Sodium Phosphate

Registered South African indications:

• Constipation 
• Bowel evacuation 

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Renal impairment (pdr)
• Appendicitis 
• Undiagnosed rectal bleeding 
• Cardiac failure 
• Bowel obstruction
• Bowel perforation
• Congenital megacolon
• Gastric bypass or bariatric surgery
• Toxic colitis
• Toxic megacolon
• Colostomy
• Ileostomy
• Hyperphosphataemia
• Coadministration with agents that increase serum potassium

Cautions

• Pregnancy
• Renal impairment (enema)
• Elderly 
• Children
• Neonates 
• Unstable angina
• History of myocardial infarction 
• Hypertension 
• Cardiomyopathy 
• Arrhythmias or risk factors thereof 
• Pre-existing electrolyte imbalances or risk factors thereof 
• Dehydration 
• Gastric retention
• Gastric hypomotility
• Ileus
• Severe chronic constipation
• Colitis
• Chronic inflammatory bowel disease
• Severe active ulcerative colitis
• Seizure disorder 
• Bulimia nervosa
• Debilitated patients 
• Impaired gag reflex
• Risk factors or aspiration or regurgitation 
• High doses
• Prolonged use
• Low sodium diet 

Forms avail. in SA and covered in this monograph: ene, pdr

Constipation

• Rectal (ene): 135ml, as a single dose

Pre­operative emptying of the bowel

• Rectal (ene): 135ml, as a single dose
• Oral (pdr): 1 sachet, 1 day prior to procedure; Then 1 sachet on the day of the procedure

 Ensure adequate clear liquid intake prior to and during bowel evacuation regimens

Lubricate prior to insertion of enema  

When inserting enema, patient should be placed on the left side with knees bent, and should remain in this position until the urge to evacuate is strong (usually within 2-5 minutes)

Forms avail. in SA and covered in this monograph: ene 

Relief of occasional constipation

Younger than 2 years

• Not established for use

Between 2-4 years

• Rectal (ene): 32ml, as a single dose

Between 5-12 years

• Rectal (ene): 64ml, as a single dose

Older than 12 years

• See adult dosage

Bowel evacuation

Less than 5 years

• Not established for use

Older than 5 years

• See adult dosage

 Ensure adequate clear liquid intake prior to and during bowel evacuation regimens

Lubricate prior to insertion of enema  

When inserting enema, patient should be placed on the left side with knees bent, and should remain in this position until the urge to evacuate is strong (usually within 2-5 minutes)

Pregnancy

• Caution
• Caution should be exercised when administering to pregnant women, as no animal reproductive studies have been conducted

Breastfeeding

• Compatible
• Sodium phosphate use is acceptable during breastfeeding. No adverse events are anticipated when used within recommended doses

Renal Impairment

• Enema: Caution; no dose adjustment recommended
• Oral: Contraindicated

Hepatic Impairment

• No dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Dizziness
• Headache
• Seizures

Cardiovascular Disorders

• Arrhythmias

Respiratory Disorders

• Bronchospasm
• Dyspnoea 

Gastrointestinal Disorders  

• Bloating
• Gas formation
• Nausea and vomiting 
• Abdominal pain 
• Cramping 
• Diarrhoea
• Ischaemic colitis 
• Rectal bleeding 

Genitourinary Disorders

• Acute phosphate nephropathy
• Nephrolithiasis
• Acute renal impairment 
• Renal tubular necrosis

Endocrine and Metabolic Disorders

• Hyperphosphataemia
• Hypocalcaemia 
• Hypokalaemia 
• Hypernatraemia 
• Dehydration 
• Increased thirst 

Skin and Subcutaneous Tissue Disorders

• Urticaria
• Rash 

Immune, Blood and Lymphatic System Disorders

• Anaphylaxis

• Angiotensin-converting enzyme inhibitors 
• Angiotensin II antagonists
• Agents that increase serum potassium
• Antacids
• Tricyclic antidepressants 
• Calcium salts 
• Diuretics 
• Iron salts 
• Magnesium salts
• Multivitamins
• Minerals
• Non-steroidal anti-inflammatory drugs
• Sucralfate

None routine. Specific cases may require

• Renal function
• Electrolytes
• ECG

Sodium phosphate exerts its osmotic effect in the small intestine by drawing water into the lumen of the gut, thereby producing distention, peristalsis and evacuation of the bowel.

Monosodium/ Disodium phosphate

Enema (per 150ml) 24g/9g

• Adco Fosenema (Adcock)

Sodium phosphate/ Sodium biphosphate

Enema (per 100ml) 6g/16g

• Lenolax Adult (Pharmacare)
• Lenolax Paediatric (Pharmacare)

Monobasic sodium phosphate/ Dibasic sodium phosphate

Powder (per sachet) 15g/10g

• Colo-prep (Cipla Medpro)