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1.6 Laxatives

1.6.1 Bulk Forming Agents

Ispaghula husk (as "Fybogel sachets")

 

1.6.2 Stimulant Laxatives   

Docusate capsules, solution               
Glycerin suppositories (Adult)                                               
Senna tablets, syrup                                                         
Bisacodyl tablets, suppositories
Sodium picosulfate elixir
Co-danthramer capsules, suspension, Forte suspension
Co-danthrusate capsules, suspension

Notes:

1. Dantron-containing laxatives have a limited indication because rodent studies indicate a potential carcinogenic risk.

2. Co-danthramer and Co-danthrusate should only be used in the terminally ill. They are relatively expensive preparations.

 

1.6.4 Osmotic Laxatives

Lactulose syrup
Sodium citrate micro enemas
Phosphate enemas
Macrogols

Third line in adults (see Lavative Guidelines). Also in children (Movicol Paediatric plain) for use in faecal impaction or resistant constipation in children.

Notes:

1. Lactulose is not suitable for rapid relief of constipation, or for 'as required' dosing. It can be up to three days before an effect is seen. Regular dosing of these drugs is required for full effect.

2.  Following a number of case reports two, sodium citrate enemas should be administered before usingnphosphate enema's.

3.  Phosphate enemas should be administered with caution to patients with renal impairment.

4. Arachis oil should be used with caution due to peanut allergy

 

1.6.5    Bowel Cleansing Solutions (endoscopy use only)

1st choice: Moviprep
2nd choice: Klean-Prep
3rd choice: Sodium picosulfate (as "Picolax") sachets.

Link to Bowel Cleansing Solutions Order Form

Link to Guidelines for use of Oral Bowel Cleansing Agents

 

1.6.6 Peripheral opioid-receptor antagonists

Methylnaltrexone injection

For opioid-induced constipation in palliative care patients resistant to standard laxatives - after palliative care recommendation only

 

1.6.7 5HT4-receptor agonists

Lubiprostone capsules. For chronic idiopathic constipation (see NICE TA 318). Specialist initiation only.
Prucalopride tablets. For chronic constipation in women (see NICE TA 211). Specialist initiation only.

Click here for the JAPC Algorithm For The Treatment of Refractory Symptomatic Chronic Constipation in Men and Women (NICE TA211 & TA318)

Linaclotide capsules  - [RED DRUG]  symptomatic treatment of moderate to severe irritable bowel syndrome with constipation (IBS-C). Click here for patient pathway.
Naloxegol  (RED drug) -  For opioid induced constipation – see NICE TA 345

 Link to BNF section: 1.6 Laxatives