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Osmotic LaxativeAka: Osmotic Cathartic, Sorbitol, Fleets Enema, Fleet Enema, Phospho-Soda, Magnesium Hydroxide, Milk of Magnesia, Magnesium Citrate, Polyethylene glycol, PEG, Miralax

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  1. See Also
    1. Laxative
    2. Constipation
    3. Functional Constipation
    4. Pediatric Constipation
  2. Mechanism
    1. Poorly absorbed, they act as hyperosmolar agents
    2. Stimulate colonic activity (via cholecystokinin)
  3. Complications
    1. Hypermagnesemia (in patients with Renal Failure)
    2. Hypocalcemia (phosphate overdose)
  4. Contraindications
    1. Renal Failure (except Lactulose and Sorbitol)
  5. Preparations: Poorly-absorbed sugars (may be used in Renal Failure)
    1. Lactulose (Chronulac)
      1. Easier to administer to young children
      2. May cause abdominal cramping and flatus
      3. More expensive then sorbitol ($10-30 per 480 ml)
      4. Onset of action within 24-48 hours
      5. Dose
        1. Adults: 15-60 ml PO daily
        2. Child (10 mg/15 ml): 1-3 cc/kg/day divided qd-bid
    2. Lactitol
      1. As effective as Lactulose with less pain and flatus
      2. Pitzalis (1995) Pediatr Med Chir 17(3):223
    3. Sorbitol 70%
      1. Less expensive than Lactulose ($7 per 480 ml)
      2. Sweet taste
      3. Dosing
        1. Adult: 15-60 ml PO daily
        2. Child: 1-3 ml/kg/day divided twice daily
  6. Preparations: Magnesium salt osmotic Laxatives
    1. Rapid onset (within 3 hours)
    2. Avoid longterm use due to electrolyte loss risk
    3. Milk of Magnesia (Magnesium Hydroxide)
      1. Cost: $3 per 360 ml
      2. Concentration: 400 mg/5 ml
        1. Adults: 15-60 ml PO qd prn
        2. Children: 1-3 cc/kg/day divided bid prn
      3. Concentration 800 mg/5 ml
        1. Children: 0.5 cc/kg/day divided bid prn
      4. Adverse effects
        1. May cause abdominal cramping in higher doses
    4. Magnesium Citrate (Citroma)
      1. Cost: $1.50 per 300 ml
      2. Dose
        1. Adult: 8 ounces PO daily prn
        2. Child: 4 ml/kg up to 200 ml PO daily prn
  7. Preparations: Mineral Oil
    1. Child: 1-3 cc/kg/day divided daily to twice daily
    2. Contraindicated if aspiration risk
    3. Not recommended under age 18 months
    4. Give chilled in juice to maximize tolerability
    5. Coadminister multivitamin daily if used chronically
  8. Preparations: Sodium salt osmotic Laxatives
    1. Phopho-Soda (Osmoprep, Visicol) 2 tablespoons in 4 ounces water orally
    2. Fleets enema (sodium phosphate) 120 ml enema
    3. Alternative agent: Tap Water Enema
    4. Precaution: Risk of permanent impact on Renal Function following use
      1. Risk Factors
        1. Diabetes Mellitus
        2. Age over 65 years
        3. Dehydration
        4. Concurrent NSAID, ACE Inhibitor, ARB or Diuretic
      2. Prevention of Renal Function impact
        1. Consider alternative Bowel Preparation if risk factors above
        2. Maintain clear fluid intake to replace fluid losses from Diarrhea
  9. Preparations: Polyethylene glycol 3350 (PEG, Miralax)
    1. Similar to bowel prep solution (GoLytely, Colyte)
    2. Onset of action with 24-48 hours
    3. No salty taste
    4. More expensive then Sorbitol: $2/day
    5. Preparation
      1. Use PEG powder 17 grams (one capful)
      2. Dissolve in 240 ml (8 ounces) water or juice
      3. May chill PEG solution or mix with flavoring (e.g. Crystal Light) to improve taste
        1. If for Colonoscopy prep, avoid colored flavoring that might interfere with visibility
    6. Dose:
      1. Adult: 17 grams (1 capful) daily
      2. Child
        1. Start 0.8-1 g/kg/day (15 ml/kg/day) divided bid
        2. Adjust dose for two soft painless stools per day
        3. Taper dose over time
    7. Efficacy
      1. Safe, well tolerated and effective
      2. More effective and better tolerated than Lactulose
    8. References
      1. Gremse (2002) Clin Pediatr 41:225
      2. Pashankar (2003) Arch Pediatr Adolesc Med 157:661
      3. Voskuijl (2004) Gut 53:1590
  10. Preparations: Not recommended
    1. Castor oil or Ricinoleic Acid (Purge)
      1. Avoid due to electrolyte disturbance
      2. Adult: 15-30 ml PO qhs
      3. Child: 5-15 ml PO qhs
    2. Soapsuds Enemas (never use)
      1. Risk of irritation or hemorrhagic colitis

Magnesium Hydroxide (C0024476)

Definition (MSH)An inorganic compound that occurs in nature as the mineral brucite. It acts as an antacid with cathartic effects.
Definition (NCI)A solution of magnesium hydroxide with antacid and laxative properties. Milk of magnesium exerts its antacid activity in low doses such that all hydroxide ions that enter the stomach are used to neutralize stomach acid. This agent exerts its laxative effect in higher doses so that hydroxide ions are able to move from the stomach to the intestines where they attract and retain water, thereby increasing intestinal movement (peristalsis) and inducing the urge to defecate.
ConceptsPharmacologic Substance (T121) , Inorganic Chemical (T197)
MSHD008276
EnglishMagnesium Hydrate, Magnesium Hydroxide, MAGNESIUM HYDROXIDE PREPARATION
Spanishhidrato de magnesio, hidroxido de magnesio
Parent ConceptsHydroxides (C0020315), Magnesium Compounds (C0206112), Laxatives (C0282090), Magnesium (C0024467), Hyperosmotic laxative (C0304551), [GA108] MAGNESIUM CONTAINING ANTACIDS (C0973545), Magnesium Hydroxide (C0024476), Magnesium-based antacid (C0304544), Saline laxative (C0304552), Drug allergen (C1320237), Duplicate concept (C1274013)
SourcesMSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Polyethylene Glycols (C0032483)

Definition (MSH)Polymers of ETHYLENE OXIDE and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. They are used as SURFACTANTS, dispersing agents, solvents, ointment and suppository bases, vehicles, and tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers.
Definition (CSP)an addition polymer of ethylene oxide and water.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Biomedical or Dental Material (T122)
MSHD011092
EnglishMacrogol, Macrogols, PEG, PEG - Polyethylene glycol, POLYETHYLENE GLYCOL, POLYETHYLENE GLYCOL PREPARATION, Polyethylene glycol product, Polyethylene Glycols, Polyethylene Oxide, Polyethyleneoxide, POLYOXYETHYLENE, POLYOXYETHYLENE PREPARATION, Polyoxyethylenes
Spanishmacrogol, polietilenglicol
Parent ConceptsGlycol (C0017945), Polyethylenes (C0032487), Ethylene Glycols (C0015086), Polymers (C0032521), Drug vehicle (C0042444), Hyperosmotic laxative (C0304551), [PH000] PHARMACEUTICAL AIDS / REAGENTS (C0973614), Unclassified Ingredients (C1372954), Inactive Ingredient Preparations (C1375189), Glycols (C0017951), Laxatives (C0282090), Osmotic laxative (C0353980), Duplicate concept (C1274013)
SourcesAOD, CSP, MSH, MTH, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Sorbitol (C0037688)

Definition (MSH)A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications.
Definition (CSP)six-carbon sugar alcohol with about half the sweetness of sucrose; occurs naturally and is also produced synthetically from glucose.
Definition (NCI)A sugar alcohol found in fruits and plants with diuretic, laxative and cathartic property. Unabsorbed sorbitol retains water in the large intestine through osmotic pressure thereby stimulating peristalsis of the intestine and exerting its diuretic, laxative and cathartic effect. In addition, sorbitol has one-third fewer calories and 60 % the sweetening activity of sucrose and is used as a sugar replacement in diabetes.
ConceptsCarbohydrate (T118) , Pharmacologic Substance (T121)
MSHD013012
EnglishD glucitol, D-Glucitol, Glucitol, Sorbitol, Sorbitol agent, SORBITOL PREPARATION
Spanishpreparado de sorbitol, sorbitol
Parent ConceptsSugar Alcohols (C0038654), Alcohols (C0001975), Sweetening Agents (C0038998), Irrigation Solution (C0593225), [PH000] PHARMACEUTICAL AIDS / REAGENTS (C0973614), Osmotic laxative (C0353980), Food sweetener (C0684173), Duplicate concept (C1274013), Food pseudoallergen (C1532524), Drug pseudoallergen (C1532650)
SourcesAOD, CSP, LCH, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


magnesium citrate (C0126774)

Definition (PDQ)The citrate salt of the element magnesium with laxative properties. The cathartic action of magnesium cations appears to result, in part, from osmotically mediated water retention, which subsequently stimulates peristalsis. In addition, magnesium ions may also stimulate the activity of nitric oxide (NO) synthase and increase the biosynthesis of the phospholipid proinflammatory mediator platelet activating factor (PAF) in the gut. NO may stimulate intestinal secretion via prostglandin- and cyclic GMP-dependent mechansisms while PAFproduces significant stimulation of colonic secretion and gastrointestinal motility. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=480467&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=480467&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C29241" NCI Thesaurus)
Definition (NCI)The citrate salt of the element magnesium with laxative properties. The cathartic action of magnesium cations appears to result, in part, from osmotically mediated water retention, which subsequently stimulates peristalsis. In addition, magnesium ions may also stimulate the activity of nitric oxide (NO) synthase and increase the biosynthesis of the phospholipid proinflammatory mediator platelet activating factor (PAF) in the gut. NO may stimulate intestinal secretion via prostglandin- and cyclic GMP-dependent mechansisms while PAFproduces significant stimulation of colonic secretion and gastrointestinal motility.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC110422
EnglishCitrate of Magnesia, magnesium citrate, MAGNESIUM CITRATE PREPARATION, Mg citrate
Spanishcitrato de magnesio
Parent ConceptsLaxatives (C0282090), Magnesium (C0024467), Organometallic Compounds (C0029252), Citric Acid (C0055819), Hyperosmotic laxative (C0304551), Citrate (C0376259), Magnesium Compounds (C0206112), Saline laxative (C0304552), Drug allergen (C1320237)
SourcesMSH, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Hyperosmotic laxative (C0304551)

ConceptsPharmacologic Substance (T121)
EnglishHyperosmotic laxative, HYPEROSMOTIC LAXATIVES
Spanishlaxante hiperosmotico, laxante osmotico
Parent ConceptsLaxatives (C0282090)
SourcesNDFRT, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


MILK OF MAGNESIA (C0591789)

ConceptsPharmacologic Substance (T121) , Inorganic Chemical (T197)
EnglishMILK OF MAGNESIA
Parent ConceptsMAGNESIUM HYDROXIDE 350-425 MG/5ML (C1378826)
SourcesNCI, NDFRT, RXNORM, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Miralax (C0876088)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHC404783
EnglishMiralax
SourcesMSH, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


PHOSPHO-SODA (C0982341)

ConceptsPharmacologic Substance (T121)
EnglishPHOSPHO-SODA, PHOSPHO-SODA PREPARATION
Parent ConceptsOther laxatives (C0350002), Unclassified Ingredients (C1372954)
SourcesNDFRT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)



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