1.6.2 Stimulant laxatives

Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet

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

Bisacodyl
  • Tablets 5mg (£6.19 = 60 tabs)
  • Suppositories 10mg (£3.53 = 12 supps)
  • Suppositories 5mg (paed) (£1.04 = 5 supps)

Indications

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
  • Tablets 7.5mg sennosides (£1.89 = 60 tabs)
  • Syrup 7.5mg sennosides in 5ml (£4.76 = 500ml)

Indications

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 (£2.09 = 30 caps)
  • Paediatric oral solution 12.5mg/5ml (£8.38 = 300ml)
  • Oral solution 50mg/5ml (£8.60 = 300ml)
  • Enema 120mg in 10g (£28 = 6 enemas)

Indications

Dose

  • Adult: up to 500mg daily in divided doses, adjusted according to response
  • Child 6 months–1 year: 12.5mg 3 times daily (use paediatric oral solution).
  • Child 2–11 years: 12.5–25mg 3 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 (£1.16 = 4g x 12 pack)

Indications

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)

  • Suspension 25mg/200mg in 5ml SF (£169.24 = 300ml)
  • Strong suspension 75mg/1000mg in 5ml SF (£337.65 = 300ml)

Indications

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)

  • Suspension 50mg/60mg in 5ml SF (£154.40 = 200ml)

Indications

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

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 for the management of chronic constipation has been accepted in Devon (see Commissioning Policy for more details).
Sodium Picosulfate
  • Elixir 5mg/5ml SF (£7.10 = 300ml)

Indications

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

 

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