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Canterbury DHB

Laxatives

1. 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.
2. 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.
3. Stimulant/Softener Combinations - commonly used in Palliative Care Coloxyl and Senna™ 1-2 tabs BD (maximum 3 tablets TDS – unapproved dose).
4. 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.

See the Constipation Nursing Fact Sheet.

Topic Code: 4098