macrogol 4000: clinical use

Prescribing considerations

• Exclude an organic cause where clinically indicated, particularly in children or unexplained persistent constipation.
• Use as an adjunct to suitable dietary, hydration, activity and bowel-habit measures.
• Consider possible reduced absorption of concurrently administered oral medicines with a narrow therapeutic index.
• Sulphur dioxide in the apple flavour can rarely cause severe hypersensitivity or bronchospasm.

Contraindications and cautions

• Hypersensitivity to macrogol 4000 or any excipient
• Severe inflammatory bowel disease or toxic megacolon associated with symptomatic stenosis
• Gastrointestinal perforation or risk of perforation
• Ileus or suspected intestinal obstruction
• Painful abdominal syndrome of undetermined cause

Monitoring

• If diarrhoea develops, consider fluid and electrolyte assessment in older people, those with hepatic or renal impairment, and people taking diuretics.
• Investigate persistent symptoms or constipation accompanied by unexplained pain, fever or abdominal swelling.

Clinical pharmacology

Macrogol 4000 is an osmotically acting, high-molecular-weight polyethylene glycol. It retains water within the intestinal lumen and undergoes negligible gastrointestinal absorption or biotransformation.

Formulation and product differences

• The selected product is an apple-flavoured powder for oral solution containing macrogol 4000 without added electrolyte salts.
• It contains saccharin sodium and sulphur dioxide within the flavouring.
• It contains less than 1 mmol sodium per sachet and is described as essentially sodium-free.
• It contains a non-significant amount of sugar or polyol.

Oral solution

Route: Oral

Strengths: 10 g