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Stimulant Laxative

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Stimulant Laxative, Stimulant Cathartic, Irritant Laxative, Anthraquinone Laxative, Diphenylmethane Laxative, Phenolphthalein, Melanosis coli

  • See Also
  1. Senna
  2. Bisacodyl
  3. Cascara
  4. Castor Oil
  5. Laxative
  6. Constipation
  7. Functional Constipation
  8. Pediatric Constipation
  • 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 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)
  • 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
  2. Phenolphthalein (OTC Preparations)
    1. Listed for historical reasons (withdrawn from U.S. market as of 2009 by FDA)
    2. Previously marketed under trade name Correctol (which is now formulated with Bisacodyl)
    3. Previously marketed under trade name Ex-Lax (which is now formulated with senna)
    4. As an OTC Medication, high risk of overuse
    5. Dose: 100 mg tablets, 1-2 orally every 8 hours
    6. 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