Download Drug Table - Constipation

Drugs used to palliate CONSTIPATION
Drug Class
Medications
Mechanism
Indications
Side Effects
Contraindications
Comments
Bulking Agent
Dietary Fiber
Psyllium
Increases stool
weight
Constipation
Flatulence
-Debilitated
-End of life
[Inability to intake
appropriate amount liquid
(1.5-2 liters/day)]
Must have
adequate fluid
intake
Constipation
Bloating
Cramps
Flatulence
Fluid retention in
stool
Osmotic
Laxatives:
Nonabsorbable
sugars
Osmotic
laxatives:
Saline and
Magnesium salts
Osmotic
Laxatives:
Saline and
Magnesium
Salts
Osmotic
Laxatives:
Saline and
Magnesium
Salts
Lactulose
Sorbitol
Magnesium
hydroxide
(Milk of
Magnesia)
Magnesium
Citrate
Sodium
Phosphate
(Fleets
Phosphosoda)
osmotic load
into the colonic
lumen stimulates
movement
osmotic load
into the colonic
lumen stimulates
movement
osmotic load
into the colonic
lumen stimulates
movement
High doses RAPID bowel
evacuation
osmotic load
into the colonic
lumen stimulates
movement
Constipation
Bowel prep
for endoscopy,
surgery
“Miralax”,
Glycolax”
High dose
Colyte
Renal Failure (can cause
hypermagnesemia if used
regularly)
Dehydration
Bowel obstruction
Electrolyte
abnormalities
Fecal impaction
Renal Failure
Very cautious use in CHF
Bowel prep
for colonoscopy,
colon surgery
High doses
RAPID bowel
evacuation
Low dose
Polyethylene
Glycol
Very sweet taste
osmotic load
into the colonic
lumen stimulates
movement
Constipation
osmotic load
Bowel prep for
Dehydration
Electrolyte
abnormalities
Bowel obstruction
Fecal impaction
Renal Failure
Very cautious use in CHF
Require
prescription
Ions can be
partially absorbed
Ions can be
partially absorbed
High doses - Rapid
bowel evacuation
Ischemic colitis –
rare side effect
Can cause acute
phosphate
nephropathy,
intratubular
deposition in
calcium phosphate
Can be given
rectally as an
enema
“taste-less”
no absorption of
ions
1-4 liters of volume
Polyethylene
Glycol
Stimulant
Laxatives
Golytely
Senna
Bisacodyl
into the colonic
lumen stimulates
movement
colonoscopy,
colon surgery
no absorption of
ions
Stimulate
intestinal motility
via
myenteric plexus
Constipation
Surfactant
Prevention of hard
stool
Detergent
“laxative” –
stool softener
Docusate
(colase)
Lubricants
Glycerin
Lubricants
Mineral Oil
Large volume
enemas
Tap water
enema
Administered
rectally:
-Osmotic
-Irritant
-Stimulates rectal
contractions
Administered
rectally:
Coats feces
Softens and
lubricates feces
Increase water
content of stool
Sodium
phosphate
Distend distal
colon
“soap suds” historical
Induce peristalsis
of prep!
Prevention of
constipation with
opiate therapy
Increases
penetration of
fluid into stool
Cramping
Requires
prescription
Melanosis coli with
long-term use
Bisacodyl can be
given rectally in
suppository form
Recent studies
have brought its
utility into question
Fecal Impaction
Fecal Impaction
Fecal impaction
NEVER use oral
mineral oil in
patients at risk of
aspiration – Lipoid
Pneumonitis