Excessive use of stimulant laxatives can cause diarrhoea and related effects such as hypokalaemia; risk of electrolyte imbalance with prolonged use (in children).

Bisacodyl

• Gastro-resistant tablets 5mg (£4.07 = 60 tabs)
• Suppositories 10mg (£2.77 = 12 suppositories)
• Suppositories 5mg (paediatric) (£1.11 = 5 suppositories)

Indications and dose

• Acute obstructed constipation and faecal impaction in adults
• Chronic constipation in adults
• Acute non-obstructed constipation in adults
• Opioid induced constipation in adults
• Constipation in pregnancy (third line)
  • Oral, 5–10mg at night, increased if necessary to maximum 20mg at night according to response
  • Rectally, 10mg in the morning
• Faecal impaction in children
• Constipation in children
  • Child 4 years and older: 5–20mg oral once daily, adjusted according to response

Notes

1. Time to effect: 10-12 hours orally, 20-60 minutes rectally
2. The tablets are licensed for use in children aged 4 years and older.
3. The usual maintenance dose is half the disimpaction dose.

Senna

(Sennoside)

• Tablets 7.5mg (£1.59 = 60 tabs)
• Oral solution sugar free 7.5mg in 5ml (£8.78 = 500ml)

Indications and dose

• Acute obstructed constipation and faecal impaction in adults
• Chronic constipation in adults
• Acute non-obstructed constipation in adults
• Opioid induced constipation in adults
• Constipation in pregnancy (third line, avoid near term or if a history of unstable pregnancy)
  • 7.5–15mg (as tablets or syrup) daily (max. daily dose: 30mg), dose usually taken at bedtime; initial dose should be low then gradually increased
• Faecal impaction in children
• Constipation in children
  • Child 1 month to 2 years: 3.75mg -15mg syrup once daily
  • Child 2–18 years: 3.75mg–30mg syrup or tablets once daily

Notes

1. Do not prescribe the 15mg OTC tablets due to higher acquisition cost
2. Time to effect: 8-12 hours
3. Licensed only for short term use.
4. Efficacy is decreased with continued use
5. Syrup not licensed for use in children under 2 years and tablets not licensed for use in children under 6 years.
6. The usual maintenance dose is half the disimpaction dose.

Docusate sodium

• Capsules 100mg (£2.09 = 30 caps)
• Paediatric oral solution sugar free 12.5mg in 5ml (£24.06 = 300ml)

Indications and dose

• Acute obstructed constipation and faecal impaction in adults
• Chronic constipation in adults
• Acute non-obstructed constipation in adults
• Opioid induced constipation in adults
• Constipation in pregnancy (third line)
  • up to 500mg daily in divided doses adjusted according to response
• Faecal impaction in children
• Constipation in children
  • Child 6 months–1 year: 12.5mg three times daily (use paediatric oral solution).
  • Child 2–11 years: 12.5–25mg three times daily (use paediatric oral solution)
  • Child 12-17 years: Up to 500mg daily in divided doses

Notes

1. Time to effect: 1-2 days
2. Adjust dose according to response
3. Has a relatively weak stimulant effect, but also stool-softening properties.
4. Only the liquid formulation is licensed for use in children younger than 12 years of age.

Glycerol

• Suppositories 4g (£3.20 = 12 suppositories)

Indications and dose

• Acute obstructed constipation and faecal impaction in adults
• Constipation in pregnancy (third line)
  • Insert one suppository when required

Notes

1. Time to effect: 15-30 minutes
2. Lubricating and weak stimulant. Can be used for hard or soft stools.
3. Licensed for occasional use only

Lecicarbon

• Lecicarbon A Suppositories (£8.20 = 10 suppositories) – For use in adults
• Lecicarbon C Suppositories (£8.20 = 10 suppositories) – For use in children

Indication and dose

• Chronic constipation in adults and children
• Adult (Lecicarbon A) and Children (Lecicarbon C)
  • Insert one suppository when required. If necessary, this can be repeated after 30-60 minutes

Notes

1. Lecicarbon suppositories contain soya lecithin and are contraindicated in patients who have peanut or soya allergies.
2. The routine commissioning of Lecicarbon A suppositories is accepted in Devon for the management of chronic constipation. (see Commissioning Policy for more details).

Co-danthramer

(Dantron with poloxamer 188)

• Oral suspension sugar free 25mg/200mg in 5ml (£245.29 = 300ml)
• Strong oral suspension sugar free 5mg/1000mg in 5ml (£503.98 = 300ml)

Indications and dose

• Only for constipation in terminally ill patients
• Adult
  • 25mg/200mg: 5–10ml at night
  • 75mg/1000mg: 5ml at night

Notes

1. For use in palliative care only
2. Time to effect: 6-12 hours
3. Patients should be warned that it discolours the urine.
4. Prolonged contact with the skin (eg. faecal or urinary incontinence) can cause a dantron burn

Co-danthrusate

(Dantron with docusate sodium)

• Oral suspension sugar free 50mg/60mg in 5ml (£236.25 = 200ml)

Indications and dose

• Only for constipation in terminally ill patients
  
  • Adult: 5–15ml at night

Notes

1. For use in palliative care only
2. Time to effect: 6-12 hours
3. Patients should be warned that it discolours the urine.
4. Prolonged contact with the skin (e.g. faecal or urinary incontinence) can cause a dantron burn