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.

Most terminally ill patients require both a softening agent and a stimulant laxative, for example, co-danthrusate (or a cheaper alternative, such as lactulose, may suffice) + senna.

Bisacodyl
  • Tablets 5mg (£1.81 = 10mg daily)
  • Suppositories 5mg (paed) (£5.82 = 5mg daily)
  • Suppositories 10mg (£8.24 = 10mg daily)

Indications

Dose

  • Adult oral: 5–10mg at night, increased if necessary to maximum 20mg at night
  • Child oral: 4–18 years 5–20mg once daily, adjusted according to response
  • Adult rectally: 10mg in the morning
  • Child rectally: 5–10mg once daily, adjusted according to response
Senna
  • Tablets 7.5mg sennosides (£2.78 = 15mg daily)
  • Syrup 7.5mg sennosides in 5ml (£2.23 = 15mg daily)

Indications

Dose

  • 2–4 tablets or 10-20ml, usually at night; initial dose should be low then gradually increased
Docusate sodium
  • Capsules 100mg (£7.80 = 200mg twice daily)
  • Paediatric oral solution 12.5mg/5ml (£7.41 = 12.5mg three times daily)
  • Oral solution 50mg/5ml (£20.50 = 200mg twice daily)
  • Enema 120mg in 10g (£4.67 each)

Indications

Dose

  • Chronic constipation, up to 500mg daily in divided doses;
  • Child 6 months–2 years 12.5mg 3 times daily; 2–12 years 12.5–25mg 3 times daily. Adjusted according to response (use paediatric oral solution)

Notes

  1. The action of docusate is to draw water into the bowel, which softens the stools, making them easier to pass.
Glycerol
  • Suppositories 1g, 2g, 4g (£1.15 = 4g x 12 pack)

Indications

Dose

  • 1 suppository when required
Co-danthramer
  • Suspension 25/200 in 5ml (£146.39 = 300ml)
  • Strong suspension 75/1000 in 5ml (£293.62 = 300ml)

Indications

Dose

  • 5–10ml at night 25/200; 5ml at night 75/1000

Note

  1. For use in palliative care only
Co-danthrusate
  • Capsules 50/60 (£52.50 = 63 capsules)
  • Suspension 50/60 in 5ml (£89.92 = 200ml)

Indications

Dose

  • 1–3 capsules at night; child 6–12 years 1 capsule at night
  • 5–15mL at night; child 6–12 years 5mL at night

Note

  1. For use in palliative care only
Lecicarbon A
  • Suppositories (£8.20 = 10 suppositories)

Indication

  • Chronic constipation

Dose

  • Insert one suppository when required. If necessary, this can be repeated after 30-60 minutes.

Notes

  1. Lecicarbon A 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 (£6.63 = 10mg daily)

Indications

Dose

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

 

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