Moviprep: composition and presentation
Moviprep is a powder in sachets for making up an oral solution. A litre of the finished solution is obtained by dissolving the contents of one sachet A and one sachet B together in water. The split into two sachets is no formality: the components are mixed only at the moment of preparation, and "sachet A" apart from "sachet B" is not the medicine. The solution is made up with water and taken by mouth; the product has no other route of administration.
The composition is given as ion concentrations per litre of finished solution: sodium 181.6 mmol, of which no more than 56.2 mmol is absorbable, sulfates 52.8 mmol, chlorides 59.8 mmol, potassium 14.2 mmol, ascorbate 29.8 mmol. Sachet A contains 0.233 g of aspartame. These figures are not a curiosity: three contraindications and half the warnings follow from them — those concerning sodium, potassium and phenylalanine, the source of which is aspartame.
How Moviprep works
Taking macrogol-based electrolyte solutions by mouth causes moderate diarrhoea and leads to rapid emptying of the large bowel. The osmotic reaction with its laxative effect is produced by three components at once: macrogol 3350, sodium sulfate and high doses of ascorbic acid. Macrogol 3350 also increases the volume of the stool, and that increased volume triggers movements of the large bowel through neuromuscular pathways. The physiological consequence is accelerated passage of softened faecal matter through the colon.
The other half of the design is the electrolytes. Those in the preparation and those coming in with the additional fluid drunk are meant to prevent clinically significant changes in the concentrations of sodium, potassium and water, and thereby to reduce the risk of dehydration. Hence the rule patients break most often: the solution flushes the bowel but does not replace ordinary drinking, and fluids must be taken in the usual amount on top of it.
Indications
There is a single indication and it is worded procedurally rather than by disease: the medicine is used in adults to cleanse the bowel before clinical procedures requiring a clean bowel, for instance before an endoscopic or radiological examination of the bowel.
In other words, this is not a treatment for constipation and not a product for "cleansing the body", but part of the preparation for a colonoscopy or a radiological study. Whether the doctor sees the whole of the mucosa depends directly on how well that preparation is done: residues of bowel content hide areas of the wall, and a small lesion may go unnoticed. That is why the schedule is set out hour by hour rather than left to the patient's discretion: a poorly done preparation often means the examination has to be repeated, that is, the whole procedure done again. Children and adolescents under 18 are not given the medicine: its action in that age group has not been studied.
Method of use and dosage
A single course of treatment for adults, elderly patients included, consists of taking 2 litres of the solution. It is strongly recommended that during the course the patient also drinks a further litre of fluids: this may be water, light clear soups, fruit juices without pulp, soft drinks, tea or coffee without milk. Each litre of solution is made up from a pair of sachets and drunk over 1 to 2 hours. The course is given either in divided doses or as a single dose, and the deadline for finishing depends on whether the procedure will be carried out under general anaesthesia.
| Conditions of the procedure | Schedule | When to finish |
| Under general anaesthesia, divided doses | 1 litre of solution on the evening before and 1 litre early on the morning of the procedure | no later than 2 hours before the start |
| Under general anaesthesia, single dose | 2 litres of solution on the evening before or 2 litres on the morning of the procedure | no later than 2 hours before the start |
| Without general anaesthesia, divided doses | 1 litre of solution on the evening before and 1 litre early on the morning of the procedure | no later than 1 hour before the start |
| Without general anaesthesia, single dose | 2 litres of solution on the evening before or 2 litres on the morning of the procedure | no later than 1 hour before the start |
The stated deadline covers not only the medicine itself but the other clear fluids as well — their intake must be finished by then too. Solid food is not taken from the moment the preparation is started until the procedure is over. And one more practical detail, placed directly in the dosage section: the patient should be told to allow enough time to travel to the colonoscopy unit. The advice sounds domestic, but there is clear logic behind it — at the moment of setting off the effect of the preparation is still going on.
Contraindications
The first group of bans is mechanical. The preparation is not given to patients in whom obstruction or perforation of the bowel or stomach is established or suspected, nor in disorders of gastric emptying such as gastroparesis, nor in ileus. The logic is plain: two litres of volume have to pass right through the bowel, and if the way is closed the fluid has nowhere to go. To this group belongs toxic dilation of the colon as well — a serious complication of acute inflammatory conditions of the large bowel, Crohn's disease and ulcerative colitis among them.
The second group has to do with the composition. Phenylketonuria is a contraindication because of the aspartame, and glucose-6-phosphate dehydrogenase deficiency because of the ascorbates. The list closes with hypersensitivity to the active substances or to any excipient. A separate line states that the preparation is not used in unconscious patients. The reason lies not in the medicine but in how it is taken: two litres of solution can only be drunk by someone able to swallow consciously.
Special warnings and precautions
Diarrhoea here is the expected effect and not a complication, and that changes how the whole section reads: caution is needed where a person will tolerate the loss of fluid itself badly. Named are very debilitated patients in poor general condition and patients with severe clinical disorders: with a diminished pharyngeal reflex or a tendency to choking and regurgitation, with disturbed consciousness, with severe renal failure at a creatinine clearance below 30 ml/min, with heart failure of NYHA class III or IV, with a risk of arrhythmia — in cardiovascular or thyroid disease, for instance — with dehydration and with a serious acute infectious illness. Dehydration must be treated before the preparation is given.
Patients with disturbed consciousness or a tendency to choking are watched closely while taking it, especially if the solution is given through a gastric tube. If signs of arrhythmia appear, or changes in fluid and electrolyte balance — oedema, breathlessness, mounting tiredness, heart failure — plasma electrolytes are measured, the ECG is monitored and treatment is given. In debilitated and wasted patients, in significant renal impairment, in arrhythmia and where electrolyte imbalance threatens, the doctor considers measuring electrolytes, assessing renal function and taking an ECG before the preparation is used and, if needed, afterwards. Rare reports have been recorded of serious disturbances of heart rhythm, atrial fibrillation among them, with ionic osmotic laxatives used for bowel preparation; they occur mostly in patients with cardiac risk factors and with electrolyte disturbances. In the event of marked bloating, abdominal distension, pain or other reactions that hinder the preparation, the intake may be slowed or paused for a time and the doctor contacted. Finally, on the composition: the 56.2 mmol of absorbable sodium per litre are taken into account by patients watching dietary sodium, the 14.2 mmol of potassium per litre by patients with renal impairment or watching potassium, and aspartame as a source of phenylalanine may be harmful in phenylketonuria. The preparation has no effect on the ability to drive.
Interactions with other medicines
The section is short but practically important: no oral medicines should be taken within an hour of taking the preparation. The reason is mechanical — they will simply be washed out of the digestive tract and will not be absorbed. This applies especially to agents with a narrow therapeutic range or a short half-life: for them the loss of one dose means dropping out of the working concentration.
The practical conclusion is worth thinking through in advance, with the doctor, because the preparation takes up an evening and a morning — that is, it covers at least two of the usual times for taking tablets. It may concern anticonvulsants, thyroid preparations, anticoagulants and glucose-lowering medicines, whose schedule has to be changed for the fast in any case. The decision belongs to the doctor arranging the examination, not to the patient.
Pregnancy and breastfeeding
There are no data on the use of the medicine in pregnant women. The wording of the description is brief: during pregnancy it should be taken only where the doctor judges it necessary. The same holds for breastfeeding — there are no data, and the decision rests with the doctor. On the effect on fertility there is no information either.
In practice the question concerns not the preparation but the reason for the examination: colonoscopy is rarely arranged in pregnancy, and usually when postponing it is more dangerous than carrying it out. If the examination is judged necessary, the preparation is planned together with the doctor managing the pregnancy, with the volume of fluids and the monitoring of wellbeing thought through separately. An absence of data is not the same as proven harm — it means only that studies in this group have not been done, and that the decision is therefore made case by case.
Adverse reactions
Because of the nature of the procedure itself, adverse effects occur in most patients during bowel preparation, and it is worth knowing that in advance. Most often, in people being prepared for a procedure, there is nausea, vomiting, bloating, abdominal pain, irritation of the anal area and disturbed sleep. Diarrhoea or vomiting may lead on to dehydration. Allergic reactions are also possible, including rash, hives, itching, breathlessness, angioedema and anaphylaxis.
By frequency, the description sets out data from studies in 825 patients along with post-marketing reports. Very often there is abdominal pain, nausea, abdominal distension, discomfort in the anal area, malaise and fever. Common effects are vomiting, indigestion, disturbed sleep, dizziness and headache, chills, thirst and hunger. Uncommonly, difficulty swallowing, discomfort and abnormal liver function tests are recorded. With unknown frequency, flatulence and retching are described, allergic reactions up to the anaphylactic, skin manifestations with angioedema, hives, itching, rash and erythema, and disturbances of electrolyte balance: a fall in blood carbon dioxide, hyper- and hypocalcaemia, hypophosphataemia, hypokalaemia, hyponatraemia and changes in chloride concentration. With that same unknown frequency, a transient rise in blood pressure, arrhythmia and palpitations have been reported, along with seizures linked to marked hyponatraemia.
Overdose
With a substantial accidental overdose and the severe diarrhoea it causes, conservative treatment is usually enough: the patient is given large amounts of fluid, fruit juices in particular. In rare cases, where the overdose has caused serious metabolic disturbance, intravenous rehydration is used.
It is worth noticing how this section is built: it speaks not of poisoning by the substance but of the consequences of excessive fluid loss. The main risk of ordinary use is built the same way: the problem is created not by the chemical action of the substance but by the volume and the speed of what happens in the bowel. Hence the same recommendation in both cases: drink enough, and do not shrug off mounting weakness, dizziness or palpitations.
How to get a Moviprep prescription online
This product is not bought for a course of treatment but for an appointed date: it is needed on the eve of a colonoscopy or a radiological examination of the bowel. At e-zdrowie.com the prescription is arranged remotely — a questionnaire, the doctor's review of the answers, and an electronic prescription as a code in a message, against which any Polish pharmacy will dispense it. The format fits particularly well here: the date of the examination is known in advance, and leaving the purchase to the last day makes no sense.
In the questionnaire state which examination has been arranged, for what date and time, and whether it will be done under general anaesthesia — that decides whether the intake must finish one hour or two hours before the start. Report bowel diseases, Crohn's disease and ulcerative colitis among them, previous abdominal operations, swallowing disorders, disease of the heart, kidneys and thyroid, phenylketonuria and glucose-6-phosphate dehydrogenase deficiency. Be sure to list the medicines you take regularly: some of them will have to be shifted or skipped on the day of preparation, and that should be settled by the doctor in advance, not by you on the morning of the procedure.
