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Home > Formulary : Adult > Chapters > 1. Gastro-Intestinal System >

BNSSG Adult Joint Formulary

1.2 Constipation and bowel cleansing

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Last edited: 02-05-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

1.2.1 Bowel cleansing preparations

Magnesium-containing Drugs

Recommended: (TLS Green)

Citramag®

 

Osmotic Laxatives 

Recommended: (TLS Green)

Moviprep®

Plenvu®

 

Stimulant Laxatives 

Recommended: (TLS Green)

Sodium picosulphate with magnesium citrate (Picolax®, CitraFleet®)

 

Phosphate-containing Drugs 

Recommended: (TLS Green)

Fleet Phospho-soda®

 

1.2.2 Constipation

BNSSG constipation guidelines

Bulk-forming Laxatives

Recommended: (TLS Green)

Ispaghula husk (Fybogel®)

Alternative: (TLS Blue)

Sterculia and Frangula (Normacol plus®)

Specific indication: (TLS Blue)

Methylcellulose

  • For high output ileostomies
  • Adequate fluid intake must be maintained to avoid intestinal obstruction

 

Magnesium-containing Drugs

Recommended: (TLS Green)

Magnesium hydroxide mixture, BP (TLS Green)

 

Opioid-receptor Antagonists (Peripheral) 

Specific indications: (TLS Blue)

Methylnaltrexone

  • Used as rescue therapy where the oral/rectal route is inappropriate, on the advice of Palliative Care

Naloxegol

  • For opioid-induced constipation as per NICE TA345

Naldemedine

  • For opioid-induced constipation as per NICE TA651

 

Osmotic Laxatives 

Recommended: (TLS Green)

Macrogol oral powder, compound (TLS Green)

  • First line treatment for chronic constipation in the elderly

  • Faecal impaction

Lactulose

  • May take at least 48 hours to be effective

Specific indications: (TLS Blue)

Sodium citrate micro-enema

 

Phosphate-containing Drugs

Recommended: (TLS Green)

Phosphate enema

 

Selective 5HT4 Receptor Agonists

Specific indication: (TLS Blue)

Prucalopride

 

Softening Drugs 

Recommended: (TLS Green)

Arachis oil enema

  • Arachis oil enemas contain peanut oil - use is contraindicated in patients with peanut allergy.

 

Stimulant Laxatives

Recommended: (TLS Green)

Docusate sodium (oral)

Senna

Glycerol (glycerin) suppositories

Alternatives: (TLS Blue)

Bisacodyl

Specific indications: (TLS Blue)

Co-danthramer

  • Terminally ill only

Co-danthramer strong

  • Terminally ill only

Note: Long-term use of stimulant laxatives is not advised due to the potential for damaging the large bowel and the loss of muscle tone in the colon.

 

Other

Lecicarbon A suppositories (TLS Amber Specialist Recommended)

Specific indication: (TLS Red)

Peppermint oil enema

  • For those patients undergoing colonoscopy who have glaucoma

 

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