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Macrogol is an osmotic laxative that binds water in the bowel and thereby softens the stool. It is considered gentle and suitable for longer-term use, during pregnancy and in children – provided it is prepared correctly and taken with enough fluid.
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If constipation persists for several days despite macrogol, or if severe abdominal pain and vomiting develop, have it checked by a doctor rather than repeatedly increasing the dose on your own. Macrogol (also called polyethylene glycol, PEG) is an osmotic laxative for constipation. It is dissolved in water and drunk, binds fluid in the bowel and softens the stool – without irritating the bowel. This is why macrogol is considered well tolerated and also suitable for longer-term use.
| Property | Details |
|---|---|
| Active ingredient | Macrogol (polyethylene glycol, PEG 3350/4000) |
| Brand name | Movicol®, Laxofalk® |
| ATC code | A06AD15 |
| Drug class | Osmotic laxative |
| Form | Powder in sachets, also as an oral solution |
| Intake | Dissolve in water and drink |
| Standard dose | 1–3 sachets daily (adults) |
| Onset of effect | Usually after 1–3 days |
| Prescription required | No – available over the counter at the pharmacy |
Macrogol is a large, water-soluble molecule that the body barely absorbs. It passes through the bowel almost unchanged and acts purely physically: through osmosis it binds water and holds it in the bowel. As a result, more fluid stays in the stool – it becomes softer, the stool volume increases, and the natural bowel movement is gently stimulated.
This is precisely what sets it apart from stimulant laxatives such as Bisacodyl or Sodium picosulfate: these irritate the bowel wall and force a movement. Macrogol, by contrast, does not interfere with the bowel nerves but works only with water. This makes it particularly gentle – including in the treatment of constipation associated with irritable bowel syndrome or recurring symptoms of diverticular disease. Because the bound water is excreted with the stool, it is important to drink enough additional fluid when taking macrogol.
Each sachet is fully dissolved in about 125 ml of water and drunk – do not swallow the powder dry. The dose depends on how pronounced the constipation is. For acute constipation, 1–3 sachets per day are usually common; for stubborn constipation (faecal impaction), more may be taken short-term under medical instruction.
| Situation | Dose |
|---|---|
| Adults, normal constipation | 1–3 sachets/day |
| Maintenance dose | 1–2 sachets/day |
| Children (depending on age/product) | As directed by a doctor |
| Stubborn constipation (faecal impaction) | Higher dose, only under medical supervision |
If you have forgotten a dose, simply take it later or carry on normally the next day – there is no need to double up. What generally applies to forgotten doses is explained in the guide Forgotten medication. Accompanying flatulence at the start is normal and usually subsides after a few days.
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Laxatives work in very different ways. For everyday use, what matters most is how gentle an agent is and whether it is suitable for longer-term use. Macrogol works purely osmotically with water, whereas stimulant agents actively stimulate the bowel wall.
| Property | Macrogol | Stimulant laxatives | Lactulose |
|---|---|---|---|
| Mechanism | Osmosis (binds water) | Irritates the bowel wall | Osmotic, broken down by bacteria |
| Examples | Movicol®, Laxofalk® | Bisacodyl, Sodium picosulfate | Lactulose syrup |
| Onset of effect | 1–3 days | 6–12 hours | 1–2 days |
| Flatulence | Rather low | Possible, cramps | More frequent |
| For longer-term use | Yes, well suited | Short-term only | Yes |
A common misunderstanding: macrogol is not a remedy for diarrhoea but for constipation. For diarrhoea, Loperamide is used instead. Which laxative is right in an individual case depends on the cause, accompanying conditions and tolerability.
Macrogol is well tolerated because the body does not absorb it. The most common complaints affect the gastrointestinal tract and are usually mild – especially at the start of treatment.
| Side effect | Frequency | What to do? |
|---|---|---|
| Flatulence, bowel sounds | Common | Usually harmless, often subsides after a few days |
| Soft stool to diarrhoea | Common | Reduce the dose |
| Mild abdominal pain, nausea | Occasional | Adjust the dose; if it increases, have it checked |
| Allergic reaction (rash, swelling) | Rare | Stop and consult a doctor |
Because macrogol does not pass into the blood, it has only few interactions. What is mainly relevant is that a faster stool transit can affect the absorption of other medicines. Check your combinations in the interaction check.
| Substance / medicine | Interaction | Recommendation |
|---|---|---|
| Thyroid hormones (Levothyroxine) | Absorption may decrease | Keep a time interval |
| Heart medicines (e.g. Digoxin) | Blood levels may change | Consult your practice |
| Antiepileptics | Absorption may decrease | Take separately |
| Other laxatives | Increased effect, more diarrhoea | Do not combine unnecessarily |
Macrogol is regarded as one of the laxatives of choice in special situations. During pregnancy and breastfeeding it is used preferentially because it is not absorbed into the body and therefore does not reach the child. In children too, macrogol – at an age-appropriate dose – is a frequently recommended remedy for constipation.
Macrogol is well suited for longer-term use: unlike stimulant laxatives, there is no risk of a habituation effect in the sense of a "sluggish bowel". Nonetheless, the following applies: if constipation persists over the long term, the cause should be clarified by a doctor rather than merely masked with rising doses. Drinking enough fluid, exercise and a fibre-rich diet help alongside.
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