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REMEDY : BNSSG referral pathways & Joint Formulary


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BNSSG Paediatric Joint Formulary

1.2 Constipation and bowel cleansing

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1.2.1 Bowel cleansing preparations

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Link to: NHSE National primary care clinical pathway for constipation in children

 

Magnesium-containing Drugs

Citramag® (TLS Amber Specialist Recommended)

 

Osmotic Laxatives

When required for bowel cleansing prior to procedures these will be prescribed by secondary care where possible. If the patient is not being seen by secondary care prior to the procedure GPs may be requested to prescribe bowel cleansing products. Prescribing guidance is available here.

Moviprep® (TLS Amber Specialist Recommended)

 

Stimulant Laxatives 

Picolax® (TLS Amber Specialist Recommended)

Bisacodyl (TLS Blue)

 

Phosphate-containing Drugs

Fleet Phospho-soda® (TLS Red)

 

1.2.2 Constipation

Bulk-forming Laxatives

Ispaghula husk (Fybogel®) (TLS Amber Specialist Recommended)

Alternative:

Sterculia / Frangula (Normacol plus®) (TLS Blue)

Specific indication:

Methylcellulose (TLS Blue)

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

 

Magnesium-containing Drugs

Magnesium Hydroxide mixture BP (TLS Green)

 

Osmotic Laxatives

Macrogol oral powder, compound (Paediatric strength) (TLS Green)

  • For patients under 12 as a laxative and for faecal impaction

Macrogol oral powder, compound ('Half-strength' or 'Full-strength') (TLS Green)

  • For patients over 12 as a laxative and for faecal impaction

Lactulose (TLS Green)

  • See BNFc for dosage and licensed indications
  • May take at least 48 hours to be effective

 

Phosphate-containing Drugs

Phosphate enema (TLS Red)

Sodium citrate enema (TLS Amber Specialist Recommended)

 

Softening Drugs

Arachis oil enema (TLS Red)

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

 

Stimulant Laxatives

Senna (TLS Green)

Glycerol (Glycerin) suppositories (TLS Green)

 

Alternatives:

Sodium picosulfate (TLS Blue)

Bisacodyl (TLS Blue)

Docusate sodium (oral) (TLS Blue)

  • For use in over 12s

 

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.