II. Precautions
- Avoid chronic use of these agents
III. Preparations: Anthraquinone Laxative
-
Cascara (Casanthranol) Extract
- Onset of activity within 6-12 hours
- Dose: 325 mg PO qhs
-
Senna Extract (Senokot)
- Onset of activity within 6-12 hours
- Adult: 10-15 ml orally at bedtime or 2-4 tablets orally twice daily
- Child: Senna Syrup (8.8 grams per 5 ml)
- Age 2-6 years: 2.5 to 7.5 ml per day divided bid
- Age 6-12 years: 5 to 15 ml per day divided bid
- Combinations with senna and Docusate
- Senekot-S
- Peri-Colace (previously contained Cascara)
IV. Preparations: Diphenylmethane Laxative
-
Bisacodyl (Dulcolax)
- Onset of activity
- Oral: 6-12 hours
- Rectal: 60 minutes
- Dose
- Adult: 10 mg PO/PR per day (PO may be repeated)
- Child (6-12 years old): 5 mg PO/PR
- Protocol
- Start at 1 tablet once daily orally after breakfast
- Advance up to 3 tablets orally twice daily
- Onset of activity
- Phenolphthalein (OTC Preparations)
- Listed for historical reasons (withdrawn from U.S. market as of 2009 by FDA)
- Previously marketed under trade name Correctol (which is now formulated with Bisacodyl)
- Previously marketed under trade name Ex-Lax (which is now formulated with senna)
- As an OTC Medication, high risk of overuse
- Dose: 100 mg tablets, 1-2 orally every 8 hours
- Associated with Stevens-Johnson Syndrome
V. Adverse Effects: Long-term use (Laxative abuse)
- Colonic denervation and atony (Cathartic colon)
- Decreased motility of right colon
- Associated with Anthraquinone Laxatives
- Results from myenteric plexus injury
- Constipation
-
Electrolyte and nutritional disturbance
- Hypokalemia
- Sodium overload
- Protein-losing Enteropathy
- Melanosis coli
- Benign darkening of colonic mucosa
- Macrophage deposition in lamina propria
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Related Studies
| stimulant laxative (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| STIMULANT LAXATIVE PLUS TABLET | Generic OTC | $0.03 each |
Ontology: Melanosis coli (C0221391)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 11256005 |
| English | Melanosis coli, melanosis coli (diagnosis), melanosis coli, colon melanosis, melanosis of colon, melanosis, coli melanosis, Colonic pseudomelanosis, Melanosis of colon, Melanosis coli (disorder), colon; melanosis, melanosis; colon |
| Italian | Melanosi del colon |
| Japanese | 結腸メラノーシス, ｹｯﾁｮｳﾒﾗﾉｰｼｽ |
| Czech | Střevní melanóza |
| Hungarian | Melanosis coli |
| Dutch | colon; melanose, melanose; colon, melanosis coli |
| Spanish | melanosis coli (trastorno), melanosis coli, melanosis del colon, seudomelanosis colónica, Melanosis del colon |
| Portuguese | Melanose do cólon |
| French | Mélanose colique |
| German | Melanosis coli |
Ontology: Stimulant laxative (C0304553)
| Concepts | Pharmacologic Substance (T121) |
| SnomedCT | 317511006, 56762002 |
| English | Stimulant laxative, STIMULANT LAXATIVES, [GA204] STIMULANT LAXATIVES, stimulant laxatives, laxatives stimulant, laxative stimulants, laxative stimulant, stimulant laxative, Stimulant laxatives, Stimulant laxative (substance), Stimulant laxatives (product), Stimulant laxative, NOS, Stimulant laxatives (substance) |
| Spanish | laxante estimulante (sustancia), laxante estimulante, laxantes estimulantes (producto), laxantes estimulantes |
Ontology: Diphenylmethane laxative (C0304558)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| SnomedCT | 61939007, 387345006 |
| English | Diphenylmethane laxative (product), Diphenylmethane laxative (substance), Diphenylmethane laxative, Diphenylmethane laxative, NOS |
| Spanish | laxante de difenilmetano (producto), laxante de difenilmetano (sustancia), laxante de difenilmetano |
Ontology: Anthraquinone laxative (C0360063)
| Concepts | Pharmacologic Substance (T121) |
| SnomedCT | 74780007, 387424000 |
| English | Anthraquinone laxatives, Anthraquinone laxative (product), Anthraquinone laxative (substance), Anthraquinone laxative, Anthraquinone laxative, NOS |
| Spanish | laxante de antraquinona (producto), laxante de antraquinona (sustancia), laxante de antraquinona |
Ontology: Phenolphthalein (C0600489)
| Definition (NCI) | An organic compound used as a laboratory reagent and pH indicator. Phenolphthalein exerts laxative effects by stimulating the intestinal mucosa and constricting smooth muscles. However, phenolphthalein is no longer used as a laxative due to the suspected carcinogenicity of this compound. |
| Definition (MSH) | An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. |
| Concepts | Pharmacologic Substance (T121) , Indicator, Reagent, or Diagnostic Aid (T130) , Organic Chemical (T109) |
| MSH | D020113 |
| SnomedCT | 255671009, 19595005, 398955002 |
| LNC | LP14911-9, MTHU002165 |
| English | phenolphthalein, Phenolphthalein, 1(3H)-Isobenzofuranone, 3,3-bis(4-hydroxyphenyl)-, phenolphthalein (medication), laxatives phenolphthalein, 3,3-Bis(4-hydroxyphenyl)-1(3H)-isobenzofuranone, 3,3-Bis(p-hydroxyphenyl)phthalide, Phenolphthalein [Chemical/Ingredient], Phenolphthalein (product), Phenolphthalein (substance), PHENOLPHTHALEIN, PHENOLPHTHALEIN,WHITE, PHENPOLPHTHALEIN |
| Swedish | Fenolftalein |
| Czech | fenolftalein |
| Finnish | Fenolftaleiini |
| Russian | FENOLFTALEIN, ФЕНОЛФТАЛЕИН |
| Japanese | フェノールフタレイン |
| Polish | Fenoloftaleina |
| Spanish | fenolftaleína (producto), fenolftaleína (sustancia), fenolftaleína, Fenolftaleína |
| French | Phénolphtaléine |
| German | Phenolphthalein |
| Italian | Fenolftaleina |
| Portuguese | Fenolftaleína |
