For the treatment of chronic constipation. Movicol is also effective in resolving faecal impaction, defined as refractory constipation with faecal loading of the rectum and/or colon.
 

Posology Chronic constipation A course of treatment for constipation with MOVICOL does not normally exceed 2 weeks, although this can be repeated if required. As for all laxatives, prolonged use is not usually recommended. Extended use may be necessary in the
care of patients with severe chronic or resistant constipation, secondary to multiple sclerosis or Parkinson's Disease, or induced by regular constipating medication in particular opioids and antimuscarinics. Adults, adolescents and older people: 1 - 3 sachets daily in divided doses, according to individual response. For extended use, the dose can be adjusted down to 1or 2 sachets daily. Children (below 12 years old): Not recommended. Alternative MOVICOL products are available for children.
Faecal impaction A course of treatment for faecal impaction with MOVlCOL does not normally exceed 3 days. Adults, adolescents and older people: 8 sachets daily, all of which should be consumed within a 6 hour period. Children (below 12 years old): Not recommended. Alternative Movicol products are available for children. Patients with impaired cardiovascular function: For the treatment of faecal impaction the dose should be divided so that no more than two sachets are taken in anyone hour. Patients with renal insufficiency: No dosage change is necessary for treatment of either constipation or faecal impaction.
Method of administration Each sachet should be dissolved in 125 ml water. For use in faecal impaction 8 sachets may be dissolved in 1 litre of water.
 

The fluid content of MOVICOL when re-constituted with water does not replace regular fluid intake and adequate flu id intake must be maintained. Diagnosis of impaction/faecal loading of the rectum should be confirmed by physical or radiological
examination of the abdomen and rectum.
Mild adverse drug reactions are possible as indicated in Section 4.8. If patients develop any symptoms indicating shifts of fluids/electrolytes (e.g. oedema, shortness of breath, increasing fatigue, dehydration, cardiac failure) MOVICOL should be stopped immediately and electrolytes measured, and any abnormality should be treated appropriately.
The absorption of other medicinal products could transiently be reduced due to an increase in gastrointestinal transit rate induced by MOVICOL (see section 4.5).

Macrogol raises the solubility of medicinal products that are soluble in alcohol and relatively insoluble in water.
There is a possibility that the absorption of other medicinal products could be transiently reduced during use with MOVICOL (see section 4.4). There have been isolated reports of decreased efficacy with some concomitantly administered medicinal products, e.g. anti-epileptics.
 

Pregnancy There are limited amount of data from the use of MOVICOL in pregnant women. Studies in animals have shown indirect reproductive toxicity (see section 5.3). Clinically, no effects during pregnancy are anticipated, since systemic exposure to macrogol 3350 is negligible.
MOVICOL can be used during pregnancy.
Breastfeeding No effects on the breast fed newborn/infant are anticipated since the systematic exposure of the breastfeeding woman to Macrogol 3350 is negligible.
MOVICOL can be used during breast-feeding.
Fertility There are no data on the effects of MOVICOL on fertility in humans. There were no effects on fertility in studies in male and female rats (see section 5.3).

Movicol has no influence on the ability to drive and use machines.
 

Reactions related to the gastrointestinal tract occur most commonly These reactions may occur as a consequence of expansion of the contents of the gastrointestinal tract, and an increase in motility due to the pharmacologic effects of MOVICOL. Mild diarrhoea usually responds to dose reduction. The frequency of the adverse effects is not known as it cannot be estimated from the available data.

System Organ Class : Adverse Event

Immune system disorders : Allergic reactions, including anaphylactic reactions, dyspnoea and skin reactions.(see below).

Skin and subcutaneous tissue Allergic skin reactions including angioedema, disorders : Allergic skin reactions including angioedema, urticarial, pruritus, rash, erythema.

Metabolism and nutrition disorders : Electrolyte disturbances, particularly hyperkalaemia and hypokalaemia.

Nervous system disorders:  Headache.

Gastrointestinal disorders : Abdominal pain, diarrhoea, vomiting, nausea, dyspepsia, abdominal distension, borborygmi, flatulence and anorectal discomfort.

General disorders and administration site conditions : Peripheral oedema.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard.

To report any side effect(s): Kingdom of Saudi Arabia 
- National Pharmacovigilance Center (NPC) Fax: +966-11-205-7662 Call NPC at +966-11-2038222 Exts: 2317- 2356- 2353- 2354- 2334- 2340. Toll- free number: 8002490000 E-mail: npc.drug@sfda.gov.sa Website: www.sfda.gov.sa/npc 
Other GCC States: - Contact the relevant competent authority.
 

Severe abdominal pain or distension can be treated by nasogastric aspiration. Extensive fluid loss by diarrhoea or vomiting may require correction of electrolyte disturbances.
 

Pharmacotherapeutic group: Osmotically acting laxatives. ATC code: A06A D65 Macrogol 3350 acts by virtue of its osmotic action in the gut, which induces a laxative effect. Macrogol 3350 increases the stool volume, which triggers colon motility via neuromuscular pathways. The physiological consequence is an improved propulsive colonic transportation of the softened stools and a facilitation of the defaecation. Electrolytes combined with macrogol 3350 are exchanged across the intestinal barrier (mucosa) with serum electrolytes and excreted in faecal water without net gain or loss of sodium, potassium and water.
For the indication of faecal impaction controlled comparative studies have not been performed with other treatments (e.g. enemas). In a non-comparative study in 27 adult patients, Movicol cleared the faecal impaction in 12/27 (44%) after I day's treatment; 23/27 (85%) after 2 days ' treatment and 24127 (89%) at the end of 3 days.
Clinical studies in the use of Movicol in chronic constipation have shown that the dose needed to produce normal formed stools tends to reduce over time. Many patients respond to between 1 and 2 sachets a day, but this dose should be adjusted depending on individual response.

Macrogol 3350 is unchanged along the gut. It is virtually unabsorbed from the gastro-intestinal tract. Any macrogol 3350 that is absorbed is excreted via the urine.
 

Preclinical studies provide evidence that macrogol 3350 has no significant systemic toxicity potential, based on conventional studies of pharmacology, repeated dose toxicity and genotoxicity. There were no direct embryotoxic or teratogenic effects in rats even at maternally toxic levels that are a multiple of 66 x the maximum recommended dose in humans for chronic constipation and 25 x for faecal impaction. Indirect embryo fetal effects, including reduction in fetal and placental weights, reduced fetal viability, increased limb and paw hyperflexion and abortions, were noted in the rabbit at a maternally toxic dose that was 3.3 x the maximum recommended dose in humans for treatment of chronic constipalion and 1.3 x for faecal impaction. Rabbits are a sensitive animal test species to the effects of GI-acting substances and the studies were conducted under exaggerated conditions with high dose volumes administered, which are not clinically relevant. The findings may have been a consequence of an indirect effect of MOVICOL related to poor maternal condition as the result of an exaggerated pharmacodynamic response in the rabbit. There was no indication of a teratogenic effect.
There are long-term animal toxicity and carcinogenicity studies involving macrogol 3350. Results from these and other toxicity studies using high levels of orally administered high molecular weight macrogols provide evidence of safety at the recommended therapeutic dose.
 

Acesulfame potassium (E950)

Lime and Lemon Flavour*

(Lime and lemon flavour contains the following constituents: acacia solids, maltodextrin, lime oil, lemon oil, citral, citric acid and water)
 

None are known.
 

Sachet: Do not store above 25°C. Reconstituted solution: Store at 2-8 °C (in a refrigerator and covered).
 

Sachets: laminate consisting of four layers: low density polyethylene. aluminium, low density polyethylene and paper.
Pack sizes: boxes of 2, 6, 8, 10, 20, 30, 50, 60 or 100 sachets.
Not all pack sizes may be marketed.

Any unused solution should be discarded within 6 hours.