Laxatives

Bowel Softeners
- oral – docusate sodium (Coloxyl™) tablets, 50 mg and 120 mg tabs – 240 mg BD maximum dose.
- rectal – glycerine suppositories, Microlax™ enemas, oil retention enemas.
Bowel Stimulants
- oral - bisacodyl (Dulcolax™) tablets 5 mg 1-2 BD, senna tabs 7.5 mg 2-4 tabs daily.
- rectal – bisacodyl suppositories (need to be placed in contact with the bowel mucosa to be effective). Adult dose 10 mg, child dose 5 mg.
Stimulant/Softener Combinations - commonly used in Palliative Care Coloxyl and Senna™ 1-2 tabs BD (maximum 3 tablets TDS – unapproved dose).
Osmotic Laxatives
- Movicol™ (macrogol and electrolytes) 1 sachet dissolved in 125 ml of water once daily. Particularly useful for faecal impaction – can be up to 8 sachets per day for 1 – 3 days until bowels open and must be consumed within 6 hours. (Cease other laxatives during Movicol treatment for impaction.)
  - 1-3 sachets/day of Movicol™ can be prescribed regularly for chronic constipation.
  - Available on special authority. See pharmac website http://www.pharmac.co.nz
- Lactulose – NOT recommended for palliative care patients as large quantities of oral fluid needed and can cause severe bloating and flatulence.

Note:

Stimulants are contraindicated for patients with complete bowel obstruction.
Assess bowel action daily and adjust laxatives accordingly.
Bulking agents and high fibre diets are not well tolerated by terminally ill patients.


Information about this Canterbury DHB document (4098):
Document Owner:	Palliative Care Service (see Who's Who)
Issue Date:	July 2009
Next Review:	July 2010
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 4098