Excessive use of stimulant laxatives can cause diarrhoea and related effects such as hypokalaemia; risk of electrolyte imbalance with prolonged use (in children).

Bisacodyl

• Gastro-resistant tablets 5mg (£3.74 = 60 tablets) [OTC]
• Suppositories 10mg (£2.99 = 12 suppositories) [OTC]
• Suppositories 5mg (paediatric) (£1.11 = 5 suppositories)

Indications

• Acute obstructed constipation and faecal impaction in adults
• Acute non-obstructed constipation in adults
• Chronic constipation in adults
• Opioid induced constipation in adults
• Constipation in pregnancy (third line)
• Constipation in children
• Faecal impaction in children

Dose

• Adult oral: 5–10mg at night, increased if necessary to maximum 20mg at night according to response
• Adult rectally: 10mg in the morning
• Child (4 years and older) oral: 5–20mg once daily, adjusted according to response
• Child (2 years and older) rectally: 5-10mg once daily, adjusted according to response

Notes

1. Time to effect: 10-12 hours orally, 20-60 minutes rectally
2. The tablets are licensed for use in children aged 4 years and older.
3. The usual maintenance dose is half the disimpaction dose.

Senna

(Sennoside)

• Tablets 7.5mg (£2.42 = 60 tablets) [OTC]
• Oral solution sugar free 7.5mg/5ml (£10.09 = 500ml) [OTC]

Indications

• Acute obstructed constipation and faecal impaction in adults
• Acute non-obstructed constipation in adults
• Chronic constipation in adults
• Opioid induced constipation in adults
• Constipation in pregnancy (third line) (avoid near term or if a history of unstable pregnancy)
• Constipation in children
• Faecal impaction in children

Dose

• Adult: 7.5–15 mg (as tablets or syrup) daily (max. daily dose: 30mg), dose usually taken at bedtime; initial dose should be low then gradually increased
• Child 1 month to 2 years: 3.75mg -15mg syrup once daily
• Child 2–18 years: 3.75mg–30mg syrup or tablets once daily

Notes

1. Do not prescribe the 15mg OTC tablets due to higher acquisition cost
2. Time to effect: 8-12 hours
3. Licensed only for short term use.
4. Efficacy is decreased with continued use
5. Syrup not licensed for use in children under 2 years and tablets not licensed for use in children under 6 years.
6. The usual maintenance dose is half the disimpaction dose.

Docusate sodium

• Capsules 100mg (£2.14 = 30 capsules) [OTC]
• Paediatric oral solution sugar free 12.5mg/5ml (£26.89 = 300ml)
• Oral solution sugar free 50mg/5ml (£16.05 = 300ml) [OTC]
• Enema 120mg/10g (£28.00 = 6 enemas)

Indications

• Acute obstructed constipation and faecal impaction in adults
• Acute non-obstructed constipation in adults
• Chronic constipation in adults
• Opioid induced constipation in adults
• Constipation in pregnancy (third line)
• Faecal impaction in children
• Constipation in children

Dose

• Adult: up to 500mg daily in divided doses, adjusted according to response
• Child 6 months–1 year: 12.5mg three times daily (use paediatric oral solution).
• Child 2–11 years: 12.5–25mg three times daily (use paediatric oral solution)
• Child 12-17 years: Up to 500mg daily in divided doses

Notes

1. Time to effect: 1-2 days
2. Adjust dose according to response
3. Has a relatively weak stimulant effect, but also stool-softening properties.
4. Only the liquid formulation is licensed for use in children younger than 12 years of age.

Glycerol

• Suppositories 4g (£2.03 = 4g x 12 suppositories) [OTC]

Indications

• Acute obstructed constipation and faecal impaction in adults
• Constipation in pregnancy (third line)

Dose

• Insert one suppository when required

Notes

1. Time to effect: 15-30 minutes
2. Lubricating and weak stimulant. Can be used for hard or soft stools.
3. Licensed for occasional use only

Co-danthramer

(Dantron with poloxamer 188)

• Oral suspension sugar free 25mg/200mg/5ml (£245.29 = 300ml)
• Strong oral suspension sugar free 75mg/1000mg/5ml (£503.98 = 300ml)

Indications

• Only for constipation in terminally ill patients

Dose

• Adult
  • 25mg/200mg: 5-10ml at night
  • 75mg/1000mg: 5ml at night

Notes

1. For use in palliative care only
2. Time to effect: 6-12 hours
3. Patients should be warned that it discolours the urine.
4. Prolonged contact with the skin (eg. faecal or urinary incontinence) can cause a dantron burn

Co-danthrusate

(Dantron with docusate sodium)

• Oral suspension sugar free 50mg/60mg/5ml

Indications

• Only for constipation in terminally ill patients

Dose

• Adult
  • 5–15ml at night

Notes

1. For use in palliative care only
2. Time to effect: 6-12 hours
3. Patients should be warned that it discolours the urine.
4. Prolonged contact with the skin (e.g. faecal or urinary incontinence) can cause a dantron burn

Lecicarbon

• Lecicarbon A Suppositories (£8.20 = 10 suppositories) – For use in adults
• Lecicarbon C Suppositories (£8.20 = 10 suppositories) – For use in children

Indication

• Chronic constipation in adults and children

Dose

• Adults (Lecicarbon A) and Children (Lecicarbon C): Insert one suppository when required. If necessary, this can be repeated after 30-60 minutes

Notes

1. Lecicarbon suppositories contain soya lecithin and are contraindicated in patients who have peanut or soya allergies.
2. The routine commissioning of Lecicarbon A suppositories is accepted in Devon for the management of chronic constipation. (see Commissioning Policy for more details).

Sodium picosulfate

• Oral solution sugar free 5mg/5ml (£29.99 = 300ml)

Indications

• Relief of constipation in adults
• Relief of constipation in children

Dose

• Adult: 5–10mg at night
• Child 1 month–4 years: 2.5–10mg once daily, adjusted according to response
• Child 4–18 years: 2.5–20 mg once daily, adjusted according to response

Notes

1. Time to effect: 6-12 hours