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- Listed for historical reasons (withdrawn from U.S. market as of 2009 by FDA)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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| stimulant laxative (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| STIMULANT LAXATIVE PLUS TABLET | Generic OTC | $0.03 each |