Fortrans: Uses, dosage and usage

Posted by Pharmacist Nguyen Thu Giang - Clinical Pharmacist - Faculty of Pharmacy - Vinmec Times City International Hospital

Fortrans is a powder for oral solution that is still commonly used to cleanse the colon. The composition of the drug includes Macrogol 4000 (mainly polyethyleneglycol 4000), Anhydrous sodium sulfate, sodium bicarbonate, potassium chloride, sodium saccharin. Particularly, Macrogol 4000 is a long, straight polymer linked to water molecules by hydrogen bonds. When taken orally in the gastrointestinal tract, they increase the amount of fluid in the intestinal lumen. This amount of fluid is not absorbed but will go out of the body through the digestive tract, so the solution has a laxative effect. Fortrans is classified as an osmotic laxative.

Fortrans is indicated for oral cleansing of the colon before endoscopic exploration, X-ray, colon surgery.
However, the drug is not used in the following cases: dehydration, severe heart failure, advanced colon cancer or other colon diseases that lead to excessive disruption of the intestinal lining, the patient is experiencing or suspected Intestinal obstruction or paralytic ileus, children under 15 years of age due to insufficient clinical data. The case of gastrointestinal perforation or the risk of gastrointestinal perforation is also contraindicated.

In order for the drug to work and reduce unwanted effects, the patient needs to use the drug properly: one pack mixed with 1 liter of water, stir until completely dissolved, then drink. The average dose is 3-4 liters of reconstituted drug solution. The drug can be taken once or in divided doses to ensure that the correct amount of solution is taken:
In divided doses: 2 liters can be taken the evening before the procedure and 2 liters on the morning of the procedure, or Drink 3 liters the night before and 1 liter on the morning of the procedure. Patients need to finish taking the medicine 3-4 hours before the procedure. With a single dose: drink 4 liters in the evening before the procedure, can rest for 1 hour after drinking 2 liters. The recommended drinking rate is 1 - 1.5 liters/hour (ie 250ml every 10-15 minutes). However, the doctor can adjust the dosage rate depending on the patient's clinical condition and comorbidities.

When taking the drug, the patient may experience some unwanted effects such as: Nausea, vomiting, abdominal distension, in addition, it may be rare: rash, urticaria, edema, anaphylaxis (very rare). . Electrolyte disturbances can also occur due to the components of the drug, so it should be used with extreme caution in patients with altered renal function, heart failure or taking diuretics.
In particular, doctors must closely monitor when using the drug for bedridden patients, patients with changes in neurological function and/or movement disorders due to the risk of aspiration pneumonia. These patients need to take medicine while sitting and through the nasogastric tube. Patients with heart failure and kidney failure are at risk of acute pulmonary edema due to sodium overload (due to the sodium content of the drug).
With the usage and special attention as above, patients should only use when indicated and monitored by the doctor.
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References: NSX, FDA.