Drugs List

Therapeutic Indications

Uses

Bowel evacuation - prior to investigative procedure
Bowel evacuation - prior to surgical procedure
Bowel evacuation before childbirth
Constipation

Contraindications

Children under 3 years
Hirschsprung's disease
Acute gastrointestinal disorder
Appendicitis
Congestive cardiac failure
Dehydration
Gastrointestinal obstruction
Gastrointestinal perforation
Gastrointestinal stenosis
Inflammatory bowel disease
Megacolon
Paralytic ileus
Severe renal impairment

Precautions and Warnings

Abdominal pain of unknown cause
Ascites
Debilitation
Elderly
Restricted sodium intake
Anal fissure
Breastfeeding
Cardiac disorder
Colostomy
Electrolyte imbalance
Neurological disorder
Pregnancy
Renal impairment
Uncontrolled hypertension

Contains benzalkonium chloride
Ensure patient has adequate fluid intake
Monitor periodically for signs of fluid or electrolyte imbalance
Prolonged or excessive use may result in dependence
Advise patient to expect frequent loose stools
Discontinue if rectal bleeding or irritation occurs
Avoid repeated or prolonged use
Advise patient to seek medical advice if treatment is ineffective

Use with caution in patients with pre-existing electrolyte disturbances as hypocalcaemia, hypokalaemia, hyperphosphataemia, hypernatraemia and acidosis may occur. Electrolyte levels should be monitored before and after administration of the enema in patients where electrolyte disorders are suspected or in those patients who may experience hyperphosphataemia.

Use with caution in patients suffering with nausea, vomiting or abdominal pain of unknown cause.

Caution is advised in the elderly due to the increased possibility of renal impairment and the risk of electrolyte disorders.

The enema should not normally be used for more than one week as dependence may occur.

Discontinue if resistance is encountered on administration as use of undue force can cause injury.

If treatment causes rectal bleeding or fails to produce a bowel movement within 5 minutes, this may indicate a serious condition. In these situations, treatment should be discontinued.

Pregnancy and Lactation

Pregnancy

Sodium phosphate enemas should be used with caution in pregnancy.

At the time of writing there is no relevant information available to evaluate the potential for foetal malformation or other foetotoxic effects on the use of sodium phosphate enema during pregnancy.

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

Sodium phosphate enemas should be used with caution in breastfeeding.

The UK Drugs in Lactation Advisory Service state that rectal administration of sodium phosphate to a mother as a laxative or for bowel evacuation is unlikely to pose a risk to a breastfed infant.

The manufacturer however, advises that as sodium phosphate may pass into the breast milk, the breast milk should be expressed and discarded for up to 24 hours after receiving the enema.

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

Abdominal distension
Abdominal pain
Acidosis
Anal pain
Blisters (application site)
Chills
Dehydration
Diarrhoea
Hypernatraemia
Hyperphosphataemia
Hypersensitivity reactions
Hypocalcaemia
Hypokalaemia
Nausea
Proctalgia
Pruritus
Rectal irritation
Stinging
Urticaria
Vasovagal attacks
Vomiting

Presentation

Enemas containing sodium dihydrogen phosphate and sodium phosphate.

Drugs List

Therapeutic Indications

Uses

Bowel evacuation - prior to investigative procedure
Bowel evacuation - prior to surgical procedure
Bowel evacuation before childbirth
Constipation

Dosage

Adults

Children

Contraindications

Children under 3 years
Hirschsprung's disease
Acute gastrointestinal disorder
Appendicitis
Congestive cardiac failure
Dehydration
Gastrointestinal obstruction
Gastrointestinal perforation
Gastrointestinal stenosis
Inflammatory bowel disease
Megacolon
Paralytic ileus
Severe renal impairment

Precautions and Warnings

Abdominal pain of unknown cause
Ascites
Debilitation
Elderly
Restricted sodium intake
Anal fissure
Breastfeeding
Cardiac disorder
Colostomy
Electrolyte imbalance
Neurological disorder
Pregnancy
Renal impairment
Uncontrolled hypertension

Contains benzalkonium chloride
Ensure patient has adequate fluid intake
Monitor periodically for signs of fluid or electrolyte imbalance
Prolonged or excessive use may result in dependence
Advise patient to expect frequent loose stools
Discontinue if rectal bleeding or irritation occurs
Avoid repeated or prolonged use
Advise patient to seek medical advice if treatment is ineffective

Use with caution in patients with pre-existing electrolyte disturbances as hypocalcaemia, hypokalaemia, hyperphosphataemia, hypernatraemia and acidosis may occur. Electrolyte levels should be monitored before and after administration of the enema in patients where electrolyte disorders are suspected or in those patients who may experience hyperphosphataemia.

Use with caution in patients suffering with nausea, vomiting or abdominal pain of unknown cause.

Caution is advised in the elderly due to the increased possibility of renal impairment and the risk of electrolyte disorders.

The enema should not normally be used for more than one week as dependence may occur.

Discontinue if resistance is encountered on administration as use of undue force can cause injury.

If treatment causes rectal bleeding or fails to produce a bowel movement within 5 minutes, this may indicate a serious condition. In these situations, treatment should be discontinued.

Pregnancy and Lactation

Pregnancy

Sodium phosphate enemas should be used with caution in pregnancy.

At the time of writing there is no relevant information available to evaluate the potential for foetal malformation or other foetotoxic effects on the use of sodium phosphate enema during pregnancy.

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

Sodium phosphate enemas should be used with caution in breastfeeding.

The UK Drugs in Lactation Advisory Service state that rectal administration of sodium phosphate to a mother as a laxative or for bowel evacuation is unlikely to pose a risk to a breastfed infant.

The manufacturer however, advises that as sodium phosphate may pass into the breast milk, the breast milk should be expressed and discarded for up to 24 hours after receiving the enema.

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

If treatment causes rectal bleeding or fails to produce a bowel movement (evacuation within 5 minutes of administration), this may indicate a serious condition. Advise patients in these situations, to discontinue treatment and seek medical advice.

In order to avoid dehydration it is recommended that in general 250 ml should be drunk every hour until the effects of the enema have worn off.

Side Effects

Abdominal distension
Abdominal pain
Acidosis
Anal pain
Blisters (application site)
Chills
Dehydration
Diarrhoea
Hypernatraemia
Hyperphosphataemia
Hypersensitivity reactions
Hypocalcaemia
Hypokalaemia
Nausea
Proctalgia
Pruritus
Rectal irritation
Stinging
Urticaria
Vasovagal attacks
Vomiting

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: May 2015.

Reference Sources

Summary of Product Characteristics: Cleen Ready-to-Use Enema. Casen Recordati S.L. Revised June 2016.

Summary of Product Characteristics: Phosphates Enema BP Formula B. Chemidex Pharma Limited. Revised September 1995.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 18 August 2017

UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 7 May 2015