sodium phosphate rectal (Fleet Enema, Pedia-Lax Enema, Fleet Enema Extra)

Dosing and uses of Fleet Enema, Pedia-Lax Enema (sodium phosphate rectal)

• Adult
• Pediatric

 

Adult dosage forms and strengths

Contains mixture of monobasic sodium phosphate and dibasic sodium phosphate

enema

• (19g/7g)/118mL
• (19g/7g)/197mL

 

Constipation & Bowel Cleansing

Indicated as laxative in the relief of occasional constipation and as part of a bowel cleansing regimen in preparing the colon for surgery, x-ray or endoscopic examination

1 bottle PR; not to exceed 1 administration/24 hr

 

Administration

Remove orange protective shield from enema tip before inserting; with steady pressure, gently insert enema tip into rectum with a slight side-to-side movement, with tip pointing toward naveL

Insertion may be easier if person receiving enema bears down, as if having a bowel movement; this helps relax the muscles around the anus

Do not force enema tip into rectum as this can cause injury

Squeeze bottle until nearly all liquid is gone; it is not necessary to empty the bottle completely, as it contains more liquid than needed

Remove enema tip from rectum and maintain position until urge to evacuate is strong (usually 1-5 minutes)

Do not retain enema solution for more than 10 minutes

Enema should be at room temperature before use

Positions for using this enema

• Left-side position: Lie on left side with knee bent, and arms resting comfortably
• Knee-chest position: Kneel, and then lower head and chest forward until left side of face is resting on surface with left arm folded comfortably

 

Pediatric dosage forms and strengths

Contains mixture of monobasic sodium phosphate and dibasic sodium phosphate

enema

• (9.5g/3.5g)/59mL

 

Constipation & Bowel Cleansing

Indicated as laxative in the relief of occasional constipation and as part of a bowel cleansing regimen in preparing the colon for surgery, x-ray or endoscopic examination

<2 years: Do not use

2-4 years: Administer one-half bottle PR of pediatric enema (ie, ~30 mL); prepare dose by unscrewing cap from bottle and removing 2 tablespoons of liquid (30 mL) with a measuring spoon, replace cap and administer remaining liquid

5-11 years: Administer 1 bottle PR of pediatric enema (ie, 59 mL)

12 years or older: Administer as in adults (adult enema)

 

Administration

Remove orange protective shield from enema tip before inserting; with steady pressure, gently insert enema tip into rectum with a slight side-to-side movement, with tip pointing toward naveL

Insertion may be easier if person receiving enema bears down, as if having a bowel movement; this helps relax the muscles around the anus

Do not force enema tip into rectum as this can cause injury

Squeeze bottle until nearly all liquid is gone; it is not necessary to empty the bottle completely, as it contains more liquid than needed

Remove enema tip from rectum and maintain position until urge to evacuate is strong (usually 1-5 minutes)

Do not retain enema solution for more than 10 minutes

Enema should be at room temperature before use

Positions for using this enema

• Left-side position: Lie on left side with knee bent, and arms resting comfortably
• Knee-chest position: Kneel, and then lower head and chest forward until left side of face is resting on surface with left arm folded comfortably

 

Fleet Enema, Pedia-Lax Enema (sodium phosphate rectal) adverse (side) effects

Frequency not defined

Hypersensitivity

Pruritus

Dehydration

Hyperphosphatemia

Hypocalcemia

Hypokalemia

Hypernatremia

Metabolic acidosis

Nausea

Vomiting

Abdominal pain

Abdominal distension

Diarrhea

Gastrointestinal pain

Chills

Blistering

Stinging

Anal discomfort

Proctalgia

 

Warnings

Contraindications

Hypersensitivity

 

Cautions

Do not use laxatives when nausea, vomiting, or severe abdominal pain is present

Caution with renal impairment or ascites

Caution in patients with a colostomy

Caution in children aged 2-11 years or elderly patients with comorbidities

Caution if coadministered with medications known to affect renal perfusion, function, or hydration

Caution with pre-existing electrolyte disturbances or patients taking diuretics or other medications that may alter electrolytes

Because of risk electrolyte disturbances, caution with medications known to prolong QT intervaL

Additional liquids by mouth are recommended to prevent dehydration

Exceeding daily dose, no return of enema solution, retention time >10 minutes, or failure to have a bowel movement within 30 minutes of enema use may lead to electrolyte disturbances, including hypernatremia, hyperphosphatemia, hypocalcemia, and hypokalemia

Severe dehydration and electrolyte abnormalities associated with serious complications (eg, acute kidney injury, arrhythmias, and death) have occurred in adults and children who overdosed using oral or rectal over-the-counter (OTC) sodium phosphate solutions to treat constipation

 

Pregnancy and lactation

Pregnancy category: C

Lactation: Unknown whether distributed in breast milk; caution because of risk for electrolyte disturbances or dehydration

Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Fleet Enema, Pedia-Lax Enema (sodium phosphate rectal)

Mechanism of action

Saline cathartic effect