II. Precautions

  1. Avoid chronic use of these agents

III. Preparations: Anthraquinone Laxative

  1. Cascara (Casanthranol) Extract
    1. Onset of activity within 6-12 hours
    2. Dose: 325 mg PO qhs
  2. Senna Extract (Senokot)
    1. Onset of activity within 6-12 hours
    2. Adult: 10-15 ml orally at bedtime or 2-4 tablets orally twice daily
    3. Child: Senna Syrup (8.8 grams per 5 ml)
      1. Age 2-6 years: 2.5 to 7.5 ml per day divided bid
      2. Age 6-12 years: 5 to 15 ml per day divided bid
    4. Combinations with senna and Docusate
      1. Senekot-S
      2. Peri-Colace (previously contained Cascara)

IV. Preparations: Diphenylmethane Laxative

  1. Bisacodyl (Dulcolax)
    1. Onset of activity
      1. Oral: 6-12 hours
      2. Rectal: 60 minutes
    2. Dose
      1. Adult: 10 mg PO/PR per day (PO may be repeated)
      2. Child (6-12 years old): 5 mg PO/PR
    3. Protocol
      1. Start at 1 tablet once daily orally after breakfast
      2. Advance up to 3 tablets orally twice daily
    4. Cost: <50 cents per day
  2. Phenolphthalein (OTC Preparations: Correctol, Ex-Lax)
    1. As an OTC medication, high risk of overuse
    2. Dose: 100 mg tablets, 1-2 PO q8 hours
    3. Associated with Stevens-Johnson Syndrome

V. Adverse Effects: Long-term use (Laxative abuse)

  1. Colonic denervation and atony (Cathartic colon)
    1. Decreased motility of right colon
    2. Associated with Anthraquinone Laxatives
    3. Results from myenteric plexus injury
  2. Constipation
  3. Electrolyte and nutritional disturbance
    1. Hypokalemia
    2. Sodium overload
    3. Protein-losing Enteropathy
  4. Melanosis coli
    1. Benign darkening of colonic mucosa
    2. Macrophage deposition in lamina propria

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Cost: Medications

stimulant laxative (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
STIMULANT LAXATIVE PLUS TABLET Generic OTC $0.03 each
bisacodyl (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BISACODYL 10 MG SUPPOSITORY Generic OTC $0.26 each
BISACODYL EC 5 MG TABLET Generic OTC $0.03 each
senna (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SENNA 8.6 MG TABLET Generic OTC $0.02 each
SENNA 8.8 MG/5 ML LIQUID Generic OTC $0.04 per ml
SENNA 8.8 MG/5 ML SYRUP Generic OTC $0.04 per ml
SENNA LAX 8.6 MG TABLET Generic OTC $0.02 each
SENNA LAXATIVE 8.6 MG TABLET Generic OTC $0.02 each
SENNA PLUS 8.6-50 MG SOFTGEL Generic OTC $0.06 each
SENNA PLUS 8.6-50 MG TABLET Generic OTC $0.03 each
SENNA PLUS TABLET Generic OTC $0.03 each
SENNA-LAX 8.6 MG TABLET Generic OTC $0.02 each
SENNA-S TABLET Generic OTC $0.03 each
SENNA-TIME 8.6 MG TABLET Generic OTC $0.02 each
SENNA-TIME S TABLET Generic OTC $0.03 each
senokot (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SENOKOT 8.6 MG TABLET Generic OTC $0.02 each
SENOKOT EXTRA STR 17.2 MG TAB OTC $0.39 each
SENOKOT-S TABLET Generic OTC $0.03 each