|Cascara Sagrada and Bisacodyl
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Some commonly used brand names are:
In the U.S.—
Oral laxatives are medicines taken by mouth to encourage bowel movements to relieve constipation.
There are several different types of oral laxatives and they work in different ways. Since directions for use are different for each type, it is important to know which one you are taking. The different types of oral laxatives include:
Bulk-formers—Bulk-forming laxatives are not digested but absorb liquid in the intestines and swell to form a soft, bulky stool. The bowel is then stimulated normally by the presence of the bulky mass. Some bulk-forming laxatives, like psyllium and polycarbophil, may be prescribed by your doctor to treat diarrhea.
Hyperosmotics—Hyperosmotic laxatives encourage bowel movements by drawing water into the bowel from surrounding body tissues. This provides a soft stool mass and increased bowel action.
There are three types of hyperosmotic laxatives taken by mouth—the saline, the lactulose , and the polymer types. The saline type is often called ""salts."" They are used for rapid emptying of the lower intestine and bowel. They are not used for long-term or repeated correction of constipation. With smaller doses than those used for the laxative effect, some saline laxatives are used as antacids. The information that follows applies only to their use as laxatives. Sodium phosphate may also be prescribed for other conditions as determined by your doctor.
The lactulose type is a special sugar-like laxative that works the same way as the saline type. However, it produces results much more slowly and is often used for long-term treatment of chronic constipation. Lactulose may sometimes be used in the treatment of certain medical conditions to reduce the amount of ammonia in the blood. It is available only with your doctor"s prescription.
The polymer type is a polyglycol (polyethylene glycol), a large molecule that causes water to be retained in the stool; this will soften the stool and increase the number of bowel movements. It is used for short periods of time to treat constipation.
Lubricants—Lubricant laxatives, such as mineral oil, taken by mouth encourage bowel movements by coating the bowel and the stool mass with a waterproof film. This keeps moisture in the stool. The stool remains soft and its passage is made easier.
Stimulants—Stimulant laxatives, also known as contact laxatives, encourage bowel movements by acting on the intestinal wall. They increase the muscle contractions that move along the stool mass. Stimulant laxatives are a popular type of laxative for self-treatment. However, they also are more likely to cause side effects. One of the stimulant laxatives, dehydrocholic acid, may also be used for treating certain conditions of the biliary tract.
Stool softeners (emollients)—Stool softeners encourage bowel movements by helping liquids mix into the stool and prevent dry, hard stool masses. This type of laxative has been said not to cause a bowel movement but instead allows the patient to have a bowel movement without straining.
Combinations—There are many products that you can buy for constipation that contain more than one type of laxative. For example, a product may contain both a stool softener and a stimulant laxative. In general, combination products may be more likely to cause side effects because of the multiple ingredients. In addition, they may not offer any advantage over products containing only one type of laxative. If you are taking a combination laxative, make certain you know the proper use and precautions for each of the different ingredients .
Most laxatives (except saline laxatives) may be used to provide relief:
Saline laxatives have more limited uses and may be used to provide rapid results:
Most laxatives are available without a prescription; however, your doctor may have special instructions for the proper use and dose for your medical condition. They are available in the following dosage forms:
Before Using This Medicine
Importance of diet, fluids, and exercise to prevent constipation—Laxatives are to be used to provide short-term relief only, unless otherwise directed by a doctor. A proper diet containing roughage (whole grain breads and cereals, bran, fruit, and green, leafy vegetables), with 6 to 8 full glasses (8 ounces each) of liquids each day, and daily exercise are most important in maintaining healthy bowel function. Also, for individuals who have problems with constipation, foods such as pastries, puddings, sugar, candy, cake, and cheese may make the constipation worse.
If you are taking this medicine without a prescription, carefully read and follow any precautions on the label. For oral laxatives, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to laxatives. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Diet—Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. Some laxatives have large amounts of sodium or sugars in them.
Pregnancy—Although laxatives are often used during pregnancy, some types are better than others. Stool softeners (emollient) laxatives and bulk-forming laxatives are probably used most often. If you are using a laxative during pregnancy, remember that:
Breast-feeding—Laxatives containing cascara and danthron may pass into the breast milk. Although the amount of laxative in the milk is generally thought to be too small to cause problems in the baby, your doctor should be told if you plan to use such laxatives. Some reports claim that diarrhea has been caused in the infant.
Children—Laxatives should not be given to young children (up to 6 years of age) unless prescribed by their doctor . Since children usually cannot describe their symptoms very well, they should be checked by a doctor before being given a laxative. The child may have a condition that needs other treatment. If so, laxatives will not help, and may even cause unwanted effects or make the condition worse.
Mineral oil should not be given to young children (up to 6 years of age) because a form of pneumonia may be caused by the inhalation of oil droplets into the lungs.
Also, bisacodyl tablets should not be given to children up to 6 years of age because if chewed they may cause stomach irritation.
Older adults—Mineral oil should not be taken by bedridden elderly persons because a form of pneumonia may be caused by the inhalation of oil droplets into the lungs. Also, stimulant laxatives (e.g., bisacodyl or casanthranol), if taken too often, may worsen weakness, lack of coordination, or dizziness and light-headedness.
Polyethylene glycol 3350 should be discontinued if diarrhea occurs, especially in elderly persons in nursing homes.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking oral laxatives, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of oral laxatives. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
For safe and effective use of your laxative:
With all kinds of laxatives, at least 6 to 8 glasses (8 ounces each) of liquids should be taken each day. This will help make the stool softer.
For patients taking laxatives containing a bulk-forming ingredient :
For patients taking laxatives containing a stool softener (emollient) :
For patients taking laxatives containing a hyperosmotic ingredient :
For patients taking laxatives containing mineral oil :
For patients taking laxatives containing a stimulant ingredient :
Dosing—There are a large number of laxative products on the market. The dose of laxatives will be different for different products. The number of capsules or tablets or teaspoonfuls of crystals, gel, granules, liquid, or powder that you use; the number of caramels or wafers that you eat; or the number of pieces of gum that you chew depends on the strength of the medicine. Follow your doctor"s orders if this medicine was prescribed, or follow the directions on the box if you are buying this medicine without a prescription .
Storage—To store this medicine:
Precautions While Using This Medicine
Do not take any type of laxative :
If you notice a sudden change in bowel habits or function that lasts longer than 2 weeks , or that keeps returning off and on, check with your doctor before using a laxative. This will allow the cause of your problem to be determined before it may become more serious.
The ""laxative habit""—Laxative products are overused by many people. Such a practice often leads to dependence on the laxative action to produce a bowel movement. In severe cases, overuse of some laxatives has caused damage to the nerves, muscles, and tissues of the intestines and bowel. If you have any questions about the use of laxatives, check with your health care professional.
Many laxatives often contain large amounts of sugars, carbohydrates, and sodium. If you are on a low-sugar, low-caloric, or low-sodium diet, check with your health care professional before using a laxative.
For patients taking laxatives containing mineral oil :
For patients taking laxatives containing a stimulant ingredient :
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Difficulty in breathing; intestinal blockage; skin rash or itching; swallowing difficulty (feeling of lump in throat)
Confusion; dizziness or light-headedness; irregular heartbeat; muscle cramps; unusual tiredness or weakness
Confusion; irregular heartbeat; muscle cramps; pink to red, red to violet, or red to brown coloration of alkaline urine (for cascara, danthron, and/or senna only); skin rash; unusual tiredness or weakness; yellow to brown coloration of acid urine (for cascara, and/or senna only)
For stool softener (emollient)-containing
Other side effects may occur that usually do not need medical attention. These side effects are less common and may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Bloating; cramping; diarrhea; nausea; gas; increased thirst
Skin irritation surrounding rectal area
Belching; cramping; diarrhea; nausea
For stool softener (emollient)-containing
Stomach and/or intestinal cramping; throat irritation (liquid forms only)
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, psyllium hydrophilic mucilloid is used in certain patients with high cholesterol (hypercholesterolemia).
For patients taking psyllium hydrophilic mucilloid for high cholesterol :
Other than the above information, there is no additional information relating to proper use, precautions, or side effects for this use.
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