyspnoea.
electrolyte imbalance.face oedema.fever.fluid
imbalance.gastrointestinal disorders.headache.
hyperhidrosis.hypersensitivity.hyperthyroidism.
hypotension.nausea.pneumonia aspiration.pulmonary
oedema.respiratory disorders.shock.skin reactions.
tachycardia.toxic epidermal necrolysis.vomiting
SPECIFIC SIDE-EFFECTS
▶With oral useOral blistering
lALLERGY AND CROSS-SENSITIVITYHypersensitivity to
iodine.
lPREGNANCYManufacturer advises caution.
lBREAST FEEDINGAmount probably too small to be
harmful.
lDIRECTIONS FOR ADMINISTRATIONIntravenous
prehydration is essential in neonates and infants. Fluid
intake should be encouraged for 3 hours after
administration.By mouth, for child bodyweight under
25 kg, diluteGastrografin®with 3 times its volume of water
or fruit juice; for child bodyweight over 25 kg, dilute
Gastrografin®with twice its volume of water or fruit juice.
By rectum, administration must be carried out slowly under
radiological supervision to ensure required site is reached.
For child under 5 years, diluteGastrografin®with 5 times
its volume of water; for child over 5 years dilute
Gastrografin®with 4 times its volume of water.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral solution
EXCIPIENTS:May contain Disodium edetate
▶Gastrografin(Bayer Plc)
Sodium amidotrizoate 100 mg per 1 ml, Meglumine
amidotrizoate 660 mg per 1 mlGastrografin oral solution sugar-
free| 1000 mlp£ 175. 00 (Hospital only)
LAXATIVES›OSMOTIC LAXATIVES
Citric acid with magnesium carbonate
(Formulated as a bowel cleansing preparation)
lINDICATIONS AND DOSE
Bowel evacuation for surgery, colonoscopy or radiological
examination
▶BY MOUTH
▶Child 5–9 years:One-third of a sachet to be given at
8 a.m. the day before the procedure and, one-third of a
sachet to be given between 2 and 4 p.m. the day before
the procedure
▶Child 10–17 years: 0. 5 – 1 sachet, given at 8 a.m. the day
before the procedure and 0. 5 – 1 sachet, given between
2 and 4 p.m. the day before the procedurelCONTRA-INDICATIONSAcute severe colitis.gastric
retention.gastro-intestinal obstruction.gastro-intestinal
perforation.toxic megacolon
lCAUTIONSChildren.colitis (avoid if acute severe colitis).
debilitated.hypovolaemia (should be corrected before
administration of bowel cleansing preparations).impaired
gag reflex or possibility of regurgitation or aspiration.
patients withfluid and electrolyte disturbances
CAUTIONS, FURTHER INFORMATIONAdequate hydration
should be maintained during treatment.
lINTERACTIONS→Appendix 1 : bowel cleansing
preparations
lSIDE-EFFECTS
▶Common or very commonGastrointestinal discomfort.
nausea.vomiting
▶UncommonDehydration.dizziness.electrolyte imbalance
.headache
SIDE-EFFECTS, FURTHER INFORMATIONAbdominal pain is
usually transient and can be reduced by taking preparation
more slowly.
lPREGNANCYUse with caution.
lBREAST FEEDINGUse with caution.
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.
lMONITORING REQUIREMENTSRenal function should be
measured before starting treatment in patients at risk of
fluid and electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATIONOne sachet should be
reconstituted with 200 mL of hot water; the solution
should be allowed to cool for approx. 30 minutes before
drinking.
lPRESCRIBING AND DISPENSING INFORMATION
Reconstitution of one sachet containing 11. 57 g
magnesium carbonate and 17. 79 g anhydrous citric acid
produces a solution containing magnesium citrate with
118 mmol Mg^2 +.
Flavours of oral powders may include lemon and lime.
lPATIENT AND CARER ADVICELow residue orfluid 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 clearfluids recommended
until procedure. Patient or carers should be given advice
on how to administer oral powder.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Effervescent powder
CAUTIONARY AND ADVISORY LABELS13, 10
ELECTROLYTES:May contain Magnesium
▶Citramag(Sanochemia Diagnostics UK Ltd)
Magnesium carbonate heavy 11.57 gram, Citric acid anhydrous
17.79 gramCitramag effervescent powder sachets sugar-free|
10 sachetp£ 18. 92Macrogol 3350 with anhydrous
sodium sulfate, potassium chloride,
sodium bicarbonate and sodium
chloride
(Formulated as a bowel cleansing preparation)
lINDICATIONS AND DOSE
Bowel cleansing before radiological examination,
colonoscopy, or surgery
▶INITIALLY BY MOUTH
▶Child 12–17 years:Initially 2 litres daily for 2 doses:first
dose of reconstituted solution taken on the continued→BNFC 2018 – 2019 Bowel cleansing 37
Gastro-intestinal system1