BNF for Children 2011-2012

BNFC 2011–2012 1.6.3 Faecal softeners 61Senokot c (Reckitt Benckiser)Tablets D, see aboveSyrup, sugar-free, brown, total sennosides (calculatedas sennoside B) 7.5 mg/5 mL. Net price 500 mL =£2.69Dose. By mouthChild 1 month–4 years 2.5–10 mL once daily, adjustedaccording to responseChild 4–18 years 2.5–20 mL once daily, adjustedaccording to responseSODIUM PICOSULFATE(Sodium picosulphate)Cautions see notes above; active inflammatory boweldisease (avoid if fulminant)Contra-indications see notes above; severe dehydrationPregnancy see Pregnancy, p. 57Breast-feeding not known to be present in milk butmanufacturer advises avoid unless potential benefitoutweighs riskSide-effects see notes aboveLicensed use elixir, licensed for use in children (agerange not specified by manufacturer); Perles c notlicensed for use in children under 4 yearsIndication and doseConstipation. By mouthChild 1 month–4 years 2.5–10 mg once daily,adjusted according to responseChild 4–18 years 2.5–20 mg once daily, adjustedaccording to responseNote onset of action 6–12 hoursBowel evacuation before abdominal radiologicaland endoscopic procedures on the colon,and surgery section 1.6.5Sodium Picosulfate (Non-proprietary)Elixir, sodium picosulfate 5 mg/5 mL, net price100 mL = £1.85Note The brand name Dulcolax c Pico Liquid (BoehringerIngelheim) is used for sodium picosulfate elixir 5 mg/5 mLDulcolax c Pico (Boehringer Ingelheim)Perles c (= capsules), sodium picosulfate 2.5 mg, netprice 20-cap pack = £1.93, 50-cap pack = £2.73Note The brand name Dulcolax c is also used for bisacodyltablets and suppositoriesBowel cleansing preparationsSection 1.6.51.6.3 Faecal softenersEnemas containing arachis oil (ground-nut oil, peanutoil) lubricate and soften impacted faeces and promote abowel movement.Bulk laxatives (section 1.6.1) and non-ionic surfactant‘wetting’ agents e.g. docusate sodium (section 1.6.2)also have softening properties. Such drugs are usefulfor oral administration in the management of analfissure; glycerol suppositories (section 1.6.2) are usefulfor rectal use.ARACHIS OILCautions intestinal obstruction; hypersensitivity tosoyaContra-indications inflammatory bowel disease,hypersensitivity to arachis oil or peanutsLicensed use licensed for use in children (age rangenot specified by manufacturerIndication and doseImpacted faeces. By rectumChild 3–7 years 45–65 mL as requiredChild 7–12 years 65–100 mL as requiredChild 12–18 years 100–130 mL as requiredAdministration warm enema in warm water beforeuseArachis Oil Enema (Non-proprietary)Enema, arachis (peanut) oil in 130-mL single-dosedisposable packs. Net price 130 mL = £7.981.6.4 Osmotic laxativesOsmotic laxatives increase the amount of water in thelarge bowel, either by drawing fluid from the body intothe bowel or by retaining the fluid they were administeredwith.Lactulose is a semi-synthetic disaccharide which is notabsorbed from the gastro-intestinal tract. It produces anosmotic diarrhoea of low faecal pH, and discourages theproliferation of ammonia-producing organisms. It istherefore useful in the treatment of hepatic encephalopathy.Macrogols are inert polymers of ethylene glycol whichsequester fluid in the bowel; giving fluid with macrogolsmay reduce the dehydrating effect sometimes seen withosmotic laxatives. Macrogols are an effective non-traumaticmeans of evacuation in children with faecalimpaction and can be used in the long-term managementof chronic constipation.Saline purgatives such as magnesium hydroxide arecommonly abused but are satisfactory for occasionaluse; adequate fluid intake should be maintained.Magnesium salts are useful where rapid bowel evacuationis required. Sodium salts should be avoided as theymay give rise to sodium and water retention in susceptibleindividuals. Phosphate enemas are useful in bowelclearance before radiology, endoscopy, and surgery.Enemas containing phosphate or sodium citrate, andoral bowel cleansing preparations (section 1.6.5)should only be used on the advice of a specialist practitioner.LACTULOSECautions lactose intolerance; interactions: Appendix1 (lactulose)Contra-indications galactosaemia, intestinal obstructionPregnancy not known to be harmful; see alsoPregnancy, p. 57Side-effects nausea (can be reduced by administrationwith water, fruit juice or with meals), vomiting,flatulence, cramps, and abdominal discomfort1 Gastro-intestinal system