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Stimulant Laxative

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Stimulant Laxative, Stimulant Cathartic, Irritant Laxative, Anthraquinone Laxative, Diphenylmethane Laxative, Phenolphthalein, Castor oil, Bisacodyl, Senna, Senokot, Cascara, Casanthranol, Peri-Colace, Melanosis coli, Ex-Lax, Correctol

  • Precautions
  1. Avoid chronic use of these agents
  • 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 PO qhs or 2-4 tablets PO bid
    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)
  • 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
  • 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