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 a day)
  • CosmoCol® Paediatric sachets (£2.79 = one twice daily)
  • CosmoCol® Half sachets (£2.79 = one twice daily)
  • Laxido® orange oral powder, sachets (£7.97 = one twice daily)
  • Movicol® – Half sachets (£9.45 = one twice daily)
  • Movicol® Paediatric sachets (£8.18 = one twice daily)

Indications

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. Macrogol preparations should be reserved only for patients where other treatments have been ineffective.
  2. Caution: may cause electrolyte disturbances. There is currently insufficient evidence to support its routine use before well-established, less expensive drugs.
  3. Due to the different preparations of macrogol '3350' we recommend that the products are prescribed by brand to avoid any confusion.
Lactulose
  • Solution (£2.47 = 500ml)

Indications

Dose

  • Initially 15ml twice daily, adjusted according to response

Notes

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

Indications

Dose

  • 5ml dose
Phosphate (rectal)
  • Enema 128ml (£3.98 per enema)

Indications

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)

Indications

 

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