PlanetRx - Learn More - Product Advice - Laxatives, Oral

This too shall pass

Be honest and informed before you reach for a laxative. First, ask yourself if you really have constipation or if you're just under the misguided impression that people should pass a bowel movement daily in order to achieve optimum health. Studies show that anywhere from three bowel movements a day to three a week is absolutely normal.

If you do need some help during times of irregularity, try an over-the-counter medication. Rest assured that these are powerful and efficient means of getting things back in motion. Stool softeners, lubricating laxatives, tablets, and liquids all relieve constipation. Just be sure that you are constipated before you treat yourself for constipation -- don't solve a problem you may not even have.

Coping with Constipation

Constipation is often caused by low-fiber diets -- increase your vegetables, fruits, and whole grains along with drinking at least eight glasses of water a day.
Increase your daily exercise -- sedentary activity can slow the bowels.
Defecate when you feel the urge to pass a bowel movement; this is particularly hard when you are traveling, but an important part of keeping yourself regular.
Don't become dependent upon laxatives -- regular use can impair your bowel-movement timing.
Ask yourself if you are really constipated; the average person passes a bowel movement anywhere between three times a day to three times a week.

Laxatives Are Not a Quick Fix

Use caution; laxatives are powerful and can cause intestinal spasms and excessive fluid loss.
Do not use stimulant laxatives for more than a week.
Your body may become dependant upon stimulant laxatives if you use them frequently or over a prolonged period of time.
Phenolphthalein and antraquinones such as aloe, cascara sagrada preparations, and senna are stimulant laxatives that may discolor the urine; this is a benign side effect and nothing to worry about.
Excessive use of any stimulant laxative can lead to diarrhea, dehydration, and loss of salts and minerals; treat for dehydration in the case of overdose or excessive use.
Castor oil is a time-honored laxative that stimulates the small intestines to evacuate the bowel; it has been approved for over-the-counter modern use, but is still considered a potentially dangerous medication when excessively or extensively used over a long period of time.
Bulk-forming laxatives are the most "natural" of pharmaceutical options. In the case of pregnancy or long-term use of antidepressants and aluminum-containing antacids, constipation can be a chronic problem. Using bulk-forming laxatives may be the only option in these situations. Consult your doctor.
Use as little laxative as possible to successfully relieve your constipation.

When Laxatives Should Not Be Used

Do not use in the case of appendicitis.
Do not give this type of laxative to children under age 2.
Do not take laxatives for more than a week; not only is prolonged laxative usage not wise, but prolonged constipation may indicate that something more serious is wrong.
Avoid using laxatives if you have a stomach ache, nausea, or vomiting.
If you begin to bleed rectally after taking a laxative, stop taking the medication and see your doctor.

Don't Forget About Dehydration

Discontinue laxatives if you show symptoms of overdose or dehydration:

Muscular cramps
Irregular heartbeat
Fatigue
Disorientation
Confusion
Extreme thirst
Dry mouth
Skin-texture changes
Cold feeling in your arms and legs

Stool softeners (emollients)

Emollient laxatives contain an agent that increases the water content of the stool to soften it, making it easier to eliminate. Common emollient laxatives include docusate sodium, docusate potassium, and docusate calcium; they are also known as stool softeners.

Stool softeners (lubricants)

Lubricant laxatives typically contain liquid petrolatum or mineral oil. This substance works to soften the stool by coating it and preventing it from losing more moisture while in the colon.

Saline

Saline laxatives contain ions or particles that cannot be absorbed by the colon. This causes water to enter the colon to balance out all the extra particles and achieve equilibrium, thus softening the stool. Common saline laxatives include monobasic sodium phosphate, dibasic sodium phosphate, magnesium citrate, magnesium hydroxide, magnesium sulfate, and sodium biphosphate. These laxatives should be used only when the bowel needs to be cleared for a medical procedure; they should not be used for the treatment of chronic constipation.

Stimulants

Stimulant laxatives are believed to work by increasing the contractions of the lower gastrointestinal tract by irritating it or by selectively acting on a set of nerves that control the intestinal muscles. These products may also increase the secretion of water into the gut as well. Common stimulants found in OTC remedies include bisacodyl, cascara sagrada, casanthranol, castor oil, senna, and sennosides. Overuse of these drugs is not recommended since it can cause severe diarrhea and imbalances in the body's fluids.

Ingredient		Description
Stool Softeners (Emollients)
Docusate Salts	?	(includes docusate calcium, docusate sodium, docusate potassium) This ingredient has been scientifically proven effective, although the mechanism is not known for sure. There are few side effects. It should be used only in minimal amounts and for brief periods, and should never be taken with mineral oil.
Stool Softeners (Lubricants)
Ingredient		Description
Castor oil	?	While safe and effective in appropriate doses, continued use of castor oil can result in excessive and dangerous loss of water and essential body salts.
Mineral Oil	?	Mineral oil is safe and effective if used properly. While not irritating, it may impair absorption of vitamins. Should not be used daily for more than a week, or in conjunction with sulfosuccinates. Persistent use can lead to leakage of fecal material and skin reactions.
Saline
Ingredient		Description
Magnesium Salts	?	Safe and effective; however, persons with kidney disease or limiting their salt intake should check label warnings
Sodium Phosphates	?	This ingredient is fast-acting, but should be avoided by those with kidney problems, and children under the age 5. Enemas or rectal doses should not be given to children under age 2, except by doctor's orders. Otherwise, this substance is judged safe and effective.
Stimulants
Ingredient		Description
Aloe	?	This plant derivative is safe and effective, but may cause harmless side effects (e.g., discoloration of urine).
Anthraquinones	?	This plant derivative is safe and effective, but may cause harmless side effects (e.g., discoloration of urine). Not commonly found in nonprescription products.
Bisacodyl	?	This drug works quickly and effectively, but may be risky; excessive use or overdosage can result in loss of vital body fluids and salts. Must be swallowed, not chewed, so those who cannot swallow the drug should not take this drug in its oral form. When used properly, it is safe and effective.
Calcium Salt of Sennosides	?	This plant derivative is safe and effective, but may cause harmless side effects (e.g., discoloration of urine). Senna products are more potent than cascara and may cause greater abdominal discomfort.
Cascara Sagrada	?	This plant derivative is safe and effective, but may cause harmless side effects (e.g., discoloration of urine). Cascara is less effective than senna products, but causes less discomfort.
Phenolphthalein	?	This substance should be used only occasionally; it can lead to excessive laxation and loss of body salts. However, the FDA has discontinued its sale due to an increased cancer risk.
Senna	?	This plant derivative is safe and effective, but may cause harmless side effects (e.g., discoloration of urine). Senna products are more potent than cascara and may cause greater abdominal discomfort.

FDA-Approved Uses

Stool softener (emollient)

For relief of occasional constipation and irregularity

Oral dosage forms: this product generally produces bowel movements in 12 to 72 hours

Stool softener (lubricant)

For relief of occasional constipation and irregularity

Oral dosage forms: this product generally produces bowel movements in six to eight hours

Saline

For relief of occasional constipation and irregularity

Oral dosage forms: this product generally produces bowel movements in 30 minutes to six hours

Stimulant

For relief of occasional constipation and irregularity

Oral dosage forms: this product generally produces bowel movements in six to 12 hours

For use as part of a bowel-cleansing regimen in preparing patients for surgery or for preparing the colon for X-ray or endoscopic examination

Recommended Dosage

Drug	Adults & Children Over Age 12	Max. Daily	Children Ages 6 to 12	Max. Daily	Children Under Age 6	Max. Daily
Stool Softener (Emollients)
Docusate Calcium (Solid)	50 to 360 mg	Refer to package or consult a physician	50 to 150 mg	Refer to package or consult a physician	Refer to package or consult a physician
Docusate Sodium (Solid)	51 to 360 mg	Refer to package or consult a physician	50 to 150 mg	Refer to package or consult a physician	Refer to package or consult a physician
Docusate Sodium (Liquid)	50 to 240 mg	Refer to package or consult a physician	40 to 120 mg	Refer to package or consult a physician	Refer to package or consult a physician
Docusate Potassium (Solid)	100 to 300 mg	Refer to package or consult a physician	100 mg	Refer to package or consult a physician	100 mg at bedtime
Stool Softener (Lubricant)
Drug	Adults & Children Over Age 12	Max. Daily	Children Ages 6 to 12	Max. Daily	Children Under Age 6	Max. Daily
Mineral oil	14 to 45 ml	Refer to package or consult a physician	10 to 15 ml	Refer to package or consult a physician	10 to 15 ml
Castor oil	15 to 60 ml	Refer to package or consult a physician	5 to 15 ml	Refer to package or consult a physician	Refer to package or consult a physician
Saline
Drug	Adults & Children Over Age 12	Max. Daily	Children Ages 6 to 12	Max. Daily	Children Under Age 6	Max. Daily
Magnesium Citrate (Liquid)	240 ml	Refer to package or consult a physician	Refer to package or consult a physician		Refer to package or consult a physician
Magnesium Hydroxide (Liquid)	15 to 40 ml	Refer to package or consult a physician	Refer to package or consult a physician		Refer to package or consult a physician
Magnesium Sulfate (Solid)	10 to 30 grams	Refer to package or consult a physician	5 to 10 grams	Refer to package or consult a physician	Refer to package or consult a physician
Dibasic Sodium Phosphate (Solid)	1.9 to 3.8 grams	Refer to package or consult a physician	Refer to package or consult a physician		Refer to package or consult a physician
Monobasic Sodium Phosphate (Solid)	8.3 to 16.6 grams	Refer to package or consult a physician	Refer to package or consult a physician		Refer to package or consult a physician
Sodium Biphosphate (Solid)	9.6 to 19.2 grams	Refer to package or consult a physician	Refer to package or consult a physician	Refer to package or consult a physician	Refer to package or consult a physician
Stimulant
Drug	Adults & Children Over Age 12	Max. Daily	Children Ages 6 to 12	Max. Daily	Children Under Age 6	Max. Daily
Anthraquinones (Solid)	120 to 250 mg	Refer to package or consult a physician	Refer to package or consult a physician		Not recommended
Aloe	120 to 200 mg FOR THOSE 15 & OVER	Refer to package or consult a physician	80 to 120 FOR THOSE 8 TO 14	Refer to package or consult a physician	Refer to package or consult a physician
Cascara Sagrada (Aromatic Fluidextract)	2 to 6 ml	Refer to package or consult a physician	1 to 3 ml FOR THOSE 2 TO 11	Refer to package or consult a physician	Refer to package or consult a physician
Cascara Sagrada (Solid)	0.3 to 1 gram	1 gram	Refer to package or consult a physician		Refer to package or consult a physician
Senna (Solid)	0.5 to 2 grams	Refer to package or consult a physician	63 mg to 250 mg	Refer to package or consult a physician	Refer to package or consult a physician
Senna (Fluidextract)	2.0 ml	Refer to package or consult a physician	Refer to package or consult a physician		Refer to package or consult a physician
Senna (Syrup)	8.0 ml	Refer to package or consult a physician	2.0 ml	Refer to package or consult a physician	Refer to package or consult a physician
Senna (Fruitextract)	3.4 to 4 ml	Refer to package or consult a physician	1.7 to 2.0 ml	Refer to package or consult a physician	1.7 to 2.0 ml
Calcium Salt of Sennosides A and B	12 to 24 mg	Refer to package or consult a physician	20 mg	Refer to package or consult a physician	20 mg at bedtime
Bisacodyl (Solid)	10 to 30 mg	Refer to package or consult a physician	5 to 10 mg	Refer to package or consult a physician	Refer to package or consult a physician
Phenolphthalein (Solid)	30 to 270 mg	Refer to package or consult a physician	30 to 60 mg	Refer to package or consult a physician	Refer to package or consult a physician
Phenolphthalein (Liquid)	60 to 194 mg at bedtime	Refer to package or consult a physician	Refer to package or consult a physician		Refer to package or consult a physician

Warnings

Stool softener (lubricant)

Consult a physician before using or do not use if you have:

Allergy to any lubricant laxatives
Intestinal blockage
Rectal bleeding
Symptoms of dehydration
Had a portion of your gastrointestinal tract removed

Or if you:

Are pregnant or a nursing mother
Are a senior; you may require a lower dosage
Are administering to a child under age 2
Are experiencing nausea, vomiting, or abdominal pain
Failed to have a bowel movement after treatment

Or if you are taking:

Docusate: when used together, docusate may increase mineral oil absorption and toxicity
Other laxatives; may increase laxative side effects
Vitamins A, D, E, and K; may decrease absorption of these fat soluble vitamins

Stool softener (emollient)

Consult a physician before using or do not use if you have:

Allergy to emollient or stool softener
Rectal bleeding
Symptoms of dehydration

Or if you:

Are pregnant or a nursing mother
Are a senior; you may require a lower dosage
Are administering to a child under age 2
Are experiencing nausea, vomiting, or abdominal pain
Failed to have a bowel movement after treatment
Plan to take continuously
Plan to take for longer than one week

Or if you are taking:

Mineral oil: when used together, docusate may increase mineral oil absorption and toxicity. Inhalation of mineral oil may also cause pneumonia.

Saline

Consult a physician before using or do not use if you have:

Allergy to any emollient laxatives
High blood pressure
Intestinal blockage
Rectal bleeding
Symptoms of dehydration

Or if you:

Are pregnant or a nursing mother
Are a senior; you may require a lower dosage
Are administering to a child under age 6
Are experiencing nausea, vomiting, or abdominal pain
Failed to have a bowel movement after treatment

Or if you are taking:

Other laxatives; may increase laxative side effects

Stimulant

Consult a physician before using or do not use if you have:

Allergy to any stimulant laxatives
Congestive heart failure
Intestinal blockage
Rectal bleeding
Symptoms of dehydration

Or if you:

Are pregnant or a nursing mother
Are a senior; you may require a lower dosage
Are administering to a child or infant
Are experiencing nausea, vomiting, or abdominal pain
Failed to have a bowel movement after treatment
Use during menses

Or if you are taking:

Antacids or milk; may cause bisacodyl's enteric coating to dissolve, resulting in stomach irritation
Other laxatives; may increase laxative side effects

Common Side Effects

None anticipated

Infrequent to Rare Side Effects

Stool softener (emollients)

Diarrhea
Stomach cramps

Stool softener (lubricant)

Anal itching
Diarrhea
Nausea
Stomach cramps
Vomiting

Saline

Diarrhea
Gas
Low blood pressure
Slow breathing
Stomach cramps

Stimulant

Dizziness
Electrolyte imbalances
Mild stomach cramps
Nausea
Vomiting

Effects of Overdose

Stool softener (emollients)

Fluid loss
Electrolyte imbalances
Persistent stomach cramps
Severe diarrhea

Stool softener (lubricant)

None anticipated

Saline

Electrolyte imbalances
Diarrhea

Stimulant

Diarrhea
Electrolyte imbalances
Stomach pain

What to Do in Case of Overdose

It is unlikely that an overdose of this medication will cause life-threatening symptoms. If you are still concerned, please seek the advice of your healthcare professional.

Websites, Organizations & Manufacturers

Sources & Further Reading

Government Sources

1. Food & Drug Administration. Federal Register 1/15/85.

2. Food & Drug Administration. Federal Register 10/1/86.

3. Food & Drug Administration. Federal Register 9/2/93.

4. Food & Drug Administration. Federal Register 9/9/97.

Books

1. Covington, TR et al. Handbook of Nonprescription Drugs, Eleventh Ed. American Pharmaceutical Assoc. Washington, DC 1996.

2. Kastrup EK et al. Drug Facts and Comparisons. Facts and Comparisons.

3. Inlander, CB and Slamans, S. The Over-the-Counter Doctor. Cader Books. New York, NY 1997.

4. Zimmerman, DR. Zimmerman's Complete Guide to Nonprescription Drugs, Second Ed. Gale Research, Inc. 1983.

Find more books on health and wellness at barnesandnoble.com.

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PlanetRx - Learn More - Product Advice - Laxatives, Oral

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