Pharmacological properties
Oral administration of macrogol electrolyte solutions causes mild diarrhea and rapid emptying of the large intestine.
Macrogol 3350, sodium sulfate and ascorbic acid in high doses act osmotically on the intestines, causing a laxative effect.
Macrogol 3350 helps to increase the volume of feces, which affects the mobility of the colon through the neuromuscular pathways. As a result, an accelerated passage of softened feces through the large intestine is achieved. The electrolytes contained in the preparation and the additional intake of a clear liquid prevent the imbalance in the water-electrolyte balance, reducing the risk of dehydration.
Macrogol 3350 remains unchanged in the intestine. It is practically not absorbed in the gastrointestinal tract. Macrogol 3350, which has been absorbed, is excreted in the urine.
Ascorbic acid is absorbed mainly in the small intestine by an active transport mechanism that is sodium dependent and saturable. There is an inverse relationship between the dose taken and the percentage of dose absorbed. With oral administration of doses of 30-180 mg, the amount of the absorbed dose is 70-85%. After oral administration, up to 12 g of ascorbic acid is absorbed only 2 g.
After oral administration of high doses of ascorbic acid and when the level of ascorbic acid in the blood plasma exceeds 14 mg / l, ascorbic acid is excreted unchanged in the urine.
Indications
For bowel cleansing prior to clinical procedures requiring bowel clearance, such as endoscopic or X-ray examination of the intestines.
Application
Adults and the elderly. during the course of treatment, 2 liters of the diluted preparation Moviprep are used. It is recommended to additionally drink 1 liter of clear liquid (water, clear soup, fruit juice without pulp, soft drinks, tea and / or coffee without milk) during the course of treatment.
To prepare the first liter of solution - the contents of 1 sachet A and 1 sachet B are dissolved in a small amount of water and brought to 1 liter with water. The prepared solution should be boiled for 1-2 hours.
The procedure for diluting the second liter of the preparation is similar.
The course of treatment can be carried out with dose distribution or at one time:
Method 1, with the distribution of the dose into 2 parts: the first liter of the diluted Moviprep preparation is taken in the evening, the second liter of the diluted Moviprep preparation is taken in the morning on the day of the clinical procedure.
Method 2, at a time: drink 2 liters of the diluted Moviprep preparation in the evening before the clinical procedure or 2 liters in the morning on the day of the clinical procedure.
Regardless of the preparation method chosen, the interval between the end of the liquid intake (Moviprep or clear liquid) in the evening and the beginning of the colonoscopy should be at least 1 hour.
When using the preparation in one dose on the morning of the clinical procedure, the interval between the end of taking Moviprep and the beginning of the colonoscopy should be at least 2 hours.
Patients should allow time for travel to the facility where the colonoscopy is performed.
During the course of treatment and until the end of the clinical procedure, solid food is contraindicated.
Dissolution of Moviprep can take up to 5 minutes. It is recommended to first pour the powder into a container, mix with a little water. The preparation Moviprep is taken only after complete dissolution in water. Solution can be taken immediately or refrigerated before use.
Contraindications
The preparation is not used in the presence or suspicion of the following conditions:
- hypersensitivity to any component of the preparation;
- obstruction or perforation of the digestive tract;
- violation of gastric emptying (for example, gastric paresis);
- ileus;
- phenylketonuria (since the preparation contains aspartame);
- deficiency of glucose-6-phosphate dehydrogenase (since the preparation contains ascorbate);
- toxic megacolon complicating inflammatory bowel diseases, including Crohn's disease, ulcerative colitis.
It is contraindicated to use the preparation in unconscious patients.
Side effects
Diarrhea is a reaction that is expected after taking preparations of this group and causes undesirable effects in most patients. the most common are nausea, vomiting, bloating, epigastric pain, anal irritation, and sleep disturbance. diarrhea and / or vomiting can cause dehydration. when using preparations containing macrogol, allergic reactions such as rash, urticaria, itching, dyspnea, angioedema, anaphylaxis may occur.
The following are the side reactions that were observed in patients after using the preparation Moviprep during clinical trials and in the post-marketing period.
In terms of frequency of occurrence, undesirable effects are classified into the following categories: very often (1/10), often (1/100, 1/10), infrequently (1/1000, 1/100), rarely (1/10 000, 1/1000 ), very rare (1/10 000), unknown (frequency not determined).
From the immune system: unknown - allergic reactions, including anaphylaxis, dyspnea, skin reactions (see below).
Metabolism and nutritional disorders: unknown - disturbances in electrolyte levels, including a decrease in the level of bicarbonate in the blood, hyper- and hypocalcemia, hypophosphatemia, hypokalemia, hyponatremia and changes in the level of chlorides in the blood, dehydration.
Mental disorders: often - sleep disorders.
From the side of the nervous system: often - dizziness, headache; unknown - seizures associated with severe hyponatremia.
From the side of the heart: unknown - a temporary increase in blood pressure, arrhythmia, accelerated heartbeat.
From the gastrointestinal tract: very often - abdominal pain, nausea, bloating, anal discomfort; often - nausea, dyspepsia; infrequently - dysphagia; unknown - flatulence, urge to vomit.
From the liver and biliary tract: infrequently - impaired liver function indicators.
Skin and subcutaneous tissue disorders: unknown - allergic reactions, including angioedema, pruritus, urticaria, rash, erythema.
General disorders: very often - malaise, hyperthermia; often - chills, thirst, hunger; infrequently - discomfort.
special instructions
Diarrhea is an expected reaction after taking Moviprep.
The preparation should be used with caution in debilitated patients and patients with severe clinical impairments, for example:
- violation of the gag reflex or a tendency to aspiration or belching;
- violation of consciousness;
- severe renal failure (creatinine clearance 30 ml / min);
- heart failure (NYHA functional class III – IV);
- dehydration;
- severe acute inflammatory diseases.
Do not dehydrate the body before taking the preparation. During the use of the preparation, the condition of patients who are semi-conscious or prone to aspiration or belching should be monitored, especially if the preparation is administered through a nasogastric tube.
If the patient develops symptoms that indicate changes in fluid / electrolyte levels (eg, edema, shortness of breath, fatigue, heart failure), plasma electrolyte levels should be checked and treated accordingly.
In debilitated, debilitated patients, patients with poor health, severe renal impairment, and patients at risk of electrolyte imbalance, the physician should check electrolyte levels and kidney function before and after treatment.
If the patient develops symptoms such as severe flatulence, bloating, abdominal pain or other reaction that makes it difficult to use the preparation, it is necessary to slow down or temporarily suspend its use and consult a doctor.
Application during pregnancy or lactation. No data available. Macrogol is used after consulting a doctor in case of urgent need, when the expected benefit to the mother outweighs the potential risk to the fetus and child.
The ability to influence the reaction rate when driving or operating machinery. Not found.
Children. The preparation is not recommended for use in children under the age of 18, since there is no clinical data on the safety of the preparation in this age group of patients.
Interactions
Macrogol should not be taken with other oral medications within 1 hour, as they may not be absorbed into the gastrointestinal tract. this is especially true for preparations with a narrow therapeutic index or short t½.
Overdose
In case of an accidental significant overdose leading to profuse diarrhea, conservative treatment is usually sufficient: drinking a sufficient amount of fluids, especially fruit juices. in exceptional cases, in case of an overdose that has caused significant metabolic disturbances, it is possible to use intravenous rehydration.
Storage conditions
At a temperature not exceeding 25 ° C in the original packaging. Store the diluted solution at 2–8 ° c.