Laxatives
Categories:
- Treatment
- Docusate ≥ Bisacodyl ≥ fleet enema?
- Opioid-Induced
- Methylnaltrexone
- Mu opioid receptor (PAM-OR) antagonist
- Methylnaltrexone
- Post-op ileus
- Alvimopan
- Mu opioid receptor (PAM-OR) antagonist
- Quaternary amine unlike methylnaltrexone, peripherally acting
- Alvimopan
- Correct potassium
- Bulk-forming Agents
- MOA: add bulk and water to stools, better for long-term maintenance
- Site: Small and Large intestines
- Onset: 12-72 hours
- Metamucil
- Citrucel
- Wheat Bran
- Flaxseeds
- Psyllium seed husk
- Promotes peristalsis
- Emollient Agents (Stool Softeners)
- MOA: Anionic surfactants that incorporate water and fats into the stool
- Notes: Prevent constipation rather than treating it
- Site: Small and Large intestines
- Onset: 12-72 hours
- Docusate (Colace, Diocto)
- Lubricant Agents
- MOA: Decrease colonic absorption of water, increase weight
- Site: Colon
- Onset: 6-8 hours
- Mineral Oil
- Osmotic Agents
- MOA: cause the intestines to hold more water, stimulates movement
- Site: Colon
- Onset: 12-72 hours oral, 25 mins – 1 hour rectal
- Polyethylene Glycol (Miralax, Colyte, Golytely, Glycolax)
- Used for bowel prep, whole bowel irrigation
- Better than lactulose
- Magnesium Salts (Milk of Magnesia)
- Lactulose
- Osmotic effect, lowers pH, decreases intestinal ammonia absorption
- Sorbitol (Enema)
- Mannitol (Enema)
- Prokinetic Agents
- Prucalopride
- Saline Laxative Agents
- Site: Small and large intesitnes
- Onset: 30mins too 3 hours oral, 2-15 minutes rectal
- Sodium Bisulfate
- Sodium Phosphate
- Magnesium Hydroxide
- Magnesium Sulfate (Epsom Salt)
- Stimulant Agents
- Site: Colon
- Onset: 6-10 hours
- Senna
- Sodium Pocosulfate
- Bisacodyl (Dulcolax)
- SE: Loss of haustral folds with chronic use (melanosis coli)
- Add Osmotic laxative or docusate if not working
- Other
- Castor Oil
- Secretagogues (Chloride Channel Activators)
- Linaclotide
- Plecanatide
- Lubiprostone