Summary of Product Characteristics (SmPC) - Compound Macrogol 13.72 g powder for oral solution
1 NAME OF THE MEDICINAL PRODUCT
Compound Macrogol 13.72 g powder for oral solution
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each sachet contains the following active ingredients:
Macrogol 3350 13.125 g
Sodium chloride 350.7 mg
Sodium bicarbonate 178.5 mg
Potassium chloride 46.6 mg
The content of electrolyte ions per sachet when made up to 125 ml of solution is as follows:
Sodium 65 mmol/l
Chloride 53 mmol/l
Potassium 5.4 mmol/l
Bicarbonate 17 mmol/l
For the full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Powder for Oral Solution.
A white crystalline powder in single dose sachets.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
For the treatment of chronic constipation. Macrogol is also effective in resolving faecal impaction, defined as refractory constipation with faecal loading of the rectum and/or colon.
4.2 Posology and method of administration
Posology
Chronic constipation
A course of treatment for constipation with Macrogol 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 the elderly: 1 –3 sachets daily in divided doses, according to individual response.
For extended use, the dose can be adjusted down to 1 or 2 sachets daily.
Children (below 12 years old): Not recommended. Alternative Macrogol products are available for children.
Faecal impaction
A course of treatment for faecal impaction with Macrogol does not normally exceed 3 days.
Adults, adolescents and the elderly: 8 sachets daily, all of which should be consumed within a 6 hour period.
Children (below 12 years old): Not recommended. Alternative Macrogol 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 any one 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 just before use. For use in faecal impaction 8 sachets may be dissolved in 1 litre of water.
4.3 Contraindications
Intestinal perforation or obstruction due to structural or functional disorder of the gut wall, ileus, severe inflammatory conditions of the intestinal tract, such as Crohn’s disease and ulcerative colitis and toxic megacolon.
Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.
4.4 Special warnings and precautions for use
The fluid content of Macrogol when re-constituted with water does not replace regular fluid intake and adequate fluid 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) Macrogol 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 gastro-intestinal transit rate induced by Macrogol (see section 4.5).
This medicinal product contains 186.87mg (8.125 mmol) sodium per dose, equivalent to 9.3% of the WHO recommended maximum daily intake for sodium. When used long term for constipation the maximum daily dose of this product is equivalent to 28% of the WHO recommended maximum daily intake for sodium. Macrogol is considered high in sodium. This should be particularly taken into account for those on a low salt diet.
In patients with swallowing problems, who need the addition of a thickener to solutions to enhance an appropriate intake, interactions should be considered, see section 4.5.
4.5 Interaction with other medicinal products and other forms of interaction
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 Macrogol (see section 4.4). There have been isolated reports of decreased efficacy with some concomitantly administered medicinal products, e.g. anti-epileptics. Therefore, other medicines should not be taken orally for one hour before, during and for one hour after taking Macrogol.
Macrogol may result in a potential interactive effect if used with starch-based food thickeners. The Macrogol ingredient counteracts the thickening effect of starch, effectively liquefying preparations that need to remain thick for people with swallowing problems.
4.6 Fertility, pregnancy and lactation
Pregnancy
There are limited amount of data from the use of Macrogol 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.
Macrogol can be used during pregnancy.
Breastfeeding
No effects on the breastfed newborn/infant are anticipated since the systemic exposure of the breast-feeding woman to Macrogol 3350 is negligible.
Macrogol can be used during breast-feeding.
Fertility
There are no data on the effects of Macrogol on fertility in humans. There were no effects on fertility in studies in male and female rats (see section 5.3).
4.7 Effects on ability to drive and use machines
Macrogol has no influence of the ability to drive and use machines.
4.8 Undesirable effects
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 Macrogol. 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 anaphylaxis, angioedema, dyspnoea, rash, urticaria and pruritus. |
| Skin and subcutaneous tissue disorders | 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 the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
4.9 Overdose
Severe abdominal pain or distension can be treated by nasogastric aspiration. Extensive fluid loss by diarrhoea or vomiting may require correction of electrolyte disturbances.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
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, Macrogol cleared the faecal impaction in 12/27 (44%) after 1 day’s treatment; 23/27 (85%) after 2 days’ treatment and 24/27 (89%) at the end of 3 days.
Clinical studies in the use of Macrogol 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.
5.2 Pharmacokinetic properties
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.
5.3 Preclinical safety data
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 embryofetal 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 constipation 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 Macrogol 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.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Acesulfame Potassium
Lemon flavour
6.2 Incompatibilities
None Known.
6.3 Shelf life
36 months
6.4 Special precautions for storage
Store below 25°C.
Store in the original package to protect from moisture.
6.5 Nature and contents of container
Four-layer laminated paper foil sachet.
Pack size: Box of 30 sachets.
6.6 Special precautions for disposal
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
7 MARKETING AUTHORISATION HOLDER
Manx Healthcare Ltd
Unit 2
Bosworth Avenue
Tournament Fields
Warwick
CV34 6UQ
United Kingdom
8 MARKETING AUTHORISATION NUMBER(S)
PL 14251/0284
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
22/10/2024
10 DATE OF REVISION OF THE TEXT
15/12/2025