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Phosphates enema

Updated 2 Feb 2023 | Osmotic laxatives


Enemas containing sodium dihydrogen phosphate and sodium phosphate.

Drugs List

  • phosphates enema long tube
  • phosphates enema standard tube
  • sodium acid phosphate 18.1% and sodium phosphate 8% enema
  • Therapeutic Indications


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



    Use one enema daily as required.


    Children aged over 12 years
    Use one enema daily as required.

    Children aged 3 to 12 years
    Reduce adult dose according to body weight. May only be given on doctors advice.

    The following alternative dosing schedule may be suitable:

    133ml (118ml delivered dose) enema
    Children aged 12 to 18 years: 90ml to 118ml once daily.
    Children aged 6 to 12 years: 60ml to 90ml once daily.
    Children aged 3 to 6 years: 40ml to 60ml once daily.

    128ml enema
    Children aged 12 to 18 years: 100ml to 128ml once daily.
    Children aged 6 to 12 years: 65ml to 100ml once daily.
    Children aged 3 to 6 years: 45ml to 65ml once daily.


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

    Precautions and Warnings

    Abdominal pain of unknown cause
    Restricted sodium intake
    Anal fissure
    Cardiac disorder
    Electrolyte imbalance
    Neurological disorder
    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


    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 ( ) or if this is unavailable at the backup site ( ).


    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


    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
    Anal pain
    Blisters (application site)
    Hypersensitivity reactions
    Rectal irritation
    Vasovagal attacks


    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 ( ) or if this is unavailable at the backup site ( ).

    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: Last accessed: 18 August 2017

    UK Drugs in Lactation Advisory Service.
    Available at:
    Last accessed: 7 May 2015

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