II. Medications: Laxatives

  1. Bulk Laxative (Fiber Supplementation, Preferred agents)
    1. Preferred agents (effective with few adverse effects)
    2. Psyllium (e.g. Metamucil)
    3. Methylcellulose (e.g. Citrucel)
    4. Calcium Polycarbophil (Fibercon)
    5. Dietary Fiber
  2. Osmotic Laxative (Preferred agents)
    1. Poorly absorbed saccharides (Lactulose, Sorbitol)
    2. Magensium Laxatives (Milk of Magnesia)
    3. Sodium bisphosphate (Fleets Phospho-Soda)
    4. Polyethylene Glycol lavage solution (GoLytely)
  3. Emollient Laxative (Stool Softener)
    1. DocusateSodium (Colace) - questionable efficacy
    2. Glycerin
    3. Mineral Oil (not recommended)
      1. Aspiration risk
      2. Depletes fat soluble Vitamins
  4. Stimulant Laxative (Risk of Laxative abuse)
    1. Other Laxative types are preferred over these
    2. Anthraquinone Laxative
      1. Cascara Sagrada Extract (Casanthranol)
      2. Senna Extract (Senokot)
    3. Diphenylmethane Laxative
      1. Bisacodyl (Dulcolax)
      2. Phenolphthalein (OTC, Correctol, Ex-Lax)
  5. Combination Agents
    1. Peri-Colace contains Cascara and Docusate
    2. Senekot-S contains senna and Docusate

III. Medications: Enemas and suppositories

  1. Precautions
    1. Never use hot water, soap, or Hydrogen Peroxide enema
  2. Tap water enema or saline enema (safest)
  3. Sodium Bisphosphate enema (Fleet Enema)
  4. Pink Lady Enema (1/2 Fleet Enema, 100 ml Docusate, 60 ml Mineral Oil, 60 ml Magnesium Citrate)
  5. Mineral Oil Enema
  6. Glycerine suppository
  7. Bisacodyl suppository (Dulcolax suppository)

IV. Medications: Prokinetic agents

  1. See Constipation Dominant Irritable Bowel Syndrome
  2. Secretagogoues
    1. Linaclotide
    2. Plecanatide
    3. Lubriprostone
    4. Tenapanor
  3. Prokinetic Agents
    1. Prucalopride
    2. Tegaserod (Zelnorm)
      1. Withdrawn from U.S. market in 2007 due to Cardiovascular Risks (but still available for limited use)
      2. Indicated only in IBS for Constipation in women

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Cost: Medications

laxative (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LAXATIVE EC 5 MG TABLET Generic OTC $0.03 each