Articles: Preparation with MOVIPREP official instructions

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Before preparing for a colonoscopy with Moviprep, answer the following questions: do you often feel nauseous, is it easy to induce vomiting? If the answer to these questions is positive, draw the doctor’s attention to this before prescribing the preparation.

Preparation for colonoscopy with Moviprep (intestinal endoscopy) includes 3 stages: following a diet, choosing a diet depending on the time of intestinal endoscopy and the process of bowel cleansing itself.

Pharmacological properties

Oral administration of macrogol-based electrolyte solutions causes mild diarrhea and leads to rapid emptying of the large intestine.

Macrogol 3350, sodium sulfate and ascorbic acid

in high doses they act on the intestines osmotically, causing a laxative result.

Macrogol 3350 helps to increase the volume of feces, which affects the mobility of the colon through the neuromuscular pathways. As a result, accelerated passage of softened feces through the colon is achieved. The electrolytes contained in the drug and the additional intake of clear liquid prevent water and electrolyte imbalance, reducing the risk of dehydration.

Macrogol 3350 remains unchanged in the intestine. It is practically not absorbed in the gastrointestinal tract. Macrogol 3350, which is absorbed, is excreted in the urine.

Ascorbic acid is absorbed primarily in the small intestine via an active transport mechanism that is sodium dependent and is considered saturable. There is an inverse relationship between the dose taken and the percentage of the dose absorbed. When oral doses of 30–180 mg are administered, the amount of dosage absorbed is 70–85%. After oral administration of up to 12 g of ascorbic acid, only 2 g are absorbed.

After oral administration of high doses of ascorbic acid and when plasma ascorbic acid levels exceed 14 mg/l, ascorbic acid is excreted unchanged in the urine.

How does Moviprep work?

The product is used immediately before endoscopic examinations of the intestines, as well as before x-rays. In addition, the drug is prescribed before intestinal surgery so that remaining stool fragments do not interfere with surgeons’ ability to detect and remove tumors, polyps and tumors.

Taking Moviprep does not imply the treatment of diseases of the colon. The product does not relieve inflammation, does not relieve pain, and is not aimed at combating pathogens. It acts as a laxative, gently removing food debris from the body. Unlike conventional laxatives, Moviprep acts within clearly defined time intervals and does not cause intestinal spasms, which is very important for patients with severe painful symptoms that accompany the course of the disease.

Gentle cleansing is provided by Macrogol, which, thanks to long polymer bonds, can capture and retain water molecules, thereby increasing the volume of feces. They, in turn, increase pressure on the intestinal walls, triggering reflex cleansing mechanisms through the activation of peristalsis.

Application

Adults and elderly people use 2 liters of diluted Moviprep during the course of treatment. It is suggested to drink an additional 1 liter of clear liquid (water, clear soup, fruit juice without pulp, soft drinks, tea and/or coffee without milk).

To prepare the first liter of solution, the contents of 1 sachet A and 1 sachet B are dissolved in a small amount of water and diluted to 1 liter with water. The prepared solution should be drunk within 1–2 hours.

The procedure for diluting the second liter of medicine is similar.

A course of treatment:

• Method 1:
  divide into 2 parts: the first liter of diluted Moviprep is taken in the evening, the second liter of diluted Moviprep is taken in the morning on the day of the clinical procedure.
• Method 2:
  drink 2 liters of diluted Moviprep the evening before the clinical procedure.

The interval between the end of taking the liquid (Moviprep medicine or clear liquid) and the start of the colonoscopy should be at least 1 hour.

During the course of treatment and until the end of the clinical procedure, it is contraindicated to eat solid food.

The dissolution of Moviprep can take up to 5 minutes. It is suggested to first pour the powder into a container, mix with a small amount of water, gradually adding water to 1 liter. The drug Moviprep is taken only after complete dissolution in water. The solution can be cooled before use.

Scope of application

In practice, the volume of liquid needed to cleanse the intestines that you need to drink is approximately the same - 3-4 liters. It differs from the volumes recommended in the annotations. For Picoprep in the annotation we find 2.6 liters. This leads to incomplete cleansing of the intestines. Therefore, it is better to add another 1.4 liters of clear liquid to these 2.6 liters. In addition, it was noticed that Picoprep acts more slowly, after taking it after 3-4 hours. For Moviprep, the manufacturer recommends a total volume of 3.0 liters. Which is also not enough in practice. And you need to bring it to 4.0 liters.

The use of both drugs involves first diluting and drinking the active laxative in sachets, and then drinking any clear liquid, for example, chicken broth, tea without milk, juice without pulp, plain water. Alcoholic and carbonated drinks are not allowed.

Contraindications

The drug is not used if the following conditions are present or suspected:

• hypersensitivity to any component of the drug;
• obstruction or perforation of the digestive tract;
• impaired gastric emptying (in particular gastric paresis);
• ileus;
• phenylketonuria (since the drug contains aspartame);
• deficiency of glucose-6-phosphate dehydrogenase (since the drug contains ascorbate);
• toxic megacolon,
• acute inflammatory bowel diseases, including Crohn's disease, ulcerative colitis.

The use of the drug in unconscious patients is contraindicated.

Purposes of using the drug Moviprep

The main indication for taking a laxative is a complete cleansing of the digestive tract 1-2 days before the scheduled diagnostic instrumental or endoscopic examination. It often becomes the first choice drug to prepare a patient for surgery. Even with severe chronic constipation, the use of Moviprep is prohibited. Its use is advisable in the following cases:

• before endoscopic examination of the gastrointestinal tract;
• before an X-ray examination of the intestines, for example, colonoscopy, rectoscopy, both with and without contrast;
• at the preparatory stage for any surgical operation.

After a single dose of the product, the intestines are cleansed more efficiently than after using oil or saline solutions for enemas. Moviprep and drugs with similar effects are often used without a doctor’s prescription for detoxification, including for preventive purposes. And also for weight loss. The instructions do not contain such indications, so it is not recommended to violate its recommendations for the use of Moviprep.

Side effects

Diarrhea is a reaction that is expected after taking drugs in this group and causes undesirable effects in most patients. The most common are nausea, vomiting, bloating, epigastric pain, anal irritation, sleep disturbance. When using drugs containing macrogol, allergic reactions such as rash, urticaria, itching, angioedema, and anaphylaxis may occur.

The following describes the adverse reactions that were observed in patients after using the drug Moviprep during clinical trials and in the post-marketing period.

Adverse effects are classified according to frequency of occurrence into the following categories:

very often (>1/10), often (>1/100, <1/10), infrequently (>1/1000, <1/100), rarely (>1/10,000, <1/1000), very rare (<1/10,000), unknown (frequency not determined).

• On the part of the immune system: unknown - anaphylaxis.
• Mental disorders: often - sleep disorders.
• From the nervous system: often - dizziness, headache; unknown - seizures associated with severe hyponatremia.
• From the heart: unknown - temporary increase in blood pressure.
• From the gastrointestinal tract: very often - abdominal pain, nausea, bloating, anal discomfort; often - nausea, dyspepsia; infrequently - dysphagia; unknown - flatulence, vomiting.
• From the liver and biliary tract: infrequently - disturbances in liver function tests.
• From the skin and subcutaneous tissues: unknown - itching, urticaria, rash.
• General disorders and reactions at the injection site: very often - malaise; often - chills, thirst, hunger; infrequently - discomfort.

Active ingredients

In terms of composition and mechanism, these are different drugs. Moviprep uses the high-molecular substance Macrogol 3350. Macrogol 3350 is a second-generation drug with a reduced molecular weight that causes minor irritation to the mucous membrane of the distal parts of the colon (sigmoid and rectum). This substance retains water in the intestinal lumen, preventing it from being absorbed through the mucous membrane, and, like a piston, squeezes everything out of the intestine and washes it out in one go. Contains sodium sulfate enhances intestinal motility.

Picoprep contains 2 saline laxatives - sodium picosulfate (the same as sodium sulfate) and magnesium oxide. These two substances enhance each other in terms of laxative effect, but are quite irritating to the intestinal mucosa, which often explains nausea, vomiting and abdominal pain.

special instructions

Diarrhea is an expected reaction after taking Moviprep.

The drug should be used with caution in debilitated patients and patients with severe clinical disorders, in particular:

• impaired gag reflex or tendency to aspiration or belching;
• disturbance of consciousness;
• severe renal failure (creatinine clearance <30 ml/min);
• heart failure (III–IV functional class according to the NYHA classification);
• dehydration;
• severe acute inflammatory diseases.

Before taking the medicine, you should not allow your body to become dehydrated. During the use of the drug, patients who are semi-conscious or prone to aspiration or belching should be monitored, especially if the drug is administered through a nasogastric tube.

If the patient experiences symptoms indicating changes in fluid/electrolyte levels (eg, edema, shortness of breath, fatigue, heart failure), plasma electrolyte levels should be checked and appropriate treatment administered.

In debilitated patients, those in poor health, those with severe renal impairment, and those at risk for electrolyte imbalance, the physician should check electrolyte levels and renal function before and after treatment.

If the patient experiences symptoms such as severe flatulence, bloating, abdominal pain, or other reactions that make it difficult to use the medication, slow down or temporarily stop using the medication and consult a doctor.

Use during pregnancy or breastfeeding. No data available. Macrogol is used after consultation with a doctor in case of urgent need, when the expected benefit to the mother outweighs the potential risk to the fetus and child.

The ability to influence the reaction speed when driving vehicles or working with machinery. Not found.

Children. The drug is not recommended for use in children under 18 years of age, since there is no clinical data on the safety of the drug in this age category of patients.

Release form and composition

Moviprep has recently appeared in pharmacies. It is produced by the UK pharmaceutical company Norgine. The drug is produced in one dosage form - in the form of a fine-crystalline powder, highly soluble in water. A special feature of Moviprep is the presence of two different sachets in the primary packaging, which is a large box with instructions for use included inside. The composition of the first sachet is represented by the following ingredients:

• macrogol;
• sodium sulfate;
• sodium chloride;
• potassium chloride;
• aspartame;
• acesulfame potassium;
• flavoring.

White powder with a slight yellowish tint intended for dilution in water. The result is a drink with a pleasant lemon aroma and a specific salty-sweet taste. To form the composition of the second sachet, the manufacturer used only two components - ascorbic acid and its derivative sodium ascorbate. After diluting the dark beige powder in water, a colorless solution with a pronounced sour taste and no odor is formed.