Glycoprep powder for solution is a white crystalline powder packed in a sachet containing 200g. When dissolved in water it produces a solution. Each 200g sachet contains macrogol 3350 (polyethylene glycol) 856.92mg/g, sodium chloride 22mg/g, potassium chloride 11.25mg/g, sodium sulfate (anhydrous) 84.51mg/g and sodium bicarbonate 25.32mg/g.

PHARMACOLOGY

Macrogol 3350 is not significantly absorbed and acts as an osmotic agent to induce a watery diarrhoea usually within 1 hour after commencing treatment and which normally removes the bowel contents by about 4 hours after commencing treatment. The water and included electrolytes are iso-osmotic with normal intestinal contents and help to reduce or prevent electrolytes or water loss.

INDICATIONS

Glycoprep is indicated for bowel emptying and cleansing by means of total gastrointestinal tract perfusion in preparation for gastrointestinal procedure (such as colonoscopy, barium enema x-ray examination), prior to intravenous pyelograms (IVP) or colonic surgery.

CONTRAINDICATIONS

Glycoprep should not be used by patients with hypersensitivity to any of the ingredients, gastrointestinal obstruction, gastric retention, bowel perforation (frank or suspected), toxic colitis, toxic megacolon, ileus, severe dehydration or whose body weight is less than 20kg.

PRECAUTIONS

Use with caution in patients with severe ulcerative colitis, those with a stoma, impaired renal function, pre-existing electrolyte disturbances, dehydration, undiagnosed stomach pain, congestive heart failure, diabetics and in the elderly.

Patients with impaired gag reflex; who are semi-conscious; who are prone to regurgitation or aspiration; and particularly those with nasogastric intubation; should be carefully observed during the administration of Glycoprep. Patients with congestive heart failure; pre-existing electrolyte disturbances; kidney disease or impaired renal function; using calcium channel blockers; diuretics or other medications which may affect electrolyte levels may need to be monitored. There have also been reports of skin reactions and rhinorrhea attributed to macrogol which is contained in Glycoprep. Glycoprep may cause bloating, distension or abdominal pain, especially if administered by nasogastric tube. If this develops, the rate of administration should be slowed or temporarily ceased until the symptoms abate.

It is not known whether Glycoprep can cause foetal harm or affect reproductive capacity. Glycoprep should only be used if clearly needed.

Caution should be exercised in the elderly as dehydration and electrolyte depletion may occur. Elderly patients must receive adequate fluids during administration.

INTERACTIONS WITH OTHER MEDICINES

Oral medication taken within one hour of the commencement of the administration of Glycoprep, to one hour after completing its administration, may be flushed from the gastrointestinal tract and not absorbed. Sustained release preparations, or medicines with a short half life or a narrow therapeutic window may need to be taken more than one hour before or after administration of Glycoprep. The low-dose contraceptive pill will not work when taken with Glycoprep as it needs as much time as possible in the gastrointestinal tract for absorption. There is a possible reduction in the effect of bacitracin and benzylpenicillin when used in conjunction due to the macrogol content of Glycoprep.

ADVERSE EFFECTS

Nausea, abdominal fullness and bloating are the most common reactions. Abdominal cramps, vomiting and anal irritation occur less frequently. These adverse reactions are usually transient and subside rapidly.

DOSAGE AND ADMINISTRATION

Glycoprep is usually taken the day before the procedure. This may be varied if considered appropriate by the doctor. Guidance for clinicians/doctors: Glycoprep can be taken in the evening prior to the procedure (if a morning procedure) or on the morning of the procedure (if an afternoon procedure).

On the day before the procedure

Patients should fast until after the procedure. Patients should only drink recommended clear sugar free fluids. During the day, patients should drink at least one glass (approx. 250mL) of fluids each hour to maintain hydration. Solid foods or milk products should not be taken.

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Recommended clear sugar free fluids: water, soups (e.g. strained chicken noodle soup), broth/bouillon, fruit juices (apple, pear, white grape), black tea or coffee (no milk), electrolyte replacing drinks, cordials (lemon / lime), plain jelly (no red or purple colourings). Barley sugar may be sucked if required.

The patient should not drink carbonated or alcoholic beverages. Glycoprep produces a watery diarrhoea which empties and cleanses the bowel before procedure or surgery. It should be prepared and taken according to the directions. The onset of diarrhoea is about 1 hour and should be complete in 4 hours.

Preparation of Solution

The contents of the sachet should be dissolved in 3 litres of water using a suitable food grade container. The solution may be chilled if desired.

Usual Dosage

Glycoprep is usually taken orally but may be given by nasogastric tube to patients who are unwilling or unable to drink it. The patient should fast for 2 hours before starting to take Glycoprep and only take recommended clear sugar free fluids until after the procedure. One or two 250mL glasses of the prepared solution should be taken every 15- 20 minutes. The recommended dosing intake rate is from 1.2 litres to 1.8 litres per hour. If nausea is experienced, the rate of intake of Glycoprep solution should be reduced. Lavage is complete when the faecal discharge is clear. No food should be taken for 2 hours prior to commencing dosing. Only recommended clear sugar free fluids are allowed during the interval between commencing the Glycoprep preparation and 6 hours prior to the procedure.

Infuse the prepared solution at a rate of 20 to 30 mL/minute. It is important that the patient follow the recommended dosing schedule.

Note:

Individual responses to laxatives may vary. The preparation may cause multiple bowel movements and usually induces frequent loose bowel movements within 2 to 3 hours of taking the first dose. Patients should be advised to remain within easy reach of toilet facilities and not plan to go out.

OVERDOSAGE

In the event of overdosage, dehydration may ensue. Calcium, potassium, chloride and sodium levels should be carefully monitored and immediate corrective action should be taken to restore electrolyte balance with appropriate fluid replacements.

PRESENTATION AND STORAGE CONDITIONS

NAME AND ADDRESS OF THE SPONSOR

Fresenius Kabi Australia Pty Limited (ABN 39 109 383 593) 964 Pacific Highway Pymble NSW 2073 Australia Tel: (02) 9391 5555 Fresenius Kabi New Zealand Limited 60 Pavilion Drive Airport Oaks, Auckland 2022 New Zealand Freecall: 0800 144 892

Glycoprep(r)

DESCRIPTION