Movicol (Macrogol/PEG) Contraindications
Movicol is absolutely contraindicated in patients with intestinal obstruction, paralytic ileus, intestinal perforation, toxic megacolon, severe inflammatory bowel disease, and undiagnosed abdominal pain. 1
Absolute Contraindications
Complete or suspected intestinal obstruction: Macrogol increases luminal volume through its osmotic effect, which could worsen obstruction or precipitate perforation in patients with mechanical bowel obstruction. 1
Paralytic ileus: The osmotic mechanism of macrogol cannot function effectively when peristalsis is absent, making it both ineffective and potentially dangerous. 1
Suspected or confirmed intestinal perforation: Increased luminal fluid from macrogol administration could exacerbate peritoneal contamination and worsen clinical outcomes. 1
Toxic megacolon: There is significant risk of perforation with increased luminal distension in patients with toxic megacolon, particularly in the context of severe ulcerative colitis. 1, 2
Severe colitis or severe abdominal inflammation: The osmotic load may worsen inflammatory damage in patients with active severe inflammatory bowel disease. 1
Undiagnosed abdominal pain: Surgical causes must be ruled out before administering osmotic laxatives, as masking symptoms could delay critical surgical intervention. 1
Relative Contraindications and Special Precautions
Renal Impairment
- Use with caution in severe renal dysfunction: While macrogol causes virtually no net gain or loss of sodium and potassium, monitoring is warranted in patients with severe kidney disease. 1
- Preferred over magnesium-containing laxatives: Macrogol is generally safer than magnesium-based osmotic laxatives in patients with renal impairment, as magnesium can accumulate to toxic levels. 1
Recent Surgery or Trauma
- Recent colorectal or gynecological surgery: Risk of anastomotic disruption exists when using osmotic laxatives in the early postoperative period. 1
- Recent anal or rectal trauma: Could worsen tissue damage and delay healing. 1
- Recent pelvic radiotherapy: Tissue fragility increases perforation risk in irradiated bowel. 1
Hematologic Conditions
- Severe neutropenia (WBC < 0.5 cells/μL): May increase infection risk, though this is a theoretical concern. 1
- Severe thrombocytopenia: May increase bleeding risk, particularly if there is underlying mucosal pathology. 1
Important Clinical Caveats
Warning Signs Requiring Immediate Evaluation
- Perform digital rectal examination and imaging if patients develop severe abdominal distension, vomiting, or complete absence of bowel movements despite treatment to rule out bowel obstruction. 1
Safety Profile Advantages
- Broader safety profile than alternatives: Macrogol has fewer absolute contraindications compared to stimulant laxatives or enemas, making it the preferred first-line osmotic laxative for most patients with chronic constipation. 1
- Well-tolerated even in vulnerable populations: Safe for long-term use in children, elderly patients, and during pregnancy, with minimal adverse effects. 3
- Low incidence of adverse events: Even known side effects like abdominal pain and bloating occur infrequently, and discontinuation due to adverse events is rare. 4
Conditions That Are NOT Contraindications
- Chronic constipation with faecal impaction: Macrogol is highly effective (89% response rate) and well-tolerated for severe constipation and faecal impaction. 4
- Pregnancy: Safe to use during pregnancy without teratogenic concerns. 3
- Elderly patients: No dose adjustment needed and well-tolerated in this population. 5, 3