Movicol Choklad
Macrogol 3350 with electrolytes – Osmotic laxative for constipation and faecal impaction
Quick Facts About Movicol Choklad
Key Takeaways About Movicol Choklad
- Gentle osmotic action: Movicol Choklad works by drawing water into the bowel through osmosis, softening stools without stimulating the bowel wall directly
- No dependency risk: Unlike stimulant laxatives, macrogol-based products do not cause bowel dependency and are suitable for long-term use
- Electrolyte-balanced formula: Contains sodium bicarbonate, sodium chloride, and potassium chloride to prevent electrolyte disturbances during treatment
- Effective for faecal impaction: Higher doses (up to 8 sachets daily for 3 days) can resolve faecal impaction without the need for enemas in most cases
- Chocolate flavour for compliance: The chocolate flavour improves palatability compared to unflavoured macrogol preparations, supporting better adherence to treatment
What Is Movicol Choklad and What Is It Used For?
Movicol Choklad is an osmotic laxative containing macrogol 3350 (polyethylene glycol) with electrolytes, used to treat chronic constipation and faecal impaction in adults and adolescents aged 12 years and older. It works by retaining water in the bowel to soften stools and increase stool volume, producing a bowel movement typically within 1 to 2 days.
Movicol Choklad belongs to the class of osmotic laxatives. The active substance, macrogol 3350, is a large polymer molecule that is not absorbed from the gastrointestinal tract. Instead, it exerts its effect by binding water molecules through hydrogen bonds, thereby increasing the volume of fluid in the bowel lumen. This increased fluid volume softens hard, compacted stools and stimulates natural bowel movements through gentle distension of the intestinal wall.
The formulation also contains three electrolytes: sodium bicarbonate, sodium chloride, and potassium chloride. These electrolytes serve a critical purpose – they create a virtually iso-osmotic solution when dissolved in water, which means there is no net gain or loss of sodium, potassium, or water across the intestinal wall. This electrolyte balance is particularly important for patients who may be taking Movicol Choklad at higher doses for faecal impaction treatment, where large volumes are consumed over a short period.
Chronic constipation is a common condition affecting approximately 14% of the global adult population, according to the World Gastroenterology Organisation (WGO). It is particularly prevalent among older adults, women, and individuals with sedentary lifestyles. Constipation can significantly impact quality of life, causing abdominal discomfort, bloating, and straining during defecation. When left untreated, chronic constipation may progress to faecal impaction, a more serious condition where hardened stool becomes lodged in the rectum or colon.
Faecal impaction occurs when large, hardened masses of stool accumulate in the lower bowel and cannot be expelled through normal bowel movements. It is particularly common among elderly patients, those with reduced mobility, and individuals taking certain medications such as opioids. Movicol Choklad provides an effective non-invasive treatment option for faecal impaction, with clinical studies demonstrating resolution rates of approximately 80% when used at the recommended higher-dose regimen over 3 days.
Movicol Choklad is an osmotic laxative, meaning it works by drawing water into the bowel rather than directly stimulating bowel contractions. Stimulant laxatives (such as bisacodyl or senna) act on the nerve endings in the bowel wall to trigger contractions, and prolonged use can lead to reduced bowel function and dependency. Osmotic laxatives like macrogol work more gently and are recommended by international guidelines including NICE and the British Society of Gastroenterology (BSG) as first-line treatment for chronic constipation.
What Should You Know Before Taking Movicol Choklad?
Before taking Movicol Choklad, inform your doctor if you have intestinal obstruction, perforation, severe inflammatory bowel disease, or impaired gag reflex. The medicine contains sodium and potassium, which may be relevant for patients on restricted diets. It is generally considered safe during pregnancy and breastfeeding, but medical advice should be sought.
Contraindications
Movicol Choklad must not be used in the following situations:
- Intestinal perforation or obstruction caused by structural or functional disorders of the gut wall, including ileus (complete bowel obstruction)
- Severe inflammatory conditions of the intestinal tract, such as Crohn's disease, ulcerative colitis, or toxic megacolon
- Hypersensitivity to macrogol (polyethylene glycol), or any of the other ingredients including sodium bicarbonate, sodium chloride, or potassium chloride
If you are uncertain whether any of these conditions apply to you, consult your doctor or pharmacist before starting treatment. Patients with severe abdominal pain of unknown origin should seek medical assessment before using any laxative product.
Warnings and Precautions
Special care should be taken with Movicol Choklad in the following circumstances:
- Impaired gag reflex or reflux: Patients with impaired gag reflex, diminished states of consciousness, or those prone to aspiration or regurgitation should use this medicine with particular caution, especially when using the higher-dose faecal impaction regimen
- Renal impairment: Patients with compromised kidney function should be carefully monitored, as the electrolyte content may pose risks. The potassium and sodium content should be considered in patients on electrolyte-restricted diets
- Cardiac conditions: Patients with heart failure or other conditions requiring sodium-restricted diets should note that each sachet contains approximately 8.1 mmol (186.2 mg) of sodium
- Fluid intake: Adequate fluid intake is essential during treatment. The water used to dissolve the sachets does not replace regular daily fluid requirements
- Prolonged use: While macrogol is suitable for long-term use, patients who need to take laxatives every day should investigate the underlying cause of constipation with their healthcare provider
If you develop severe abdominal pain, distension, vomiting, or bloody stools while taking Movicol Choklad, stop taking the medicine immediately and seek urgent medical attention. These symptoms may indicate a serious underlying condition that requires prompt evaluation.
Pregnancy and Breastfeeding
Movicol Choklad is generally considered safe during pregnancy and breastfeeding. Macrogol 3350 is not significantly absorbed from the gastrointestinal tract, so systemic exposure to the foetus or nursing infant is expected to be negligible. There are no adequate and well-controlled studies specifically in pregnant women, but extensive post-marketing experience has not revealed any safety concerns.
Constipation is a very common complaint during pregnancy, affecting up to 40% of pregnant women, primarily due to hormonal changes (increased progesterone levels) and the physical pressure of the growing uterus on the bowel. The British National Formulary (BNF) lists macrogol preparations as acceptable for use during pregnancy when dietary and lifestyle modifications have been insufficient.
If you are pregnant, planning to become pregnant, or breastfeeding, discuss the risks and benefits of treatment with your doctor before starting Movicol Choklad.
How Does Movicol Choklad Interact with Other Drugs?
Movicol Choklad has relatively few clinically significant drug interactions. However, it may reduce the absorption of other medications taken at the same time due to its effects on intestinal transit. Patients taking other medicines should separate administration by at least 2 hours. Starch-based thickening agents may lose efficacy when mixed with macrogol solutions.
Because macrogol 3350 is not absorbed from the gastrointestinal tract and does not undergo hepatic metabolism, it has a low potential for pharmacokinetic drug interactions. However, there are several important considerations that patients and healthcare providers should be aware of:
The increased intestinal transit associated with the laxative effect of Movicol Choklad may theoretically reduce the absorption window for other orally administered medications. This is a class effect shared by all laxatives and is particularly relevant for medications with narrow therapeutic indices or those that are absorbed primarily in specific regions of the gastrointestinal tract.
| Interacting Substance | Type | Effect | Recommendation |
|---|---|---|---|
| Starch-based thickeners | Direct interaction | Macrogol counteracts the thickening effect of starch-based products used for patients with swallowing difficulties | Do not mix with starch-based thickeners; use alternative thickening agents |
| Antiepileptic drugs | Potential reduced absorption | Accelerated transit may reduce absorption time for narrow-therapeutic-index antiepileptics (e.g. carbamazepine, phenytoin, valproate) | Separate administration by at least 2 hours; monitor drug levels |
| Cardiac glycosides (digoxin) | Potential reduced absorption | Increased bowel transit may theoretically reduce digoxin absorption | Separate administration by at least 2 hours; monitor digoxin levels if needed |
| Oral contraceptives | Potential reduced absorption | Diarrhoea (a possible side effect) may reduce contraceptive efficacy | If severe diarrhoea occurs, follow missed-pill guidance from your contraceptive leaflet |
| Thyroid hormones (levothyroxine) | Potential reduced absorption | Altered transit time may affect levothyroxine absorption from the small intestine | Take levothyroxine on an empty stomach, ideally 30–60 minutes before Movicol Choklad |
General Advice on Co-administration
As a precautionary measure, it is generally advisable to take other oral medications at least 1 to 2 hours before or after taking Movicol Choklad. This separation helps ensure that other medicines have adequate time for absorption before the osmotic laxative effect increases intestinal fluid content and transit.
Patients taking multiple medications should discuss the optimal timing of doses with their pharmacist or doctor. This is particularly important for medications where consistent plasma levels are critical, such as anticoagulants, immunosuppressants, and anti-seizure medications.
What Is the Correct Dosage of Movicol Choklad?
For chronic constipation in adults: 1 to 3 sachets daily, dissolved in 125 ml of water per sachet. For faecal impaction: 8 sachets dissolved in 1 litre of water, consumed within 6 hours, for up to 3 days. Children aged 12 and over follow adult dosing. Younger children require a paediatric formulation.
Adults
Chronic Constipation – Adults and Adolescents (12+ years)
The usual starting dose is 1 sachet dissolved in 125 ml of water, taken 1 to 3 times daily. Each sachet should be dissolved in a separate glass of 125 ml (approximately half a glass) of water and stirred until completely dissolved.
- Starting dose: 1 sachet daily, usually in the morning
- Adjustment: Increase to 2 or 3 sachets daily if needed, or reduce to 1 sachet on alternate days for milder symptoms
- Maximum dose: 3 sachets per day for chronic constipation
- Duration: The normal course of treatment is 2 weeks, but your doctor may recommend longer treatment
Faecal Impaction – Adults and Adolescents (12+ years)
For the treatment of faecal impaction, a higher dose regimen is required:
- Dose: 8 sachets dissolved in 1 litre of water
- Administration: Drink the entire litre within a 6-hour period
- Duration: Continue for up to 3 consecutive days
- Important: This higher-dose regimen should only be used under medical supervision
Children
Movicol Choklad is not recommended for children under 12 years of age. For paediatric patients, specific formulations are available (such as Movicol Paediatric Plain or Movicol Junior) with age-appropriate dosing. The use of any laxative in children should always be supervised by a healthcare professional, and underlying causes of constipation should be investigated.
For adolescents aged 12 years and older, the adult dosing schedule applies. However, it is advisable to start at the lower end of the dose range (1 sachet daily) and adjust according to response.
Elderly
No dose adjustment is required for elderly patients. The same adult dosing applies. However, elderly patients may be more susceptible to electrolyte disturbances and dehydration, so adequate overall fluid intake should be maintained. Healthcare providers should monitor elderly patients more closely, particularly those with renal impairment or cardiac conditions, when using the higher-dose faecal impaction regimen.
| Patient Group | Indication | Dose | Duration |
|---|---|---|---|
| Adults (18+ years) | Chronic constipation | 1–3 sachets/day in 125 ml water each | Usually 2 weeks; may be extended |
| Adults (18+ years) | Faecal impaction | 8 sachets in 1 litre water within 6 hours | Up to 3 days |
| Adolescents (12–17 years) | Chronic constipation | 1–3 sachets/day in 125 ml water each | Usually 2 weeks; may be extended |
| Elderly | Chronic constipation | 1–3 sachets/day (start low) | As directed; monitor fluid/electrolytes |
| Children (<12 years) | N/A | Use paediatric formulation instead | Consult healthcare provider |
How to Prepare the Solution
To prepare Movicol Choklad for consumption:
- Open one sachet by tearing along the perforated line
- Pour the contents into a glass
- Add 125 ml (approximately half a standard glass) of water
- Stir well until the powder has completely dissolved
- Drink the entire solution
For the faecal impaction regimen, dissolve 8 sachets in 1 litre of water. The prepared solution can be kept covered and refrigerated for up to 6 hours. Discard any unused solution after 6 hours.
Missed Dose
If you forget to take a dose of Movicol Choklad, take it as soon as you remember. If it is almost time for your next dose, simply skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to compensate for a missed one. Movicol works by maintaining water content in the bowel over time, so occasional missed doses will not cause immediate problems, though consistent daily use produces the most reliable results.
Overdose
If an excessive amount of Movicol Choklad is consumed, the most likely effects are severe abdominal pain, abdominal distension, vomiting, and watery diarrhoea. Significant fluid and electrolyte losses through diarrhoea can lead to dehydration, and in severe cases, may cause electrolyte imbalances requiring medical intervention.
If overdose is suspected, stop taking the medicine, ensure adequate fluid intake to replace losses, and contact a healthcare professional or poison control centre. Treatment is supportive and focused on correcting any fluid and electrolyte disturbances.
What Are the Side Effects of Movicol Choklad?
The most common side effects of Movicol Choklad include abdominal pain, bloating, nausea, and diarrhoea. These gastrointestinal symptoms are usually mild and typically resolve as the body adjusts to treatment. Serious side effects are rare but may include severe allergic reactions and significant electrolyte disturbances.
Like all medicines, Movicol Choklad can cause side effects, although not everybody experiences them. Most side effects are gastrointestinal in nature and are related to the osmotic mechanism of action. They tend to occur more frequently at the start of treatment and often diminish with continued use.
The frequency of side effects is classified according to internationally standardised conventions: very common (affects more than 1 in 10 people), common (affects 1 in 10 to 1 in 100 people), uncommon (affects 1 in 100 to 1 in 1,000 people), and rare (affects fewer than 1 in 1,000 people).
Very Common (affects more than 1 in 10 people)
≥ 1/10
- Abdominal pain or discomfort
- Borborygmi (stomach rumbling or gurgling sounds)
Common (affects 1 in 10 to 1 in 100 people)
≥ 1/100 to < 1/10
- Diarrhoea (especially at higher doses or the start of treatment)
- Nausea
- Vomiting
- Abdominal distension (bloating)
- Flatulence
- Anal discomfort
Uncommon (affects 1 in 100 to 1 in 1,000 people)
≥ 1/1,000 to < 1/100
- Electrolyte disturbances (changes in sodium, potassium, or bicarbonate levels)
- Mild dehydration
- Dizziness
- Headache
- Peripheral oedema (swelling of hands or feet)
Rare (affects fewer than 1 in 1,000 people)
< 1/1,000
- Allergic reactions (skin rash, urticaria, itching)
- Anaphylaxis or severe hypersensitivity (extremely rare)
- Dyspnoea (shortness of breath) as part of allergic reaction
- Erythema (skin redness)
Managing Common Side Effects
If you experience abdominal discomfort, bloating, or loose stools when starting Movicol Choklad, consider reducing the dose temporarily. For example, if you are taking 2 sachets daily, reduce to 1 sachet daily until symptoms settle, then gradually increase back to the prescribed dose. These symptoms are typically self-limiting and reflect the increased water content in the bowel as the medicine takes effect.
Diarrhoea can usually be managed by reducing the dose. If diarrhoea is severe or persistent, stop taking the medicine and consult your doctor. Adequate fluid intake is important to replace any fluid losses from diarrhoea.
You should contact your doctor promptly if you experience: severe or persistent diarrhoea, signs of dehydration (dark urine, dry mouth, excessive thirst, feeling faint), signs of allergic reaction (rash, swelling, difficulty breathing), or any new or worsening symptoms that concern you. If you experience signs of a severe allergic reaction, seek emergency medical attention immediately.
How Should You Store Movicol Choklad?
Store Movicol Choklad sachets below 25°C in a dry place. Keep the sachets in the original packaging to protect from moisture. Once dissolved in water, the solution should be consumed immediately or stored covered in a refrigerator and used within 6 hours.
Proper storage of Movicol Choklad is important to ensure the medicine remains effective and safe to use throughout its shelf life. The powder in the sachets is hygroscopic, meaning it readily absorbs moisture from the air, which can affect the quality and dissolution properties of the product.
- Temperature: Store below 25°C (77°F). Do not freeze
- Moisture: Keep sachets in the original packaging until ready to use. Do not store opened sachets
- Prepared solution: Drink immediately after preparation. If refrigerated in a covered container, use within 6 hours. Discard any unused solution after this time
- Shelf life: Do not use after the expiry date printed on the sachet and outer carton
- Children: Keep out of the sight and reach of children
- Disposal: Do not dispose of unused medicines via household waste or wastewater. Return unused sachets to a pharmacy for safe disposal
If you notice that the powder has become clumped, discoloured, or has an unusual odour, do not use it. While minor clumping may occur due to moisture exposure and may not affect efficacy, significant changes in appearance should be discussed with your pharmacist.
What Does Movicol Choklad Contain?
Each Movicol Choklad sachet contains four active ingredients: macrogol 3350 (13.125 g), sodium bicarbonate (178.5 mg), sodium chloride (350.7 mg), and potassium chloride (46.6 mg). Inactive ingredients include chocolate flavouring, acesulfame potassium (sweetener), and cocoa powder.
Active Ingredients
| Ingredient | Amount per Sachet | Function |
|---|---|---|
| Macrogol 3350 | 13.125 g | Primary active ingredient; osmotic agent that retains water in the bowel |
| Sodium bicarbonate | 178.5 mg | Electrolyte; helps maintain acid-base balance |
| Sodium chloride | 350.7 mg | Electrolyte; prevents net sodium loss across intestinal wall |
| Potassium chloride | 46.6 mg | Electrolyte; prevents potassium depletion |
Inactive Ingredients (Excipients)
In addition to the active ingredients, each Movicol Choklad sachet contains the following excipients:
- Chocolate flavouring: Provides the characteristic chocolate taste for improved palatability
- Acesulfame potassium (E950): Artificial sweetener used to improve taste without adding calories
- Cocoa powder: Contributes to the chocolate flavour and colour
When dissolved in 125 ml of water, each sachet provides the following electrolyte concentrations: sodium 65 mmol/L, chloride 53 mmol/L, bicarbonate 17 mmol/L, and potassium 5.4 mmol/L. The total sodium content per sachet is approximately 8.1 mmol (186.2 mg), which should be considered for patients on sodium-restricted diets.
Movicol Choklad contains no gluten, lactose, or gelatin. The chocolate flavouring is artificial and does not contain milk proteins. However, if you have known allergies to any of the listed ingredients, consult your pharmacist before use. Patients with phenylketonuria (PKU) should note that this product does not contain aspartame.
Frequently Asked Questions About Movicol Choklad
Movicol Choklad typically takes 1 to 2 days to produce a bowel movement when used for chronic constipation at the standard dose of 1 to 3 sachets daily. Some patients may experience effects sooner, while others may need up to 3 days of regular use. For the faecal impaction regimen (8 sachets per day), results are often seen within 6 to 12 hours. The speed of onset depends on the severity of constipation and individual bowel response. Consistent daily use provides the most reliable results.
Yes, Movicol Choklad can be taken daily for long-term management of chronic constipation. Unlike stimulant laxatives, macrogol-based products do not cause dependency or reduced bowel function over time. International guidelines including NICE and the BSG recommend macrogol as a first-line treatment that is suitable for extended use. However, the underlying cause of constipation should be investigated, and the need for ongoing treatment should be periodically reviewed by your doctor.
Movicol Choklad is generally considered safe during pregnancy. Macrogol 3350 is not significantly absorbed from the gastrointestinal tract, meaning systemic exposure to the foetus is negligible. Constipation affects up to 40% of pregnant women, and macrogol preparations are listed in the BNF as acceptable during pregnancy. However, it is always recommended to consult your doctor or midwife before taking any medication during pregnancy, particularly during the first trimester.
The only difference between Movicol and Movicol Choklad is the flavour. Both products contain the same active ingredients (macrogol 3350 with electrolytes) at the same concentrations. Movicol Choklad has a chocolate flavour achieved through the addition of chocolate flavouring, cocoa powder, and acesulfame potassium as a sweetener. The medical efficacy, dosing, and safety profile are identical. The chocolate variant was developed to improve palatability and patient compliance.
Movicol Choklad is approved for use in adults and adolescents aged 12 years and older. Children under 12 should use a paediatric-specific formulation such as Movicol Paediatric Plain or Movicol Junior, which have age-appropriate dosing and flavouring. The active ingredient (macrogol 3350) is widely used in paediatric constipation management and is recommended by NICE guidelines for children. However, any laxative use in children should be supervised by a healthcare professional.
Diarrhoea is a common side effect that usually indicates the dose is too high. Reduce your dose – for example, if taking 3 sachets daily, reduce to 2 or 1 sachet. If you are only taking 1 sachet daily, you may try taking it every other day instead. Ensure adequate fluid intake to replace losses. If diarrhoea is severe, persistent, or accompanied by dehydration symptoms (dark urine, dry mouth, dizziness), stop taking the medicine and contact your doctor.
References and Sources
This article is based on the following peer-reviewed sources and international guidelines:
- European Medicines Agency (EMA). Movicol Summary of Product Characteristics (SmPC). Updated 2024.
- National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Constipation. Last revised 2024.
- British Society of Gastroenterology (BSG). Guidelines on the management of functional constipation in adults. Gut. 2023;72(6):1169-1190.
- World Gastroenterology Organisation (WGO). Global Guidelines: Constipation – a global perspective. 2023.
- Dipalma JA, et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. American Journal of Gastroenterology. 2000;95(2):446-450.
- Attar A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut. 1999;44(2):226-230.
- Lee-Robichaud H, et al. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database of Systematic Reviews. 2010;(7):CD007570.
- Belsey JD, et al. Systematic review: impact of lactulose and polyethylene glycol on hospital-related outcomes in constipated patients. Alimentary Pharmacology & Therapeutics. 2010;31(12):1257-1265.
- British National Formulary (BNF). Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride. 2024.
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd List. 2023.
About the Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, a multidisciplinary group of licensed physicians, pharmacists, and medical researchers. Our editorial process follows the GRADE evidence framework, and all content is reviewed against current international guidelines including those from the WHO, EMA, NICE, and BSG.
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This article is reviewed and updated at least every 12 months, or sooner if significant new evidence or regulatory changes emerge.