Drugs List

Therapeutic Indications

Uses

Preparation for radiological, endoscopic and surgical procedures on colon

Administration

For oral administration.

The contents of each sachet should be dissolved in 200ml of hot water half an hour before taking and allowed to cool.

Contraindications

Children under 5 years
Constipation
Delayed gastric emptying
Gastrointestinal obstruction
Gastrointestinal perforation
Gastrointestinal ulcer
Inflammatory bowel disease
Paralytic ileus
Renal impairment - glomerular filtration rate below 30ml/minute/1.73m sq
Renal impairment associated with hepatic coma
Toxic colitis
Toxic megacolon

Precautions and Warnings

Debilitation
Disorder of fluid balance
Elderly
Impaired consciousness
Predisposition to aspiration or regurgitation
Breastfeeding
Electrolyte imbalance
Hypermagnesaemia
Pregnancy
Reflux oesophagitis
Renal impairment
Ulcerative colitis

Observe patients prone to aspiration/regurgitation during administration
Correct hypovolaemia prior to administration
Maintain adequate hydration during therapy
Oral medications given < 1 hr before treatment may be rendered ineffective
Measure renal function where risk of fluid or electrolyte imbalance
Monitor serum magnesium regularly in patients with renal impairment
Reduce dose in debilitated patients
Reduce dose in elderly
Advise patient of appropriate fluid / dietary intake prior to procedure
Advise patient of the vigorous nature of the purgation

Caution is advised when the bowel cleansing treatment is used in patients taking ACE inhibitors, angiotensin-II receptor antagonists and NSAIDs due to the risk of dehydration and hypovolaemia. Consider withholding these drugs on the day and for up to 72 hours after the procedure. Caution is also advised in patients already receiving diuretics which may be associated with hypokalaemia. Consider withholding diuretics on the day that the bowel cleansing preparation is given.

Pregnancy and Lactation

Pregnancy

Use with caution in pregnancy. No data available to confirm safety.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution in breast feeding. No data available to confirm safety.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Arrhythmias
Bradycardia
Hypermagnesaemia
Hyporeflexia
Lethargy
Prolongation of QT interval
Respiratory depression

Presentation

Oral formulations containing heavy magnesium carbonate and anhydrous citric acid

Drugs List

Therapeutic Indications

Uses

Preparation for radiological, endoscopic and surgical procedures on colon

Dosage

Adults

Elderly

Children

Patients with Renal Impairment

Patients with Hepatic Impairment

Administration

For oral administration.

The contents of each sachet should be dissolved in 200ml of hot water half an hour before taking and allowed to cool.

Contraindications

Children under 5 years
Constipation
Delayed gastric emptying
Gastrointestinal obstruction
Gastrointestinal perforation
Gastrointestinal ulcer
Inflammatory bowel disease
Paralytic ileus
Renal impairment - glomerular filtration rate below 30ml/minute/1.73m sq
Renal impairment associated with hepatic coma
Toxic colitis
Toxic megacolon

Precautions and Warnings

Debilitation
Disorder of fluid balance
Elderly
Impaired consciousness
Predisposition to aspiration or regurgitation
Breastfeeding
Electrolyte imbalance
Hypermagnesaemia
Pregnancy
Reflux oesophagitis
Renal impairment
Ulcerative colitis

Observe patients prone to aspiration/regurgitation during administration
Correct hypovolaemia prior to administration
Maintain adequate hydration during therapy
Oral medications given < 1 hr before treatment may be rendered ineffective
Measure renal function where risk of fluid or electrolyte imbalance
Monitor serum magnesium regularly in patients with renal impairment
Reduce dose in debilitated patients
Reduce dose in elderly
Advise patient of appropriate fluid / dietary intake prior to procedure
Advise patient of the vigorous nature of the purgation

Caution is advised when the bowel cleansing treatment is used in patients taking ACE inhibitors, angiotensin-II receptor antagonists and NSAIDs due to the risk of dehydration and hypovolaemia. Consider withholding these drugs on the day and for up to 72 hours after the procedure. Caution is also advised in patients already receiving diuretics which may be associated with hypokalaemia. Consider withholding diuretics on the day that the bowel cleansing preparation is given.

Pregnancy and Lactation

Pregnancy

Use with caution in pregnancy. No data available to confirm safety.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution in breast feeding. No data available to confirm safety.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

Advise patient to follow the dosage instructions and suggested times of administration carefully.

Side Effects

Arrhythmias
Bradycardia
Hypermagnesaemia
Hyporeflexia
Lethargy
Prolongation of QT interval
Respiratory depression

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: August 2014

Reference Sources

Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press [Accessed on 21 August 2014].

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications [Accessed on 21 August 2014].

Summary of Product Characteristics: Citramag. Sanochemia Diagnostics UK Ltd. Revised November 2012