Products
Macrogol 4000 has been approved in many countries since 1987 as granules in combination with salts for bowel emptying and treatment of constipation (e.g., Isocolan). In 2013, a monopreparation that does not contain electrolytes was approved in many countries for the first time (Laxipeg). It is also available without flavoring (pure macrogol). The pure macrogol powder is also prescribed as an extemporaneous formulation and is used primarily in pediatrics as a laxative. An advantage is the lack of taste, as it does not contain salty electrolytes. Macrogol 4000 is available as a powder for specialty retailers, for example, from Hänseler in pharmacopoeia quality.
Structure and properties
Macrogols are mixtures of linear polymers with the general formula H-(OCH2-CH2)n-OH, indicating the average number of oxyethylene groups. The macrogol type is defined by a number indicating the average molecular mass. Macrogol 4000 is a white, solid, odorless substance with a waxy or paraffin-like appearance. It is very soluble in water due to its high hydrophilicity. Low molecular weight macrogols, such as macrogol 400, exist as viscous liquids.
Effects
Macrogol 4000 (ATC A06AD15) has a high affinity for water due to its numerous polar oxygen atoms. One molecule of macrogol binds more than 100 water molecules to itself via hydrogen bonds. Since it is not absorbed, the stool volume increases and Macrogol 4000 has a laxative effect in this way. At the same time, the stool becomes softer and more slippery. Macrogol 4000 is neither absorbed nor metabolized and, according to the scientific literature, is also well suited for children.
Indications
Macrogol 4000 is used alone or in combination with salts for the symptomatic treatment of constipation and for bowel evacuation before diagnostic and surgical procedures. It is also used as a pharmaceutical excipient, for example, as a base for making suppositories or ointments.
Dosage
According to the SmPC The drug is taken dissolved in water. For infants and young children, addition to milk is also possible. The effect occurs after 12 to 48 hours and depends on the dose and the preparation.
Contraindications
- Hypersensitivity
- Severe inflammatory bowel disease
- Toxic megacolon, associated with symptomatic stenosis.
- Perforation or risk of perforation in the digestive tract.
- Intestinal obstruction
- Suspected intestinal obstruction
- Abdominal pain of unknown origin
Full precautions can be found in the drug label.
Interactions
According to the SmPC, drug-drug interactions with other medications are not known to date. Interactions with digoxin and hydrocortisone have been described in the scientific literature. Concomitant use reduced bioavailability. It is also known from pharmaceutical technology that macrogols are incompatible with a number of active ingredients (e.g., penicillins).
Adverse effects
Possible adverse effects include flatulence, lower abdominal pain, nausea, vomiting, and diarrhea. Very rarely, hypersensitivity reactions occur. Electrolyte disturbances and dehydration have been reported (frequency unknown).
