Drug Info: L: Laxatives (Oral)

Some commonly used brand names are:

In the U.S.—

In Canada—

• Antacid --Magnesium Hydroxide ; MagnesiumOxide
• Antidiarrheal --Polycarbophil; PsylliumHydrophilic Mucilloid
• Antihyperammonemic --Lactulose
• Antihyperlipidemic --Psyllium HydrophilicMucilloid
• Hydrocholeretic --Dehydrocholic Acid
• Laxative, bulk-forming --Malt SoupExtract; Malt Soup Extract and Psyllium; Methylcellulose;Polycarbophil; Psyllium; Psyllium Hydrophilic Mucilloid;Psyllium Hydrophilic Mucilloid andCarboxymethylcellulose
• Laxative, bulk-forming and stimulant--Psyllium and Senna; Psyllium Hydrophilic Mucilloid andSenna; Psyllium Hydrophilic Mucilloid and Sennosides
• Laxative, carbon dioxide-releasing --Potassium Bitartrate and Sodium Bicarbonate
• Laxative, hyperosmotic --Glycerin;Lactulose; Polyethylene Glycol
• Laxative, hyperosmotic and lubricant--Magnesium Hydroxide and Mineral Oil; Mineral Oil andGlycerin
• Laxative, hyperosmotic and stimulant--Magnesium Hydroxide and Cascara Sagrada
• Laxative, hyperosmotic, saline --MagnesiumCitrate; Magnesium Hydroxide; Magnesium Oxide; MagnesiumSulfate; Sodium Phosphate
• Laxative, lubricant --Mineral Oil
• Laxative, stimulant and stool softener(emollient) -- Bisacodyl and Docusate;Casanthranol and Docusate; Danthron and Docusate;Dehydrocholic Acid and Docusate; Sennosides andDocusate
• Laxative, stimulant or contact--Bisacodyl; Casanthranol; Cascara Sagrada and Bisacodyl ;Cascara Sagrada; Cascara Sagrada and Aloe; Castor Oil;Dehydrocholic Acid; Senna; Sennosides
• Laxative, stool softener (emollient)--Docusate ; Poloxamer 188

Oral laxatives are medicines taken by mouth to encouragebowel movements to relieve constipation.

There are several different types of oral laxatives andthey work in different ways. Since directions for use aredifferent for each type, it is important to know which oneyou are taking. The different types of oral laxativesinclude:

Bulk-formers

Bulk-forming laxatives are not digested but absorb liquidin the intestines and swell to form a soft, bulky stool. Thebowel is then stimulated normally by the presence of thebulky mass. Some bulk-forming laxatives, like psyllium andpolycarbophil, may be prescribed by your doctor to treatdiarrhea.

Hyperosmotics

Hyperosmotic laxatives encourage bowel movements bydrawing water into the bowel from surrounding body tissues.This provides a soft stool mass and increased bowelaction.

There are three types of hyperosmotic laxatives taken bymouth—the saline, the lactulose , and the polymertypes. The saline type is often called ''salts.'' They are usedfor rapid emptying of the lower intestine and bowel. They arenot used for long-term or repeated correction ofconstipation. With smaller doses than those used for thelaxative effect, some saline laxatives are used as antacids.The information that follows applies only to their use aslaxatives. Sodium phosphate may also be prescribed for otherconditions as determined by your doctor.

The lactulose type is a special sugar-like laxative thatworks the same way as the saline type. However, it producesresults much more slowly and is often used for long-termtreatment of chronic constipation. Lactulose may sometimes beused in the treatment of certain medical conditions to reducethe amount of ammonia in the blood. It is available only withyour doctor's prescription.

The polymer typeis a polyglycol (polyethylene glycol), alarge molecule that causes water to be retained in the stool;this will soften the stool and increase the number of bowelmovements. It is used for short periods of time to treatconstipation.

Lubricants

Lubricant laxatives, such as mineral oil, taken by mouthencourage bowel movements by coating the bowel and the stoolmass with a waterproof film. This keeps moisture in thestool. The stool remains soft and its passage is madeeasier.

Stimulants

Stimulant laxatives, also known as contact laxatives,encourage bowel movements by acting on the intestinal wall.They increase the muscle contractions that move along thestool mass. Stimulant laxatives are a popular type oflaxative for self-treatment. However, they also are morelikely to cause side effects. One of the stimulant laxatives,dehydrocholic acid, may also be used for treating certainconditions of the biliary tract.

Stool softeners (emollients)

Stool softeners encourage bowel movements by helpingliquids mix into the stool and prevent dry, hard stoolmasses. This type of laxative has been said not to cause a bowel movement but instead allows the patient to have a bowel movement withoutstraining.

Combinations

There are many products that you can buy for constipationthat contain more than one type of laxative. For example, aproduct may contain both a stool softener and a stimulantlaxative. In general, combination products may be more likelyto cause side effects because of the multiple ingredients. Inaddition, they may not offer any advantage over productscontaining only one type of laxative. If you are taking a combination laxative, make certainyou know the proper use and precautions for each of thedifferent ingredients.

Most laxatives (except saline laxatives) may be used toprovide relief:

• during pregnancy.
• for a few days after giving birth.
• during preparation for examination or surgery.
• for constipation of bedfast patients.
• for constipation caused by other medicines.
• following surgery when straining should beavoided.
• following a period of poor eating habits or a lack ofphysical exercise in order to develop normal bowel function(bulk-forming laxatives only).
• for some medical conditions that may be made worse bystraining, for example:
  • Heart disease
  • Hemorrhoids
  • Hernia (rupture)
  • High blood pressure (hypertension)
  • History of stroke

Saline laxatives have more limited uses and may be used toprovide rapid results:

• during preparation for examination or surgery.
• for elimination of food or drugs from the body in casesof poisoning or overdose.
• for simple constipation that happens on occasion(although another type of laxative may be preferred).
• in supplying a fresh stool sample for diagnosis.

Most laxatives are available without a prescription;however, your doctor may have special instructions for theproper use and dose for your medical condition. They areavailable in the following dosage forms:

• Oral
• • Malt Soup Extract
    • Powder (U.S.)
    • Oral solution (U.S.)
    • Tablets (U.S.)
  • Malt Soup Extract and Psyllium
    • Powder (U.S.)
  • Methylcellulose
    • Capsules (U.S.)
    • Granules (U.S.)
    • Powder (U.S.)
    • Oral solution (U.S.)
    • Tablets (U.S.)
  • Polycarbophil
    • Tablets (U.S.)
    • Chewable tablets (U.S. and Canada)
  • Psyllium
    • Caramels (U.S.)
    • Granules (U.S.)
    • Powder (U.S.)
  • Psyllium Hydrophilic Mucilloid
    • Granules (U.S. and Canada)
    • Powder (U.S. and Canada)
    • Effervescent powder (U.S.)
    • For oral suspension (Canada)
    • Wafers (U.S.)
  • Psyllium Hydrophilic Mucilloid andCarboxymethylcellulose
    • Granules (U.S.)
• • Psyllium and Senna
    • Granules (U.S.)
  • Psyllium Hydrophilic Mucilloid and Senna
    • Granules (Canada)
  • Psyllium Hydrophilic Mucilloid and Sennosides
    • Powder (U.S.)
• • Lactulose
    • Solution (U.S. and Canada)
• • Polyethylene glycol 3350
    • Powder (U.S. and Canada)
• • Magnesium Citrate
    • Oral solution (U.S. and Canada)
  • Magnesium Hydroxide
    • Milk of magnesia (U.S. and Canada)
    • Tablets (U.S. and Canada)
  • Magnesium Oxide
    • Tablets (U.S.)
  • Magnesium Sulfate
    • Crystals (U.S. and Canada)
    • Tablets (U.S.)
  • Sodium Phosphate
    • Effervescent powder (U.S.)
    • Oral solution (U.S. and Canada)
• • Milk of Magnesia and Mineral Oil
    • Emulsion (U.S. and Canada)
  • Mineral Oil and Glycerin
    • Emulsion (Canada)
• • Milk of Magnesia and Cascara Sagrada
    • Oral Suspension (U.S.)
• • Mineral Oil
    • Oil (U.S. and Canada)
    • Emulsion (U.S. and Canada)
    • Gel (Canada)
    • Oral suspension (U.S.)
• • Bisacodyl
    • Tablets (U.S. and Canada)
  • Casanthranol
    • Syrup (U.S.)
  • Cascara Sagrada
    • Fluidextract (U.S. and Canada)
    • Tablets (U.S. and Canada)
  • Cascara Sagrada and Aloe
    • Tablets (U.S. and Canada)
  • Cascara Sagrada and Bisacodyl
    • Tablets (U.S. and Canada)
  • Castor Oil
    • Oil (U.S. and Canada)
    • Emulsion (U.S.)
  • Dehydrocholic Acid
    • Tablets (U.S.)
  • Senna
    • Granules (U.S.)
    • Oral solution (U.S. and Canada)
    • For oral solution (U.S.)
    • Syrup (U.S.)
    • Tablets (U.S. and Canada)
  • Sennosides
    • Granules (U.S. and Canada)
    • Oral solution (Canada)
    • Syrup (U.S. and Canada)
    • Tablets (U.S. and Canada)
• • Bisacodyl and Docusate
    • Tablets (Canada)
  • Casanthranol and Docusate
    • Capsules (U.S. and Canada)
    • Syrup (U.S.)
    • Tablets (U.S.)
  • Danthron and Docusate
    • Capsules (Canada)
    • Tablets (Canada)
  • Dehydrocholic Acid and Docusate
    • Capsules (U.S.)
    • Tablets (U.S.)
  • Sennosides and Docusate
    • Tablets (U.S. and Canada)
• • Docusate
    • Capsules (U.S. and Canada)
    • Oral solution (U.S. and Canada)
    • Syrup (U.S. and Canada)
    • Tablets (U.S.)
  • Poloxamer 188
    • Capsules (U.S.)

Importance of diet, fluids, and exercise to preventconstipation

Laxatives are to be used to provide short-term reliefonly, unless otherwise directed by a doctor. A proper dietcontaining roughage (whole grain breads and cereals, bran,fruit, and green, leafy vegetables), with 6 to 8 full glasses(8 ounces each) of liquids each day, and daily exercise aremost important in maintaining healthy bowel function. Also,for individuals who have problems with constipation, foodssuch as pastries, puddings, sugar, candy, cake, and cheesemay make the constipation worse.

If you are taking this medicine without a prescription,carefully read and follow any precautions on the label. Fororal laxatives, the following should be considered:

Allergies—Tell your doctor if you haveever had any unusual or allergic reaction to laxatives. Alsotell your health care professional if you are allergic to anyother substances, such as foods, preservatives, or dyes.

Diet—Make certain your health careprofessional knows if you are on any special diet, such as alow-sodium or low-sugar diet. Some laxatives have largeamounts of sodium or sugars in them.

Pregnancy—Although laxatives are oftenused during pregnancy, some types are better than others.Stool softeners (emollient) laxatives and bulk-forminglaxatives are probably used most often. If you are using alaxative during pregnancy, remember that:

• Some laxatives (in particular, the bulk-formers)contain a large amount of sodium or sugars, which may havepossible unwanted effects such as increasing blood pressureor causing water to be held in the body.
• Saline laxatives containing magnesium, potassium, orphosphates may have to be avoided if your kidney functionis not normal.
• Mineral oil is usually not used during pregnancybecause of possible unwanted effects on the mother orinfant. Mineral oil may interfere with the absorption ofnutrients and vitamins in the mother. Also, if taken for along time during pregnancy, mineral oil may cause severebleeding in the newborn infant.
• Stimulant laxatives may cause unwanted effects in theexpectant mother if improperly used. Castor oil inparticular should not be used as it may cause contractionsof the womb.

Breast-feeding—Laxatives containingcascara and danthron may pass into the breast milk. Althoughthe amount of laxative in the milk is generally thought to betoo small to cause problems in the baby, your doctor shouldbe told if you plan to use such laxatives. Some reports claimthat diarrhea has been caused in the infant.

Children—Laxatives should not be given to young children (up to 6years of age) unless prescribed by their doctor . Sincechildren usually cannot describe their symptoms very well,they should be checked by a doctor before being given alaxative. The child may have a condition that needs othertreatment. If so, laxatives will not help, and may even causeunwanted effects or make the condition worse.

Mineral oil should not be given to young children (up to 6years of age) because a form of pneumonia may be caused bythe inhalation of oil droplets into the lungs.

Also, bisacodyl tablets should not be given to children upto 6 years of age because if chewed they may cause stomachirritation.

Older adults—Mineral oil should not betaken by bedridden elderly persons because a form ofpneumonia may be caused by the inhalation of oil dropletsinto the lungs. Also, stimulant laxatives (e.g., bisacodyl orcasanthranol), if taken too often, may worsen weakness, lackof coordination, or dizziness and light-headedness.

Polyethylene glycol 3350 should be discontinued ifdiarrhea occurs, especially in elderly persons in nursinghomes.

Other medicines—Although certainmedicines should not be used together at all, in other casestwo different medicines may be used together even if aninteraction might occur. In these cases, your doctor may wantto change the dose, or other precautions may be necessary.When you are taking oral laxatives, it is especiallyimportant that your health care professional know if you aretaking any of the following:

• Anticoagulants, oral (blood thinners you take by mouth)or
• Digitalis glycosides (heart medicine)—The use ofmagnesium-containing laxatives may reduce the effects ofthese medicines

• Ciprofloxacin (e.g., Cipro) or
• Etidronate (e.g., Didronel) or
• Sodium polystyrene sulfonate—Use ofmagnesium-containing laxatives will keep these medicinesfrom working

• Tetracyclines taken by mouth (medicine forinfection)—Use of bulk-forming ormagnesium-containing laxatives will keep the tetracyclinemedicine from working

• Appendicitis (or signs of) or
• Rectal bleeding of unknown cause—These conditionsneed immediate attention by a doctor

• Colostomy or
• Intestinal blockage or
• Ileostomy—The use of laxatives may create otherproblems if these conditions are present

• Diabetes mellitus (sugar diabetes)—Diabeticpatients should be careful since some laxatives contain largeamounts of sugars, such as dextrose, galactose, and/orsucrose

• Heart disease or
• High blood pressure—Some laxatives contain largeamounts of sodium, which may make these conditions worse

• Kidney disease—Magnesium and potassium (containedin some laxatives) may build up in the body if kidney diseaseis present; a serious condition may develop

• Swallowing difficulty—Mineral oil should not beused since it may get into the lungs by accident and causepneumonia; also, bulk-forming laxatives may get lodged in theesophagus of patients who have difficulty in swallowing

For safe and effective use of your laxative:

• Follow your doctor's instructions if this laxative wasprescribed.
• Follow the manufacturer's package directions if you aretreating yourself.

With all kinds of laxatives, at least 6 to 8 glasses (8ounces each) of liquids should be taken each day. This willhelp make the stool softer.

For patients taking laxatives containing a bulk-formingingredient:

• Do not try to swallow in the dry form. Take withliquid.
• To allow bulk-forming laxatives to work properly and toprevent intestinal blockage, it is necessary to drinkplenty of fluids during their use. Each dose should betaken in or with a full glass (8 ounces) or more of coldwater or fruit juice. This will provide enough liquid forthe laxative to work properly. A second glass of water orjuice by itself is often recommended with each dose forbest effect and to avoid side effects.
• When taking a product that contains only a bulk-formingingredient, results often may be obtained in 12 hours.However, this may not occur for some individuals untilafter 2 or 3 days.

For patients taking laxatives containing a stool softener(emollient):

• Liquid forms may be taken in milk or fruit juice toimprove flavor.
• When taking a product that contains only a stoolsoftener, results usually occur 1 to 2 days after the firstdose. However, this may not occur for some individualsuntil after 3 to 5 days.

For patients taking laxatives containing a hyperosmoticingredient:

• Each dose should be taken in or with a full glass (8ounces) or more of cold water or fruit juice. This willprovide enough liquid for the laxative to work properly. Asecond glass of water or juice by itself is oftenrecommended with each dose for best effect and, in the caseof saline laxatives, to prevent you from becomingdehydrated.
• The unpleasant taste produced by some hyperosmoticlaxatives may be improved by following each dose withcitrus fruit juice or citrus-flavored carbonatedbeverage.
• Lactulose may not produce laxative results for 24 to 48hours.
• Polyethylene glycol may not produce laxative resultsfor 2 to 4 days.
• Saline laxatives usually produce results within ½to 3 hours following a dose. When a larger dose is taken onan empty stomach, the results are quicker. When a smallerdose is taken with food, the results are delayed.Therefore, large doses of saline laxatives are usually nottaken late in the day on an empty stomach.

For patients taking laxatives containing mineral oil:

• Mineral oil should not be taken within 2 hours of mealsbecause of possible interference with food digestion andabsorption of nutrients and vitamins.
• Mineral oil is usually taken at bedtime (but not whilelying down) for convenience and because it requires about 6to 8 hours to produce results.

For patients taking laxatives containing a stimulantingredient:

• Stimulant laxatives are usually taken on an emptystomach for rapid effect. Results are slowed if taken withfood.
• Many stimulant laxatives (but not castor oil) are oftentaken at bedtime to produce results the next morning(although some may require 24 hours or more).
• Castor oil is not usually taken late in the daybecause its results occur within 2 to 6 hours.
• The unpleasant taste of castor oil may be improved by chilling in therefrigerator for at least an hour and then stirring thedose into a full glass of cold orange juice just before itis taken. Also, flavored preparations of castor oil areavailable.
• Bisacodyl tablets are specially coated to allow themto work properly without causing irritation and/or nausea.To protect this coating, do not chew, crush, or take thetablets within an hour of milk or antacids.

Dosing—

There are a large number of laxative products on themarket. The dose of laxatives will be different for differentproducts. The number of capsules or tablets or teaspoonfulsof crystals, gel, granules, liquid, or powder that you use;the number of caramels or wafers that you eat; or the numberof pieces of gum that you chew depends on the strength of themedicine. Follow your doctor's orders if this medicine wasprescribed, or follow the directions on the box if you arebuying this medicine without a prescription.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the capsule, tablet, granules, or powderform of this medicine in the bathroom, near the kitchensink, or in other damp places. Heat or moisture may causethe medicine to break down.
• Keep the liquid form of this medicine fromfreezing.
• Do not keep outdated medicine or medicine no longerneeded. Be sure that any discarded medicine is out of thereach of children.

Do not take any type of laxative:

• if you have signs of appendicitis or inflamed bowel(such as stomach or lower abdominal pain, cramping,bloating, soreness, nausea, or vomiting). Instead, checkwith your doctor as soon as possible.
• for more than 1 week unless your doctor hasprescribed or ordered a special schedule for you. This istrue even when you have had no results from thelaxative.
• within 2 hours of taking other medicine because thedesired effect of the other medicine may be reduced.
• if you do not need it, as for the common cold, ''toclean out your system'' or as a ''tonic to make you feelbetter.''
• if you miss a bowel movement for a day or two .
• if you develop a skin rash while taking a laxativeor if you had a rash the last time you took it. Instead,check with your doctor.

If you notice a sudden change in bowel habits or functionthat lasts longer than 2 weeks, or that keeps returningoff and on, check with your doctor before using a laxative.This will allow the cause of your problem to be determinedbefore it may become more serious.

The ''laxative habit''—Laxative products areoverused by many people. Such a practice often leads todependence on the laxative action to produce a bowelmovement. In severe cases, overuse of some laxatives hascaused damage to the nerves, muscles, and tissues of theintestines and bowel. If you have any questions about the useof laxatives, check with your health care professional.

Many laxatives often contain large amounts of sugars,carbohydrates, and sodium. If you are on a low-sugar,low-caloric, or low-sodium diet, check with your health careprofessional before using a laxative.

For patients taking laxatives containing mineral oil:

• Mineral oil should not be taken often or for longperiods of time because:
  • gradual build-up in body tissues may createadditional problems.
  • the use of mineral oil may interfere with the body'sability to absorb certain food nutrients and vitamins A,D, E, and K.
• Large doses of mineral oil may cause some leakage fromthe rectum. The use of absorbent pads or a decrease in dosemay be necessary to prevent the soiling of clothing.
• Do not take mineral oil within 2 hours of a stoolsoftener (emollient laxative). The stool softener mayincrease the amount of mineral oil absorbed.

For patients taking laxatives containing a stimulantingredient:

• Stimulant laxatives are most often associated with:
  • overuse and the laxative habit.
  • skin rashes.
  • intestinal cramping after dosing (especially if takenon an empty stomach).
  • potassium loss.

Along with its needed effects, a medicine may cause someunwanted effects. Although not all of these side effects mayoccur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of thefollowing side effects occur:

• For bulk-forming-containing
  • Difficulty in breathing; intestinal blockage; skinrash or itching; swallowing difficulty (feeling of lumpin throat)
  
  

• For hyperosmotic-containing
  • Confusion; dizziness or light-headedness ;irregular heartbeat; muscle cramps; unusual tirednessor weakness
  
  

• For stimulant-containing
  • Confusion; irregular heartbeat; muscle cramps; pinkto red, red to violet, or red to brown coloration ofalkaline urine (for cascara, danthron, and/or sennaonly); skin rash; unusual tiredness or weakness; yellowto brown coloration of acid urine (for cascara, and/orsenna only)
  
  

• For stool softener (emollient)-containing
  • Skin rash
  
  

Other side effects may occur that usually do not needmedical attention. These side effects are less common and maygo away during treatment as your body adjusts to themedicine. However, check with your doctor if any of thefollowing side effects continue or are bothersome:

• For hyperosmotic-containing
  • Bloating; cramping; diarrhea; nausea; gas;increased thirst
  
  

• For lubricant-containing
  • Skin irritation surrounding rectal area
  
  

• For stimulant-containing
  • Belching; cramping; diarrhea; nausea
  
  

• For stool softener (emollient)-containing
  • Stomach and/or intestinal cramping; throatirritation (liquid forms only)
  
  

Other side effects not listed above may also occur in somepatients. If you notice any other effects, check with yourdoctor.

Once a medicine has been approved for marketing for acertain use, experience may show that it is also useful forother medical problems. Although this use is not included inproduct labeling, psyllium hydrophilic mucilloid is used incertain patients with high cholesterol(hypercholesterolemia).

For patients taking psyllium hydrophilic mucilloid for high cholesterol:

• Importance of diet—Before prescribing medicinefor your condition, your doctor will probably try tocontrol your condition by prescribing a personal diet foryou. Such a diet may be low in fats, sugars, and/orcholesterol. Many people are able to control theircondition by carefully following their doctor's orders forproper diet and exercise. Medicine is prescribed only whenadditional help is needed. Follow carefully the special diet your doctor gaveyou, since the medicine is effective only when aschedule of diet and exercise is properly followed.
• Do not try to swallow the powder form of this medicinein the dry form. Mix with liquid following the directionsin the package.
• Remember that this medicine will not cure yourcholesterol problem but it will help control it. Therefore,you must continue to take it as directed by your doctor ifyou expect to lower your cholesterol level.

Other than the above information, there is no additionalinformation relating to proper use, precautions, or sideeffects for this use.