LAXATIVES

 Used for the treatment of constipation, which is defined as the abnormally infrequent and difficult passage
of feces through the lower GI tract.
 Most of the misused OTC medications. Chronic and often inappropriate use of laxatives may result in laxative
dependence, produce damage to the bowel, or lead to previously non-existent intestinal problems.
 Laxatives are divided into five major groups based on their mechanism of action: bulk forming, emollient,
hyperosmotic, saline and stimulant laxatives.

Bulk forming Laxatives

Act in a manner similar to that of the fiber naturally contained in the diet. They absorb water into the
intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel
movement.

Emollient Laxatives

Also referred to as stool softeners and lubricant laxatives. It works by lowering the surface tension of GI
fluids, so that more water and fat are absorbed into the stool and the intestines.

Hyperosmotic Laxatives

Work by increasing fecal water content, which results in distention, increased in peristalsis, and evacuation.

Saline Laxatives

Increase osmotic pressure in the small intestine by inhibiting water absorption and increasing both water
and electrolyte secretions by the bowel wall into the bowel lumen.

Stimulant Laxatives

Stimulate the nerves that innervate the intestines, which results in increased peristalsis. They also increase
fluid in the colon, which increases bulk and softens the stool.

Prototype Drug: psyllium mucilloid (Metamucil, others)

Therapeutic class:

Pharmacologic class:

ACTIONS AND USES

ADVERSE EFFECTS

CONTRAINDICATIONS

DRUG DRUG INTERACTIONS

 Categories Laxative drugs
Bulk forming Psyllium, polycarbopil, methylcellulose
Emollient Docusate salts, mineral oil
Hyperosmotic Polyethylene glycol, lactulose, sorbitol. glycerin
Saline Magnesium hydroxide, magnesium sulphate, magnesium phosphate, magnesium
citrate, sodium phosphate
Stimulant Caster oil, senna, anthaquinones

Laxatives: Drug Categories and Selected Drugs

Laxatives: Drug Effects

Drug Effect Bulk Emollient Hyperosmotic Saline Stimulant

Increases peristalsis Y Y Y Y Y
Causes increased secretion of water Y Y N Y Y
and electrolytes in small bowel
Inhibits absorption of water in small Y Y N Y Y
bowel
Increases wall permeability in small N Y N N Y
bowel
Acts only in large bowel N N Y N N
Increases water in fecal mass Y Y Y Y Y
Softens fecal mass Y Y Y Y Y

Laxatives: Indications

Category Indication
Bulk forming Acute and chronic constipation, irritable bowel
syndrome
Emollient Acute and chronic constipation, softening of fecal
impaction, facilitation of bowel movements in anorectal
conditions.
Hyperosmotic Chronic constipation, bowel preparation for diagnostic
and surgical procedures
Saline Constipation, removal of helminths and parasites, bowel
preparation for diagnostic and surgical procedures
Stimulant Acute constipation, bowel preparation for diagnostic and
surgical procedures

Contraindications
 All categories of laxatives share the same general contraindications and precautions, including drug allergy
and the need for cautious use in the presence of the following: acute surgical abdomen; appendicitis symptoms such
as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and
undiagnosed abdominal pain.

Laxatives: Adverse Effects

Category Adverse Effects

Bulk forming Impaction above strictures, fluid disturbances, electrolyte imbalances, gas formation,
esophageal blockage, allergic reaction.
Emollient Skin rashes, decreased absorption of vitamins, lipid pneumonia, electrolyte imbalances.
Hyperosmotic Abdominal bloating, rectal irritation, electrolyte imbalances
Saline Magnesium toxicity (with renal insufficiency) electrolyte imbalances, cramping, diarrhea,
increased thirst.
Stimulant Nutrient malabsorption, skin rashes, gastric irritation, electrolyte imbalances, discoloured
urine, rectal irritation.