macrogol 3350 + potassium chloride + sodium chloride + sodium hydrogen carbonate: clinical use

Prescribing considerations

• Confirm suspected faecal impaction clinically; selected adult product information specifies physical or radiological assessment.
• Review swallowing safety, particularly when thickeners are required or gag reflex, consciousness or reflux is impaired.
• Account for sodium exposure in patients following a sodium-restricted diet or with conditions sensitive to sodium and fluid load.
• Check age-specific licensing and excipients rather than assuming formulations are interchangeable.
• Consider temporarily reduced absorption of concurrent oral medicines.

Contraindications and cautions

• Intestinal perforation or obstruction caused by a structural or functional gut disorder
• Ileus
• Severe inflammatory intestinal disease, including severe Crohn’s disease or ulcerative colitis
• Toxic megacolon
• Hypersensitivity to active substances or product excipients

Monitoring

• Routine electrolyte monitoring is not specified for otherwise stable patients.
• Stop treatment and assess fluid status and electrolytes if oedema, breathlessness, increasing fatigue, dehydration or cardiac failure develops.
• Assess hydration and clinical response; investigate persistent, worsening or unexplained bowel symptoms.

Clinical pharmacology

Macrogol 3350 is a virtually unabsorbed polyethylene glycol that exerts an osmotic effect in the intestinal lumen. Increased stool water and volume promote neuromuscular colonic propulsion. Any absorbed macrogol is excreted in urine.

Formulation and product differences

• The selected paediatric plain powder is licensed for chronic constipation from age 1; the paediatric chocolate product is licensed from age 2. Both include faecal-impaction licensing from age 5.
• Adult chocolate powder requires reconstitution; the selected ready-to-take adult product is used directly from the sachet.
• Chocolate-flavoured products contain benzyl alcohol and other flavouring excipients. The ready-to-take product contains propylene glycol.
• Sodium content is clinically relevant, particularly during prolonged use or for people advised to restrict sodium.
• Prepared powder solutions have product-specific refrigerated storage and disposal instructions; consult the current leaflet.