Fleet Enema

Fleet Enema,

trademark for a manufactured enema formula containing 16 g sodium biphosphate and 6 g sodium phosphate per 100 mL solution. It is available in disposable plastic pouches fitted with prelubricated rectal tubes.

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sodium phosphates

Fleet Enema, Fleet Pediatric Enema, Fleet Phospho-Soda, Visicol

Pharmacologic class: Phosphoric acid salt

Therapeutic class: Saline laxative

Pregnancy risk category NR

Action

Promote hyperosmotic effect in small intestine and increase water retention, which indirectly stimulates peristalsis

Availability

Enema: 160 mg/ml sodium phosphate and 60 mg/ml dibasic sodium phosphate

Liquid: 2.4 g/5 ml monobasic sodium phosphate and 900 mg/5 ml dibasic sodium phosphate

Tablets: 1.102 g sodium phosphate and 0.398 g dibasic sodium phosphate

⊘Indications and dosages

➣ Bowel evacuation before colonoscopy

Adults: On night before procedure, three tablets P.O. with 240 ml of clear liquid q 15 minutes; repeat dose until patient has received 7.96 g dibasic sodium phosphate and 22.04 g sodium phosphate (20 tablets). On day of procedure, repeat dose 3 to 5 hours before procedure.

➣ Constipation

Adults and children older than age 12: 20- to 30-ml solution mixed with 120 ml cold water P.O., or 60 to 135 ml P.R. as an enema

Contraindications

• Hypertension
• Signs or symptoms of appendicitis (nausea, vomiting, abdominal pain)
• Acute surgical abdomen
• Renal impairment
• Megacolon
• Intestinal obstruction or perforation
• Edema
• Heart failure
• Sodium-restricted diet

Precautions

Use cautiously in:
• anal excoriation or large hemorrhoids
• pregnant patients.

Administration

• Mix oral solution as indicated on label. Have patient drink it right away.

Route	Onset	Peak	Duration
P.O.	0.5-3 hr	Variable	Variable
P.R.	5-10 min	Variable	Variable

Adverse reactions

CV: hypotension, widened QRS complex, arrhythmias, cardiac arrest

GI: nausea, diarrhea, cramps

Metabolic: fluid and electrolyte disturbances (such as hypernatremia and hyperphosphatemia)

Other: laxative dependence

Interactions

Drug-diagnostic tests. Electrolytes: decreased levels (with prolonged use)

Phosphate, sodium: increased levels

Patient monitoring

• Monitor fluid balance, electrolyte levels, and cardiovascular status if patient is using drug regularly.
• Monitor bowel habits. Watch for indications of laxative dependence.

Patient teaching

• Tell patient to mix oral solution as indicated on label and to drink it right after mixing.
• For enema use, instruct patient (or caregiver as appropriate) to use water-based lubricant to coat tip of applicator bottle.
• Teach patient to recognize and report signs or symptoms of fluid and electrolyte imbalances.
• Inform patient that drug can cause significant cardiovascular and metabolic effects. Instruct him to use it only for short-term therapy.
• Tell patient that long-term use can cause laxative dependence. Encourage him to increase dietary fiber and fluid intake (unless otherwise contraindicated) to help prevent constipation.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.