1.6.4 Osmotic 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

Macrogol oral powder, compound
  • CosmoCol® oral powder, sachets (un-flavoured, orange, orange lemon & lime) (£7.37 = one twice daily)
  • CosmoCol® Paediatric sachets (£5.58 = one twice daily)
  • CosmoCol® Half sachets (£5.58 = one twice daily)
  • Laxido® orange oral powder, sachets (£7.37 = one twice daily)
  • Movicol® – Half sachets (£9.91 = one twice daily)
  • Movicol® Paediatric sachets (£8.18 = one twice daily)

Indication

Dose

  • Chronic constipation, adult and child over 12 years: 1–3 sachets daily in divided doses usually for up to 2 weeks; maintenance, 1–2 sachets daily
  • Faecal impaction, adult and child over 12 years: 4 sachets on first day, then increased in steps of 2 sachets daily to maximum 8 sachets daily

Notes

  1. Prescribe by brand to maintain continuity and avoid confusion
  2. Caution: may cause electrolyte disturbances
  3. Caution in elderly and fluid restricted patients
  4. Time to effect: 2-3 days
  5. Some patients find it difficult to drink the prescribed volume
  6. Courses should not normally exceed 2 weeks
Lactulose
  • Solution (£2.32 = 500ml)

Indication

Dose

  • Initially 15ml twice daily, adjusted according to response (doses used in hepatic encephalopathy are generally much higher)

Notes

  1. Lactulose takes up to 48 hours to work but is often inappropriately used "when required". Some patients find it unpleasant to take and compliance may be a problem. Its main clinical benefit is in the management of hepatic encephalopathy
  2. Fluid needs to be increased whilst taking lactulose
Sodium Citrate
  • Micro-enema 450mg/5ml (£0.43 = 5ml enema)

Indication

Dose

  • 5ml dose

Notes

  • Time to effect: 5-15 minutes
  • Advantages: rapid effect. Smaller volume than a phosphate enema. Useful to remove hard, impacted stools
  • Disadvantages: licensed for occasional use only, Correct administration important to prevent damage to rectal mucosa
Phosphate (rectal)
  • Enema 128ml - standard length (£3.98 per enema)

Indication

Dose

  • 128ml dose

Notes

  1. Cautions elderly and debilitated; with enema, electrolyte disturbances, congestive heart failure, ascites, uncontrolled hypertension, maintain adequate hydration
  2. Contra-indications acute gastro-intestinal conditions (including gastro-intestinal obstruction, inflammatory bowel disease, and conditions associated with increased colonic absorption)
  3. Conditions pre-disposing the patient to retention of the enema can make the use of the product hazardous
Magnesium Hydroxide
  • Suspension (£3.22 = 200ml)

Indication

Dose

  • 30-45ml at bedtime mixed with water

 

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