measures. It may take 72 hours before laxative effect is seen. Laxative class Generic name (Brand name) Mechanism and expected onset of action Administration & Safety considerations Stool softeners Docusate sodium (Coloxyl®) Act as surfactants resulting in an increased penetration of fluid into the stool. 24 – 72 hours onset Adverse effects: Infrequent Abdominal discomfort, colic, cramps. Often combined with a stimulant laxative for opioids-induced constipation. There is limited evidence of effectiveness when used alone. Stimulant Senna (Senokot®) Direct stimulation of sensory nerve endings in colonic mucosa resulting in increased motility. 6 – 12 hours onset Adverse effects: Infrequent Abdominal pain, nausea, vomiting, dizziness. Bisacodyl (Lax-tab®, Dulcolax®) Stool softener + Stimulant Docusate + senna (Laxsol®) See above See above Osmotic Lactulose syrup (Laevolac®) A non-absorbable disaccharide that is broken down by colonic bacteria. The Adverse effects: Common Flatulence, bloating Contraindicated in intestinal or Document No: MDHB-7120 Page 5 of 7 Version: 1 /var/filecabinet/temp/converter_assets/9d/10/9d1028f32e6c5d80f281c0cd4707b89005ac57ec.doc Printed
Guideline for Management and Prevention of Opioid Related Constipation metabolites exert an osmotic effect in the colon, resulting in distention and stimulates peristalsis. 24 – 72 hours onset. Needs to be charted regular for maximal effect. bowel obstruction. Take each dose with a large glass of water. Requires adequate fluid to exert its pharmacological action. Avoid if poor fluid intake. Less effective in opioid-induced constipation, however this may be considered for constipation of other causes. Macrogol 3350 (Lax-Sachet®, Movicol®) A large polymer that exerts iso-osmotic activity with respect to normal intestinal contents, thus retaining water in the gut. 0.5 – 3 hours onset Adverse effects: Common Abdominal distension and pain, nausea, flatulence Fluid and electrolyte disturbances may occur, monitor accordingly. Use with caution in patients with congestive heart failure and renal impairment. **Restricted medication on PHARMAC Hospital Medicines List** Refer to prescribing criteria on PHARMAC website . Requires Special Authority number for full subsidy in the community. Rectal Laxatives Laxative class Generic name (Brand name) Mechanism and expected onset of action Administration & Safety considerations Osmotic Glycerol suppository A non-absorbable sugar, draws water into the stool. It has lubricating effects as well as stimulant effects due to its local irritant effects.
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- Fall '16
- Jeff Miller