What is it used for?

• To empty the bowel before surgery or an examination such as colonoscopy or barium enema.

How does it work?

• Klean-Prep sachets contain the active ingredient macrogol, which is a type of medicine known as an osmotic laxative. Klean-Prep also contains sodium sulphate, sodium bicarbonate, sodium chloride and potassium chloride.
• Macrogol is an inert substance that passes through the gut without being absorbed into the body. It works because it causes the water it is taken with to be retained in the bowel instead of being absorbed into the body. This increases the water content and volume of the stools in the bowel, making them softer and easier to pass.
• The sodium sulphate, sodium bicarbonate, sodium chloride and potassium chloride (electrolytes) are included in this medicine to help ensure that the laxative works without causing the body to gain or lose significant amounts of sodium, potassium or water.
• Klean-Prep is used to cleanse the bowel prior to examination or surgical procedures that require the colon to be clean of stools, eg colonoscopy, barium enema or colonic resection. It is not used to treat constipation.

How do I take it?

• Follow the instructions given by your doctor. The dose prescribed will be printed on the dispensing label that your pharmacist has put on the packet of medicine.
• The usual dose is four sachets taken over a four to six hour period.
• Klean-Prep should be started the day before your hospital procedure. For a morning appointment at the hospital, you should start treatment with Klean-Prep during the afternoon or evening of the day before your appointment. For an afternoon appointment, you should take two sachets on the evening before your appointment and then the remaining two sachets the next morning.
• Klean-Prep solution is prepared by pouring the contents of one sachet into a litre of water and stirring until the solution is clear. Flavouring such as clear fruit cordial can be added if needed. It is best to make up just one sachet at a time.
• One glass of the solution should be drunk about every 15 minutes until you have drunk the whole litre. Keep the made-up solution covered in a refrigerator. Make sure no-one else will drink the medicine by accident.
• This procedure should be repeated with the next three sachets.
• You should start having bowel movements one to two hours after you start drinking the Klean-Prep solution. You should make sure you stay near a toilet.
• If you experience abdominal pain, bloating, nausea or vomiting you can slow down the rate at which you are drinking the solution or stop temporarily until this passes.
• If after taking three sachets you are passing clear liquids, rather than solid or liquid stools, there is no need to take the final sachet.
• Any solution that has not been used after 24 hours should be discarded.

Use with caution in

• Elderly people.
• Weak or debilitated people.
• People who have difficulty swallowing (an impaired gag reflex).
• People with inflammation of the foodpipe due to acid reflux (reflux oesophagitis).
• People with reduced levels of consciousness.
• People prone to regurgitating or accidentally breathing in (aspirating) food.
• Kidney failure.
• Heart failure.
• People taking diuretic medicines.
• People who have disturbances in the normal levels of electrolytes (such as sodium and potassium) in their blood.
• Inflammatory bowel disease such as ulcerative colitis or Crohn's disease.
• An inherited disorder of protein metabolism called phenylketonuria. (Klean-Prep contains aspartame, which is a source of phenylalanine.)

Not to be used in

• Severe congestive heart failure.
• People with severe dehydration.
• People with a blockage in the stomach or intestines.
• People with an abnormal hole in the stomach or intestines (gastrointestinal perforation).
• People with reduced muscle activity in the intestines (ileus).
• People with retention of food in the stomach (gastric retention).
• People with severe inflammation of the large intestine (toxic colitis).
• People with a sudden expansion of the large intestine seen in advanced ulcerative colitis or Crohn's disease (toxic megacolon).

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

• Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
• The safety of this medicine during pregnancy and breastfeeding has not been established. It should only be used during pregnancy or breastfeeding if considered essential by your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Abdominal pain.
• Anal discomfort.
• Swelling of the abdomen (bloating).
• Flatulence (wind).
• Nausea and vomiting.
• Headache.
• Dizziness.
• Shivering.
• Dehydration.
• Decreased level of potassium or sodium in the blood.
• Hypersensitivity reactions such as narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), or itchy rash.

If you experience abdominal pain, bloating, nausea or vomiting you can slow down the rate at which you are drinking the solution or stop temporarily until this passes.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

You should tell your doctor or pharmacist what medicines you are taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine.

You should not take other medicines by mouth in the hour before or the hour after taking Klean-Prep. This is because other medicines will be flushed through the gut without having time to be absorbed.

This medicine can sometimes cause an imbalance in the amount of fluid and salts (electrolytes) in your body. This effect may be enhanced if you are also taking one of the medicines listed below. If you are taking one of these, your doctor may recommend that you don't take it on the day you start taking this medicine and for up to three days after:

• ACE inhibitors, eg captopril, enalapril
• angiotensin-II receptor antagonists, eg losartan, valsartan
• diuretic medicines, eg furosemide or bendroflumethiazide
• non-steroidal anti-inflammatory painkillers (NSAIDs) , eg diclofenac, indometacin
• steroid medicines, eg prednisolone, dexamethasone.

References:

https://www.netdoctor.co.uk/medicines/digestion/a6965/klean-prep/

https://www.hpra.ie/homepage/site-tools/error-page

https://www.beaconhospital.ie/preparation-for-your-colonoscopy-klean/

https://www.medicines.org.uk/emc/product/1024/pil

https://www.blackrock-clinic.ie/wp-content/uploads/2015/07/AM-Prep-instructions.pdf

https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/ulh/hospitals/uhl/hospdept/periop/endoscopy/colonoscopy.html

https://www.medbroadcast.com/drug/getdrug/klean-prep