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1
Werth, Barry L., and Sybèle-Anne Christopher. "Laxative Use in the Community: A Literature Review." Journal of Clinical Medicine 10, no. 1 (January 4, 2021): 143. http://dx.doi.org/10.3390/jcm10010143.
Abstract:
Laxatives are widely available without prescription and, as a consequence, they are commonly used for self-management of constipation by community-dwelling adults. However, it is not clear to what extent laxatives are used. Nor is it clear how laxatives are chosen, how they are used and whether consumers are satisfied with their performance. This review of published literature in the last 30 years shows the prevalence of laxative use in community-dwelling adults varied widely from 1% to 18%. The prevalence of laxative use in adults with any constipation (including both chronic and sporadic constipation) also varied widely from 3% to 59%. Apart from any geographical differences and differences in research methodologies, this wide range of estimated prevalence may be largely attributed to different definitions used for laxatives. This review also shows that laxative choice varies, and healthcare professionals are infrequently involved in selection. Consequently, satisfaction levels with laxatives are reported to be low and this may be because the laxatives chosen may not always be appropriate for the intended use. To improve constipation management in community and primary healthcare settings, further research is required to determine the true prevalence of laxative use and to fully understand laxative utilisation.
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Konovalova, N. V., O. V. Stopinchuk, and O. Y. Krikus. "Inconvenient topic: laxative abuse. review and clinical case." Reports of Vinnytsia National Medical University 24, no. 4 (December 28, 2020): 720–25. http://dx.doi.org/10.31393/reports-vnmedical-2020-24(4)-28.
Abstract:
Annotation. Laxatives are drugs with different mechanism of action that are used to treat or prevent constipation. Use of laxatives to control body weight is considered a dangerous tendency, especially among young women with eating disorders. Natural or synthetic stimulant purgatives are the most commonly used for weight loss because they are cost-effective, have rapid onset of action, and available in various dosage forms. Excessive use of laxatives results in a gradual efficacy decrease causes specific damage of the gastrointestinal tract, other organs and systems. This condition is known as "laxative abuse". The purpose of this review is to summarize the available scientific data on behavioral characteristics, clinical and diagnostic criteria and tactics of treatment of laxative abuse with a clinical case description. Laxatives abuse should be suspected in case of eating disorders, clinical, laboratory, endoscopic and histological changes in the gastrointestinal tract. Treatment of laxative abuse requires gradual laxatives withdrawal, potassium replacement therapy and mandatory training in the healthy eating principles. The clinical case describes a young woman who tried to stop taking laxatives, but she started to use diuretics due to peripheral swelling. At the time of examination, the daily dose of furosemide was 600 mg (15 tablets a day). Laxative abuse is relatively common among young women and requires monitoring by physicians of various specialties.
3
Sazhin, Vladimir, and Pushkal Pushkal. "Predictors of laxative use in inpatients with schizophrenia on clozapine." Australasian Psychiatry 30, no. 1 (October 27, 2021): 105–9. http://dx.doi.org/10.1177/10398562211042368.
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Objectives: Constipation, a clinical manifestation of gastrointestinal hypomotility, is a common and potentially serious complication of clozapine therapy, requiring laxatives for its prevention and treatment. We explored the predictive factors of the increased laxative use in inpatients receiving a long-term clozapine therapy. Methods: In the cross-sectional study of 93 patients in a psychiatric rehabilitation hospital, we examined a four-week prevalence of laxative use and a range of demographic and clinical factors associated with the number of prescribed laxatives. Results: Seventy-four percent of inpatients with schizophrenia were prescribed laxatives, and they were statistically significant older and taking higher daily doses of clozapine. In generalized Poisson regression analysis, the clozapine dose, age, and comorbid diabetes mellitus and hypothyroidism were independently associated with the number of concurrently used laxatives. No association was found between the laxatives and gender, duration of clozapine treatment, and the number of other medications with a potential to cause constipation. Conclusion: The clozapine dose, age, diabetes mellitus, and hypothyroidism were shown to be the independent predictors of the increased laxative use among inpatients on clozapine and might be associated with the increased risk of clozapine-induced constipation and gastrointestinal hypomotility.
4
Bruin, Frans de, Karin Hek, Jan van Lieshout, Monique Verduijn, Pim Langendijk, Marcel Bouvy, and Martina Teichert. "Laxative co-medication and changes in defecation patterns during opioid use." Journal of Oncology Pharmacy Practice 25, no. 7 (September 27, 2018): 1613–21. http://dx.doi.org/10.1177/1078155218801066.
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Introduction Opioid-induced constipation is a clinically relevant side effect and a cause of potentially avoidable drug-related hospital admissions. Objectives To describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of opioid initiators. Methods In this observational study community pharmacists evaluated the availability of laxative co-medication in starting opioid users and registered reasons for non-use. Two opioid initiators per pharmacy were invited to complete questionnaires (‘Bristol stool form scale’ and ‘Rome III Diagnostic Questionnaire for the Adult Functional Gastrointestinal Disorders’) on their defecation prior to and during opioid use. Descriptive statistics and Chi square tests were used to analyse reasons for non-use of laxatives and changes in defecation patterns. Results Eighty-one pharmacists collected data from 460 opioid initiators. Of those, 344 (74.8%) used laxatives concomitantly. Main reason not to use laxatives was that either prescribers or patients did not consider them necessary. Sixty-seven (89.3%) of the 75 opioid starters with two questionnaires completed were not constipated at opioid start. Eleven of them (16%) developed constipation during opioid use (Chi square p=0.003). At follow-up within laxative users 10.6% were constipated compared to 20.7% in subjects without laxatives. Conclusion One in four opioid starters did not dispose of laxative co-medication, mainly because they were not considered necessary by either the prescriber or the patient. The prevalence of constipation doubled during opioid use. A watchful waiting strategy for the use of laxative co-medication might include a monitoring of defecation patterns with validated questionnaires.
5
Hoang Anh, Trung, Phung-Anh Nguyen, Anh Duong, I.-Jen Chiu, Chu-Lin Chou, Yu-Chen Ko, Tzu-Hao Chang, et al. "Contact Laxative Use and the Risk of Arteriovenous Fistula Maturation Failure in Patients Undergoing Hemodialysis: A Multi-Center Cohort Study." International Journal of Environmental Research and Public Health 19, no. 11 (June 3, 2022): 6842. http://dx.doi.org/10.3390/ijerph19116842.
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Laxatives are commonly prescribed for constipation management; however, they are recognized as an independent factor associated with cardiovascular diseases. Arteriovenous fistula (AVF) is the closest to the ideal model of hemodialysis (HD) vascular access and part of the cardiovascular system. Our study aims to explore the association of contact laxative use with AVF maturation outcomes in patients undergoing HD. We conducted a multi-center cohort study of 480 contact laxative users and 472 non-users who had undergone initial AVF creation. All patients were followed until the outcomes of AVF maturation were confirmed. Multivariable logistic regression models were performed to evaluate the risk of AVF maturation failure imposed by laxatives. Here, we found that patients who used contact laxatives were significantly associated with an increased risk of AVF maturation failure compared to non-users (adjusted odds ratio, 1.64; p = 0.003). Notably, the risk of AVF maturation failure increased when increasing their average daily doses and cumulative treatment days. In conclusion, our study found a significant dose- and duration-dependent relationship between contact laxative use and an increased risk of AVF maturation failure. Thus, laxatives should be prescribed with caution in this population. Further studies are needed to validate these observations and investigate the potential mechanisms.
6
White, Nicole C., Rafael Mendo-Lopez, Konstantinos Papamichael, Christine A. Cuddemi, Caitlin Barrett, Kaitlyn Daugherty, Nira Pollock, Ciaran P. Kelly, and Carolyn D. Alonso. "Laxative Use Does Not Preclude Diagnosis or Reduce Disease Severity in Clostridiodes difficile Infection." Clinical Infectious Diseases 71, no. 6 (October 4, 2019): 1472–78. http://dx.doi.org/10.1093/cid/ciz978.
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Abstract Background To optimize utility of laboratory testing for Clostridiodes difficile infection (CDI), the 2017 Infectious Diseases Society of America–Society for Healthcare Epidemiology of America (IDSA-SHEA) clinical practice guidelines recommend excluding patients from stool testing for C. difficile if they have received laxatives within the preceding 48 hours. Sparse data support this recommendation. Methods Patients with new-onset diarrhea (≥3 bowel movements in any 24-hour period in the 48 hours before stool collection) and a positive stool C. difficile nucleic acid amplification test were enrolled. Laxative use within 48 hours before stool testing, severity of illness (defined by 4 distinct scoring methods), and clinical outcomes were recorded. Results 209 patients with CDI were studied, 65 of whom had received laxatives. There were no significant differences in the proportion of patients meeting severe CDI criteria by 4 severity scoring methods in patients receiving versus not receiving laxatives (66.2% vs 56.3%, respectively; P = .224) by IDSA-SHEA, the primary scoring system. Similar rates of serious outcomes attributable to CDI, including death, intensive care unit admission, and colectomy, were observed in the laxative and no laxative groups. Conclusions Our study found similar rates of severe CDI and serious CDI-attributable clinical outcomes in CDI-diagnosed patients who did or did not receive laxatives. Precluding recent laxative users from CDI testing, as proposed by the IDSA-SHEA guideline, carries a potential for harm due to delayed diagnosis and treatment.
7
Pranoto, Wiji Joko, Supriatmo Supriatmo, Melda Deliana, and Atan Baas Sinuhaji. "Oral versus rectal laxatives for functional constipation in child." Paediatrica Indonesiana 56, no. 3 (July 1, 2016): 162. http://dx.doi.org/10.14238/pi56.3.2016.162-6.
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Background Functional constipation is a common childhood condition. Benefits of oral and rectal laxatives in terms of recovery and recurrence in children with functional constipation are still controversial.Objective To compare the effectiveness of oral and rectal laxatives in terms of recovery and recurrence in children with functional constipation.Methods Children aged 8 to 17 years who met the Rome III criteria for functional constipation were enrolled in this open randomised trial. Data was collected through questionnaires, interviews, and physical examinations. The participants were randomly assigned to receive stimulant laxatives (5 mg bisacodyl) either orally for three consecutive days or rectally in a single dose. Subjects kept daily defecation records for 7 days, and were followed up on days 14, 21, 28, 35, and 42. Comparisons of defecation patterns and recurrence of constipation between groups were assessed using Chi-square test.Results Of 99 subjects, 46 children (5 boys, 41 girls) received oral laxatives (group I) and 45 children (8 boys, 37 girls) received rectal laxatives (group II). Four children in each group dropped out. Baseline characteristics are comparable between the groups. Rate of recovery in the first 7 days was higher in the oral compared to rectal groups [84.8% versus 73.3%, respectively, but this was not statistically sininficant (P=0.278)]. In the second week, the recurrence of constipation was significantly higher in the rectal (57.5%) than in the oral laxative group (42.5%) (P=0.026).Conclusion Although recovery tends to occur more with oral compared to rectal laxative agents, the difference was not statistically significant. Higher recurrence in the second week after treatment occurred with rectal laxative agent. [Paediatr Indones. 2016;56:162-6.].
8
Khartode, Swati, Chandrakant Sahare, Kiran Shinde, Sushant Shinde, Chagan Khartode, and Namdev Jagtap. "Raisins with clarified butter or ghee for the relief of acute and chronic constipation - A Clinical Study." American Journal of Food Sciences and Nutrition 3, no. 2 (October 18, 2021): 1–15. http://dx.doi.org/10.47672/ajfsn.816.
Abstract:
Background: Constipation is a very distressful symptom, affecting to all age group. The only treatment is laxatives, which is having many adverse effects mainly dependency on laxatives.
Purpose: To evaluate the laxative effect of raisins and to get relief from daily dependency on laxative medicines for acute and chronic constipation
Methods: Interventional / Experimental study of raisins and clarified butter or ghee performed at ‘Vishwaraj Hospital’ Pune, Maharashtra, India from March 2021 to June 2021, after appropriate ethical approval obtained from the Vishwaraj Hospital’s Ethics Committee (Registration number- ECR/1138/Inst/MH/2018). Fifty one patients of constipation who were on laxatives or PR enema enrolled in this study, diagnosis confirmed by gastro-enetrologist. Laxatives had been asked to stop before enrollment. Questionnaire form were given at the time of enrollment and telephonic follow up for OPD patients and by visiting to admit patients had been taken on 2nd day after consumption of raisins and clarified butter or ghee then on 7th and 15th day. Forms were collected once they were visit to their respective doctors for follow up.
Results: Statistical tool used in this study is the 95 % confidence interval. The variables of interest were 1) percent of patients have restarted laxatives or not and 2) number of days required to get relief from constipation. 94.12 % of patients (n=48) did not restart laxatives after consumption of raisins and clarified butter or ghee and the population percent of patients that might not restart laxatives would be 88% to 100% with 95 % confidence. Also the number of days to get relief from constipation after consumption of raisins and clarified butter or ghee for a patient in population would be 3-4 days with 95 % confidence.
Conclusion: Raisins and CB or ghee had given relief from acute and chronic constipation; worked very well on irritable bowel syndrome, fissure in ano, hemorrhoids and helped to stop PR bleeding and bloating causes by these diseases. Patients got relief from constipation on 3rd and 4th day. This study concluded that raisins with clarified butter or ghee can be taken instead of laxatives or enema to get relief from constipation; this might be the great substitute for laxatives and per rectum enema.
9
Paré, Pierre, and Richard N. Fedorak. "Systematic Review of Stimulant and Nonstimulant Laxatives for the Treatment of Functional constipation." Canadian Journal of Gastroenterology and Hepatology 28, no. 10 (2014): 549–57. http://dx.doi.org/10.1155/2014/631740.
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BACKGROUND: Constipation is an uncomfortable and common condition that affects many, irrespective of age. Since 1500 BC and before, health care practitioners have provided treatments and prevention strategies to patients for chronic constipation despite the significant variation in both medical and personal perceptions of the condition.OBJECTIVE: To review relevant research evidence from clinical studies investigating the efficacy and safety of commercially available pharmacological laxatives in Canada, with emphasis on studies adopting the Rome criteria for defining functional constipation.SEARCH METHODS: PubMed, Medline, Embase and Evidence-Based Medicine Reviews databases were searched for blinded or randomized clinical trials and meta-analyses assessing the efficacy of nonstimulant and stimulant laxatives for the treatment of functional constipation.RESULTS: A total of 19 clinical studies and four meta-analyses were retrieved and abstracted regarding study design, participants, interventions and outcomes. The majority of studies focused on polyethylene glycol compared with placebo. Both nonstimulant and stimulant laxatives provided better relief of constipation symptoms than placebo according to both objective and subjective measures. Only one study compared the efficacy of a nonstimulant versus a stimulant laxative, while only two reported changes in quality of life. All studies reported minor side effects due to laxative use, regardless of treatment duration, which ranged from one week to one year. Laxatives were well tolerated by both adults and children.
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Ji-Xu, A., C. Moezinia, N. Lovett, and D. Krishan Sharma. "18 The Use of A Multifactorial Intervention to Improve Bowel Chart Recording and Laxative Prescription in A Tertiary Geriatrics Department." Age and Ageing 49, Supplement_1 (February 2020): i1—i8. http://dx.doi.org/10.1093/ageing/afz183.18.
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Abstract Introduction Constipation has a high prevalence of 30-40% in those aged over 65. It can lead to complications including delirium, faecal impaction, stercoral ulceration, and bowel obstruction. Although stool charts are used in geriatric wards to monitor bowel movements to guide management of constipation, they are often inconsistently recorded. Similarly, regular laxatives are often not prescribed for constipated patients due to ward pressures or unawareness regarding their importance. Aims Our aims were to audit the rates of recording on stool charts and laxative prescription in a geriatrics department, and to assess whether a multifactorial intervention aimed at both doctors and nursing staff improved these rates. Methods Two independent assessors audited the recording of stool charts, and rates of constipating medications and laxative prescription in two geriatrics wards in a tertiary UK hospital. A multifactorial intervention was implemented, consisting of didactic sessions for doctors and nurses, healthcare assistant champions to promote the recording of stool charts, and consolidation of bowel movement recording onto a single paper stool chart by the bedside rather than multiple charts. After the intervention, the data was re-audited on the same wards. Descriptive statistics and frequency tabulation were used for data analysis. Results Data was collected from 33 patients. Pre-intervention, stool charts were recorded daily in 13 patients, 10 patients had no stool chart record, 20 patients were on at least one constipating medication, 12 patients were prescribed at least one laxative, and 5 out of 7 patients with opiates had laxatives co-prescribed. Post-intervention, stool charts were recorded daily in 21 patients, all patients had a stool chart record, 20 patients were on at least one constipating medication, 23 patients were prescribed at least one laxative, and 2 out of 4 patients with opiates had laxatives co-prescribed. Our intervention improved daily recording on stool charts by 24%, resulted in all patients having a current stool chart and improved prescription of regular laxatives by 34%. Conclusions A multifactorial intervention based on educational sessions, healthcare assistants acting as champions, and consolidation of recording of bowel movements into a single chart, improved stool chart recording and prescription of regular laxatives in a tertiary geriatrics department. Future auditing will extend the sample size and generalise the intervention to other hospital departments.
11
Boyd, Holly, and Anna Manso de Zuniga. "Clozapine & constipation: an audit of bowel habit monitoring and laxative prescribing in inpatients on clozapine." BJPsych Open 7, S1 (June 2021): S67. http://dx.doi.org/10.1192/bjo.2021.220.
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AimsTo establish how often bowel habits are monitored in inpatients on clozapineTo determine how many of these patients are prescribed laxatives and whether these are utilisedBackgroundIt's estimated that 30-60% of patients will suffer from constipation whilst on clozapine; this can lead to ileus, intestinal obstruction and bowel ischaemia, all of which can be fatal. Constipation is much more common than clozapine-induced blood dyscrasias, and has a higher mortality rate. Despite this, there is no strict universal framework for bowel habit monitoring equivalent to the compulsory FBC monitoring. Local trust guidance indicates that bowel habits should be monitored regularly, at least at any point of blood sampling. However, monitoring processes across the trust were noted to be variable, as were laxative prescribing practices.MethodThe data sample of current inpatients on clozapine across the trust was identified from pharmacy records. The patient's Rio notes from the preceding 3 months were searched for predetermined terms relating to bowel habits and constipation, and the notes were then analysed for assessment of bowel habit. The number of FBCs collected during this 3 month period was then used to produce comparison with the audit standard. The data on laxative prescribing were collected from current medication lists on EPMA.ResultA data sample of 31 current inpatients was identified. The audit found that only 54.8% (17) of patients had their bowel habits monitored at least with every FBC taken. There was significant variability between different wards, with the best performing ward having 100% adherence to the audit standard, and the worst performing having 0%. In terms of laxative prescribing, it was found that 87.1% (27) of patients had at least 1 regular or 1 PRN laxative prescribed. Regular laxatives were prescribed for 61.2% (19) of patients, whereas only PRN laxatives were prescribed in 25.8% (8) of patients. Of those prescribed only PRN laxatives, only 50% (4) ever utilised this medication.ConclusionBowel habits are not consistently monitored across the trust in inpatients on clozapine, leaving room for potentially life-threatening side effects to be missed. Additionally, regular laxative prescribing is not standard throughout the trust, which could further add to the potential for significant constipation-related morbidity to occur. A standard method of monitoring bowel habits throughout the trust, as well as a trust laxative prescribing policy, could be a way of remedying this issue and preventing harmful outcomes for our patients on clozapine.
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&NA;. "Laxatives." Reactions Weekly &NA;, no. 354 (June 1991): 10. http://dx.doi.org/10.2165/00128415-199103540-00041.
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Round, Andrew M., Min Cheol Joo, Carolyn M. Barakso, Nader Fallah, Vanessa K. Noonan, and Andrei V. Krassioukov. "Neurogenic Bowel in Acute Rehabilitation Following Spinal Cord Injury: Impact of Laxatives and Opioids." Journal of Clinical Medicine 10, no. 8 (April 14, 2021): 1673. http://dx.doi.org/10.3390/jcm10081673.
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Objective: To explore the association between bowel dysfunction and use of laxatives and opioids in an acute rehabilitation setting following spinal cord injury (SCI). Methods: Data was collected regarding individuals with acute traumatic/non-traumatic SCI over a two-year period (2012–2013) during both the week of admission and discharge of their inpatient stay. Results: An increase in frequency of bowel movement (BM) (p = 0.003) and a decrease in frequency of fecal incontinence (FI) per week (p < 0.001) between admission and discharge was found across all participants. There was a reduction in the number of individuals using laxatives (p = 0.004) as well as the number of unique laxatives taken (p < 0.001) between admission and discharge in our cohort. The number of individuals using opioids and the average dose of opioids in morphine milligram equivalents (MME) from admission to discharge were significantly reduced (p = 0.001 and p = 0.02, respectively). There was a positive correlation between the number of laxatives and frequency of FI at discharge (r = 0.194, p = 0.014), suggesting that an increase in laxative use results in an increased frequency of FI. Finally, there was a significant negative correlation between average dose of opioids (MME) and frequency of BM at discharge, confirming the constipating effect of opioids (r = −0.20, p = 0.009).
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Gasior, Alessandra, Giulia Brisighelli, Karen Diefenbach, Victoria Lane, Carlos Reck, Richard Wood, and Marc Levitt. "Surgical Management of Functional Constipation: Preliminary Report of a New Approach Using a Laparoscopic Sigmoid Resection Combined with a Malone Appendicostomy." European Journal of Pediatric Surgery 27, no. 04 (October 25, 2016): 336–40. http://dx.doi.org/10.1055/s-0036-1593606.
Abstract:
Introduction Functional constipation is a common problem in children. It usually can be managed with laxatives but a small subset of patients develop intolerable cramps and need to be temporarily treated with enemas. The senior author has previously reported: 1) open sigmoid resection as a surgical option, but this did not sufficiently reduce the laxative need, then 2) a transanal approach (with resection of rectosigmoid), but this led to a high rate of soiling due to extensive stretching of the anal canal and loss of the rectal reservoir. The understanding of these procedures' results has led us to use a laparoscopic sigmoid ± left colonic resection with a Malone appendicostomy for these patients, to decrease the laxative requirements, temporarily treat with antegrade flushes, and to reduce postoperative soiling. Methods A single-institution retrospective review (3/2014–9/2015) included patients who failed our laxative protocol, and therefore were considered surgical candidates. Patients with anorectal malformation (ARM), Hirschsprung disease, spina bifida, tethered cord, trisomy 21, cerebral palsy, mitochondrial disease, prior colon resection at other facilities, or those that did not participate in our laxative program were excluded. Demographics, duration of symptoms, prior treatments, postoperative complications, and postoperative bowel regimens were evaluated. Results A total of 6 patients (3 males; median age of 12.5 years) presented with soiling related to constipation and intolerance to laxatives. Four patients failed preoperative cecostomy (done prior to referral to us). An average of 4.7 medication treatments were previously tried. In all, 4 patients had required in-patient disimpactions. Duration of symptoms was 7.5 years (median). The median senna dose was 30 mg (range, 15–150 mg), and all patients had intolerable symptoms or failed to empty their colon, which we considered a failed laxative trial. All had contrast enemas that demonstrated a dilated and/or redundant sigmoid colon, and colonic manometry was abnormal in 4. All patients underwent laparoscopic sigmoid and left colon resection, or only sigmoid resection (a low anterior resection). Two patients had postoperative colitis treated with oral antibiotics. The median follow-up was 52 days (range, 8–304 days). Five patients are on antegrade enemas with plans to convert to laxatives at 6 months, 1 is taking laxatives alone at a 33% lower dosage. Five of six are completely clean, 1 soils occasionally and their daily flush is being adjusted. Conclusion Only a minority of patients with functional constipation are medically unmanageable. This preliminary report shows that laparoscopic colon resection combined with antegrade flushes is an effective surgical technique to treat that group. A laparoscopic approach, guided by contrast enema and colonic manometry, allows for a defined resection of the abnormal segment of colon with the advantages of minimally invasive surgery including allowing for an extensive rectal resection (an improvement over open sigmoid resection) and avoidance of overstretching of the anal canal and removal of the rectal reservoir (an improvement over the transanal approach). Having antegrade access is useful to manage soiling and avoiding cramping from laxatives in the early postoperative period. Although our series is small, we believe that long-term most patients can avoid antegrade flushes and be on no, or a dramatically reduced, laxative dose.
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Laiyemo, Adeyinka O., Kolapo A. Idowu, Clinton Burnside, Carla D. Williams, Momodu Jack, Getachew Mekasha, Hassan Ashktorab, et al. "Comparison of patterns of laxative ingestion to improve bowel preparation for colonoscopy: a pilot randomized clinical trial." Endoscopy International Open 08, no. 05 (April 17, 2020): E617—E622. http://dx.doi.org/10.1055/a-1118-3526.
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Abstract Background and study aims Negative experiences with bowel preparation are a barrier to uptake of colonoscopy. The aim of this study was to examine the impact of different flavoring of polyethylene glycol (PEG) laxatives on patient satisfaction with and adequacy of bowel preparation during colonoscopy. Patients and methods This was a single-blind (endoscopist), parallel design, randomized trial (NCT 02062112) during which patients scheduled for colonoscopy were assigned to one of three groups: Group 1 (no laxative flavoring, n = 84); Group 2 (flavored entire laxative, n = 90) and Group 3 (tasted PEG with and without flavoring and decided how they want to drink the rest of the laxatives (choice group), n = 82). Patients rated their bowel preparation experience (satisfaction) and endoscopists accessed adequacy of bowel preparation during colonoscopy. Results There were no differences in patient ratings across the groups (1, 2 and 3) in taste of the laxatives (P = 0.67), ease of drinking (P = 0.53), and overall experience of bowel preparation process (P = 0.18). However, higher percentage of patients in the choice group would want the same laxative again if they were going to have a repeat colonoscopy in the future (72.5 % vs 81.3 % vs 88.9 %, P = 0.04). Surprisingly, adequacy of bowel preparation was highest among patients who drank their PEG unflavored (89.3 % vs 80 % vs 75.5 %, P = 0.07) and the had highest rates of adenoma detection (40.5 % vs 23.3 vs 39.0, P = 0.03). Conclusions There were no differences in overall tolerability of bowel preparation by patterns of flavoring of PEG. Those who drank unflavored PEG were less satisfied but had better clinical outcome, suggesting minimum justification effect in bowel preparation process.
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Kim, Won Shik, and Beom Jae Lee. "Safe and appropriate use of laxatives for colonoscopy." Journal of the Korean Medical Association 64, no. 8 (August 10, 2021): 561–69. http://dx.doi.org/10.5124/jkma.2021.64.8.561.
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Background: Appropriate bowel preparation is essential for effective colonoscopy. Inadequate use of bowel preparation solutions reduces patient compliance, makes the detection of lesions such as adenoma difficult, and increases the risk of complication such as perforation. Current Concepts: A 4-L polyethylene glycol (PEG) solution can be safely used for bowel preparation, even in most individuals with underlying diseases. However, it requires a high preparation-volume intake and has poor patient compliance due to its unpleasant taste. Therefore, a 2- or 1- L sulfate-free, PEG-based laxative was developed to, reduce the amount of PEG and improve the taste. Furthermore, simethicon-containing laxative formulation was developed to eliminate gas bubbles. In addition, oral bowel preparation solutions with enema agents and prokinetics were used to improve bowel preparation, but no improvement was observed. Various alternative laxatives are available; however, PEG-based bowel preparation solutions are still recommended in most cases due to their stability. Discussion and Conclusion: Although a 4-L PEG solutions recommended for bowel preparation in most cases, several laxatives have been introduced to overcome its disadvantages. The laxative agent must be selected according to each patient’s specific characteristics. Moreover, the method of taking bowel preparation solutions and additional bowel preparation medications must be carefully chosen. In addition, patient education via various methods, such as using a smartphone, when taking a bowel preparation agent may help improve bowel preparation quality.
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Gelder, Chloé Louise, Melissa Bautista, Sidra Arif Awan, and Ian A. Anderson. "Unaccounted for enteral volume loss linked to delayed cerebral ischemia after subarachnoid hemorrhage." Neurosurgical Focus 52, no. 3 (March 2022): E5. http://dx.doi.org/10.3171/2021.12.focus21603.
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OBJECTIVE Delayed ischemic neurological deficit (DIND) is seen as a clinical manifestation of cerebral vasospasm and is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Currently, the standard of care for DIND prevention in patients who have sustained aSAH is prophylactic nimodipine therapy and ensuring adequate fluid intake, alongside other treatments such as bowel care. Osmotic laxatives trap water within the bowel lumen to accelerate the transport of the gut contents through the bowel. Given the potential for DIND secondary to cerebral vasospasm, it is perhaps counterintuitive that gastrointestinal fluid loss and use of osmotic laxatives are not commonly considered in many aSAH management protocols. METHODS A retrospective case note analysis was performed for all adult patients (aged > 16 years) admitted to the Department of Neurosurgery at Leeds General Infirmary with a diagnosis of aSAH between August 2019 and September 2020. RESULTS A total of 105 patients were included, 62% of whom were female, with a mean and median age of 54 years (range 24–84 years). Diarrhea was noted in 12 patients (11.4%), 58% of whom subsequently developed DIND (OR 15.30, CI 3.92–59.14; p = 0.0001). All patients received osmotic laxatives (97% having received ≥ 2 laxative agents). CONCLUSIONS Patients with aSAH who subsequently developed diarrhea had significantly increased odds of developing DIND. Enteral volume loss due to osmotic laxative use is a potential risk factor for DIND after aSAH.
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Al-Bahou, Amanda, Rod Quilitz, Yanina Pasikhova, and John Greene. "755. Clostridioides difficile Testing and the Use of Laxatives in Immunocompromised Adults." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S474—S475. http://dx.doi.org/10.1093/ofid/ofab466.952.
Abstract:
Abstract Background Clostridioides difficile infection (CDI) rates have plateaued at historical highs in the United States since 2010 and remains a major health problem. While optimal CDI testing remains unclear, current literature recommends testing patients whose symptoms are not clinically attributable to underlying conditions, e.g., laxatives. At Moffitt Cancer Center, a soft-stop alert was implemented to alert the provider if the patient received a laxative within the previous 48 hours of CDI testing. We aim to evaluate the incidence of CDI rates with prior laxative use in immunocompromised patients, as well as, the impact of the soft-stop alert in reducing CDI testing. Methods Retrospective, single-center, review of adult patients who were tested for CDI after the implementation of the soft-stop alert from October 1, 2020 to December 21, 2020. These patients were compared to a historical cohort of patients who were tested for CDI prior to the alert implementation from October 1, 2019 to December 31, 2019. The primary outcome was the percent of patients that received a laxative within 48 hours of CDI testing pre-alert compared to post-alert. Secondary outcomes included the percent of colonization versus active infection in this immunocompromised population, number and type of laxatives administered prior to testing, and the frequency of alert and reduction of CDI tests ordered. A cost-benefit analysis was also performed. Results In the historical cohort (n=480), 14.8% received a laxative within 48 hours of CDI testing (Figure 1). Within patients who received a laxative in this group, 4.2% had a definitive active infection. After the alert was implemented, a total of 630 CDI tests were ordered from October 1, 2020 to December 31, 2020, and the alert was fired for 123 (19.5%) tests ordered (Figure 2). Of the tests where the alert was fired, the CDI test was removed for 42.3% and continued for 57.7% of orders resulting in savings of &3,263. In this cohort, 5.6% of patients had a definitive active CDI infection who received a laxative and testing was continued (Figure 3). Figure 2: CDI Test and Laxative Administration Alert Figure 3: Post-Alert Laxatives Administered and CDI Test Result Conclusion The soft-stop alert implemented reduced CDI testing in patients who received a laxative in the last 48 hours correlating with a financial benefit, improvement in guideline adherence, and reduction in laboratory labor. Disclosures All Authors: No reported disclosures
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Torriani, Francesca, Frank Myers Robert El-Kareh, Minji Kang, Randy Taplitz, and Shira Abeles. "Clostridioides difficile Testing Stewardship for Laxative Use Is Effective and Safe When Combined With Expert Clinical Input." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s169—s170. http://dx.doi.org/10.1017/ice.2020.696.
Abstract:
Background: In January 2019, our large academic medical center implemented hard stops for ordering Clostridiodes difficile nucleic acid amplification testing (NAAT), and required a discussion with an infectious diseases physician if the order was placed in a clinical scenario not consistent with the 2017 IDSA/SHEA C. difficile infection (CDI) testing guidelines. Recently, some groups have expressed concerns that requiring the discontinuation of laxatives may delay the diagnosis of CDI and result in serious adverse outcomes. Methods:C. difficile testing stewardship interventions were performed at 2 hospitals within the same university health system to reduce inappropriate testing. In January 2019, a best practice advisory (BPA) was implemented to alert providers ordering C. difficile NAAT if patients had received laxatives within 24 hours, requiring a discussion with the ID physician to override the hard stop. We reviewed clinical outcomes of patients who had a BPA alert due to laxative use within the past 24 hours April 23 to October 23, 2019. Results: During the study period, there were 235 patients with a BPA because of laxative use within the past 24 hours. Moreover, 55 (23.4%) continued to experience diarrhea after the discontinuation of laxatives and were retested for CDI within 7 days. Only 8 tests returned positive, suggesting that, at most, 3.4% of cases had delayed diagnoses because of the hard stop. This finding is supported by the increase in the percentage of tests positive from 11.6% observed overall to 14.6% (8 of 55) after this intervention. There were no severe CDI cases (ICU admission, colectomy, or death) among patients who had delayed testing due to laxative use. Conclusions: In the setting of laxative use, C. difficile testing stewardship interventions with C. difficile NAAT using a hard-stop BPA are effective in reducing unnecessary testing and safe if they are used in combination with a real-time expert input of the risk of clinical disease.Funding: NoneDisclosures: None
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Kirkpatrick, F., and P. Crawford. "551 EASING THE STRAIN OF CONSTIPATION IN CARE HOMES." Age and Ageing 50, Supplement_2 (June 2021): ii8—ii13. http://dx.doi.org/10.1093/ageing/afab116.20.
Abstract:
Abstract Introduction Older individuals are particularly prone to constipation with a reported prevalence of up 50% for those living in community with the prevalence rising to 70% within nursing homes (De Giorgio et al, 2015 1). Objectives To assess impact of staff education & pharmacist intervention on appropriateness of laxative use: Staff education: Examine the baseline knowledge of care home staff on constipation and laxative use: Formulate an education package to deliver to care home staff on key aspects of laxative use: Evaluate the staff knowledge, post the educational intervention.: Impact of pharmacist medication review on laxative use: Evaluate impact of pharmacist review on appropriateness of laxative use in care Homes. Method Three BHSCT Care Homes being case managed by the Medicines Optimisation Pharmacist were included in the study. Staff Education: The baseline knowledge of care home staff was examined by questionnaire, pre- and post-educational intervention on key aspects of laxative use. Staff directly administering medication or directly impacting on patients’ care in were included. An education package on key aspects of laxative use for delivery in nursing homes was designed and implemented. Impact of Pharmacist medication review on laxative use: We retrospectively examined if 30 patients were prescribed multiple laxatives from the same group as an indicator of inappropriate laxative use, pre and post pharmacist intervention. Results Staff education: Thirty-three staff completed the questionnaires. The educational package developed on laxative use had a positive impact on the knowledge of the staff on constipation and laxative use with statistically significant improvements in staff knowledge post education, with p-value <0.05. Healthcare assistants’ mean percentage increase in knowledge following education mirrored that of nursing staff at almost 50%. Impact of Pharmacist medication review on laxative use: There was a statistically significant improvement in appropriateness of laxative prescribing following the pharmacist led medication review of 30 residents. Fewer patients were prescribed laxatives from the same class following medication reviews with a p value of < 0.00001, the result is significant at p < 0.05. Discussion The positive impact of this study supports the conclusion by Chen et al 2 (2014) that patient and carer education should be first line treatment for non-severe constipation. Shen Q et al 3 (2018) suggested that educational intervention for patients can effectively improve constipation symptoms, treatment and result in improved health habits however this study provides further evidence that the education of care home staff plays a significant role in improving the appropriate management of constipation for care home residents. Pharmacist-led review of laxatives has the potential to improve a Care Home resident’s quality of life, as previously suggested by Dennison et al 4 (2005), with the potential to reduce the risk of complications or hospital admissions from ineffective treatment of chronic constipation. Conclusion The development & delivery of a bespoke laxative educational package along with pharmacist medication review of residents’ current laxatives regimes resulted in a statistically improved appropriateness in laxative use. The education package developed will be shared with Medicines Optimisation for Older People (MOOP) Care Home Pharmacists for delivery in NI trusts. References 1. De Giorgio et al. 2015. Chronic constipation in the elderly: a primer for gastroenterologist. BMC Gastroenterology, 14:130. 2. Dennison, C et al. 2005. the health-related quality of life and economic burden of constipation. Pharmaceoconmics 23 (5), 461–476. 3. Chen I. C. et al. (2014). Prevalence and effectiveness of laxative use among elderly residents in a regional hospital affiliated nursing home in Hsinchu County. Nursing and Midwifery Studies, 3(1), e13962. 4. Shen Q et al. (2018) Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation. West J Nurs Res. 2018 Jun;40(6):874–888. 5. Dennison et al. (2005) The Health-Related Quality of Life and Economic Burden of Constipation. Pharmacoeconomics, 23 (5), 461–476.
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McMillan, Matthew, and Alexandra Jayne Burgess. "Prescribe, Review, Now!: an assessment of adequate PRN analgesia and associated laxative prescribing using Hospital Electronic Prescribing and Medicines Administration (HEPMA)." BMJ Open Quality 12, no. 1 (February 2023): e002090. http://dx.doi.org/10.1136/bmjoq-2022-002090.
Abstract:
IntroductionOn HEPMA there is no way to notify a prescriber if patients are regularly accessing PRN (as-required) analgesia. We aimed to assess how well PRN analgesia use is identified, the WHO analgesic ladder and whether laxatives were prescribed with opioid analgesia.Methods3 data collection cycles were carried out for all medical inpatients between February-April 2022. Medication was reviewed to determine: 1) PRN analgesia prescribed? 2) Is the patient accessing it >3 times in 24hours? 3) Con-current laxatives prescribed. Between each cycle, an intervention was implemented. Intervention 1: Posters were placed on each ward and circulated electronically as a cue to a review and change analgesia “Prescribe. Review. Now!” Intervention 2: A presentation on data, the WHO analgesic ladder and laxative prescribing was created, and circulated.ResultsSee Figure 1 – Comparison of prescribing per cycle. Cycle 1 - 167 inpatients surveyed, 58%female, 42%male, mean age 78(±13.4). Cycle 2 - 159 inpatients,65% female, 35% male, mean age of 77 (±15.7). Cycle 3 - 157 inpatients, 62% female, 38% male, mean age 78 (±15.7). Adequate prescriptions on HEPMA improved by a total of 31% (p<0.005), over 3 cycles and 2 interventions.ConclusionsAfter each intervention there was a significant statistical improvement in prescribing analgesia and laxatives. However, there is still room for further improvement, especially in ensuring adequate laxative cover is prescribed for all patients either >65 years old, or those on opioid-based analgesia. Visual reminders on wards of regularly checking PRN medication showed to be an effective intervention.
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Filho, Aldo J. Peixoto, and M. Nathan Lassman. "Severe Hyperphosphatemia Induced by a Phosphate-Containing Oral Laxative." Annals of Pharmacotherapy 30, no. 2 (February 1996): 141–43. http://dx.doi.org/10.1177/106002809603000206.
Abstract:
OBJECTIVE: To describe a case of severe hyperphosphatemia following unintentional overdosage with an oral phosphate laxative, and raise attention to the risks of using such medications in the elderly. CASE SUMMARY: An 84-year-old white woman was admitted with confusion 8 hours after inadvertently ingesting 12 fluid ounces of Fleet Phospho-Soda (instead of the prescribed 1½ fluid ounces) prior to a colonoscopy. Her serum phosphate and ionized calcium concentrations were 10.3 mmol/L and 0.56 mmol/L, respectively. She was treated conservatively with oral phosphate binders and made an uneventful recovery. DISCUSSION: Several previous reports have described hyperphosphatemia in association with phosphate laxatives, especially in patients with renal or colonic disease. Our case again presents two important issues in the use of phosphate laxatives by the elderly: (1) the frequently overlooked underlying renal insufficiency in which, despite “normal” serum creatinine values, renal phosphate handling may be impaired; and (2) the potential for drug misuse and poor compliance in the elderly. CONCLUSIONS: Caution should be taken with the use of phosphate laxatives in the elderly in the face of potentially serious metabolic abnormalities that may be generated.
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Christensen, Helene Nordahl, Urban Olsson, Jesper From, and Harald Breivik. "Opioid-induced constipation, use of laxatives, and health-related quality of life." Scandinavian Journal of Pain 11, no. 1 (April 1, 2016): 104–10. http://dx.doi.org/10.1016/j.sjpain.2015.12.007.
Abstract:
AbstractBackground and aimsReal-life data on laxative use in patients suffering from opioid-induced constipation (OIC) are very limited, and many OIC patients are only using over the counter laxatives to resolve their constipation. Our aim was to describe laxative utilization and quality of life in participants in Norway who ever experienced OIC.MethodsThis was a cross-sectional online survey conducted between 27th of June and 3rd of July 2014 among participants above 18 years with self-reported OIC and who had agreed to receive information from the pharmacy chain (Boots A/S, Norway). The questionnaire comprised a series of multiple choice, close-ended, and free text questions on abdominal symptoms, laxative use and health-related quality of life.ResultsA total of 417 participants met the study eligibility criteria: (1) treated with opioid for a minimum of 4 weeks, (2) actively accepted participation, and (3) confirmed ever experiencing OIC and in addition completed the survey. Among the eligible participants, 86% were females, 85% were younger than 60 years of age, and 57% were currently suffering OIC. More than half of the currently constipated participants were experiencing moderate to very severe abdominal bloating (63%), abdominal pain (55%) and/or pain during bowel movement (50%). Less than every fourth participant (23%) had consulted health care professionals (HCPs) about their constipation. Up to 39% reported that they handled their OIC by self-management, e.g., bought laxative, reduced the dose and/or changed opioid without consulting HCP or pharmacy. Less than half (48%) of the laxative users were satisfied with the laxative they were using to relieve their constipation. The EQ-5D health-related quality of life score was mean (SD): 0.587 (0.272). Although not statistically significant (p = 0.067), there was a tendency of lower quality of life among the participants who were currently constipated compared with those not currently constipated (difference of mean EQ-5D: 0.629-0.555 = 0.074). A significantly lower (p = 0.001) quality of life was found among participants who were dissatisfied with their laxative [mean (SD): 0.424 (0.350)] than among those who were satisfied or neither satisfied nor dissatisfied [mean (SD): 0.628 (0.235) and 0.673 (0.155), respectively].ConclusionsThe results suggest a high degree of moderate to very severe abdominal symptoms, a high degree of self-management of opioid-induced constipation, a low degree of satisfaction with laxative, and low health-related quality of life of patients suffering from chronic pain necessitating long-term opioid treatment, subsequent constipation and laxatives use.ImplicationsPatients suffering from OIC with low quality of life and remaining symptoms despite use of two or more laxatives are a vulnerable patient group in need of optimized healthcare management, who also might benefit from more specific and innovative therapy.
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Rockney, Randy. "LAXATIVES [letter]." Pediatric Annals 28, no. 7 (July 1, 1999): 412. http://dx.doi.org/10.3928/0090-4481-19990701-05.
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Spiller, H. A. "Senna Laxatives." Clin-Alert 41, no. 9 (May 15, 2003): 3. http://dx.doi.org/10.1177/0069477003041009004.
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Lee, Bong Eun, Tae Hee Lee, Seong-Eun Kim, Kyung Sik Park, Seon-Young Park, Jeong Eun Shin, Kee Wook Jung, Suck Chei Choi, Kyoung Sup Hong, and Sung Noh Hong. "Conventional Laxatives." Korean Journal of Medicine 88, no. 1 (2015): 1. http://dx.doi.org/10.3904/kjm.2015.88.1.1.
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Shelton, Joseph H., Carol A. Santa Ana, Donald R. Thompson, Michael Emmett, and John S. Fordtran. "Factitious Diarrhea Induced by Stimulant Laxatives: Accuracy of Diagnosis by a Clinical Reference Laboratory Using Thin Layer Chromatography." Clinical Chemistry 53, no. 1 (January 1, 2007): 85–90. http://dx.doi.org/10.1373/clinchem.2006.077883.
Abstract:
Abstract Background: Surreptitious ingestion of laxatives can lead to serious factitious diseases that are difficult to diagnose. Most cases involve ingestion of bisacodyl or senna. Thin layer chromatography (TLC) of urine or stool is the only commercially available test for these laxatives. Such testing is considered highly reliable, but its accuracy in clinical practice is unknown. Our aim was to evaluate the reliability of TLC laxative testing by a clinical reference laboratory in the United States. Methods: Diarrhea was induced in healthy volunteers by ingestion of bisacodyl, senna, or a control laxative (n = 11 for each laxative group). Samples of urine and diarrheal stool were sent in blinded fashion to the clinical reference laboratory for bisacodyl and senna analysis. Results: TLC testing for bisacodyl-induced diarrhea revealed a sensitivity of 73% and specificity of 91% when urine was tested and sensitivity and specificity of 91% and 96%, respectively, when stool was analyzed. When diarrhea was induced by senna, the TLC assay for senna failed to identify even a single urine or stool specimen as positive (zero% sensitivity). Conclusions: Considering the expected prevalence of surreptitious laxative abuse in patients with chronic idiopathic diarrhea (2.4%–25%, depending on the clinical setting), TLC of urine or stool for bisacodyl by this reference laboratory would often produce misleading results, and testing for senna would have no clinical value. The major problems are false-positive tests for bisacodyl and false-negative tests for senna.
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Plotnikova, E. Yu, T. Yu Gracheva, M. N. Sinkovа, and L. K. Isakov. "The role of dietary fiber in the correction of digestion and constipation of various etiologies." Medical Council, no. 14 (October 11, 2019): 99–106. http://dx.doi.org/10.21518/2079-701x-2019-14-99-106.
Abstract:
Psyllium is a predominantly soluble fiber among other natural plant-based dietary fiber used in food and pharmaceuticals and is sold as a laxative fiber. Isphagula (lat. ispaghula)– international nonproprietary name of a medicine of «psyllium». Accordingly to ATX belongs to the group of «Laxatives», subgroup «A06AC «Laxatives increasing volume of intestinal contents» (Bulking laxatives) and has the following code and name: «A06AC01 «Ispaghula» (plantain oval seeds)». Isphagula is a medical dietary fiber; in the context of gastrointestinal problems in terms of «ispaghula» and «psyllium» are synonymous. Psyllium flour has virtually no digestible carbohydrates. This fact is a significant advantage of psyllium over oat bran, in which such carbohydrates are more than 60%. A distinctive feature of psyllium is that it is almost completely (80–85%) consists of fiber (about 70% of which is soluble), which in contact with water turns into a soft gel. Only 1 gram of fiber ground fiber flour is able to absorb up to 45 ml of water. In the colon, psyllium is resistant to fermentation, remains intact in the feces and significantly increases the water content in the feces, providing a laxative effect. Psyllium softens hard stools in constipation, normalizes loose stools in diarrhea, and normalizes stool shape in patients with IBS, relieving gastrointestinal symptoms. Dietary supplement «Fitomucil® Norm» contains 4.5 g of psyllium (Plantago psyllium), and dry pulp of prunes (Prunus domestica) – 0.5 g. This combination of psyllium and prunes can be widely used in patients with constipation and other functional digestive disorders in different age groups, including pregnant and lactating women, as a first-line remedy.
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Plotnikova, E. Yu, and K. A. Krasnov. "Constipation needs to be treated." Medical Council, no. 14 (October 10, 2018): 61–66. http://dx.doi.org/10.21518/2079-701x-2018-14-61-66.
Abstract:
The article presents etiology, pathophysiology and epidemiology of constipation. The main groups of drugs that are used for this pathology are described in the section Treatment of Constipation. Stimulant laxatives are the most commonly demanded by the patients. The article provides the analysis of the use of sodium picosulfate in various clinical studies. Sodium picosulfate is one of the main drugs from the stimulant laxative group.
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Morales, M. A., D. Hernández, S. Bustamante, I. Bachiller, and A. Rojas. "Is Senna Laxative Use Associated to Cathartic Colon, Genotoxicity, or Carcinogenicity?" Journal of Toxicology 2009 (2009): 1–8. http://dx.doi.org/10.1155/2009/287247.
Abstract:
Due to their natural origin, apparent low oral toxicity, effectiveness, and accessibility without a medical prescription, the anthranoid laxatives are a popular remedy for constipation and are frequently used abusively. Therefore, it is important to characterize its harmful and/or toxic effects. The sennosides, main active metabolites of senna, exhibit a very low toxicity in rats, and its genotoxic activity in bacterial strains as well as mammal cells was classified as weak in those cases where it was shown to be significant. The toxicological and mutagenic status of the crude extract of senna, however, is not as well characterized, and it is necessary to do so since it is frequently, and at the same time incorrectly, believed that the chronic use of anthranoid laxatives is a risk factor for the development of colorectal cancer. The objective of this article was to review the information that arises in various scientific medical databases using key words such as senna, sen,Senna alexandrina, Cassia angustifolia, sennosides, laxative toxicity, mainly ISI and non-ISI articles of journals with an editorial committee. Web pages of products or companies that publicize or commercialize this type of laxative were not included. This analysis establishes that (1) there is no convincing evidence that the chronic use of senna has, as a consequence, a structural and/or functional alteration of the enteric nerves or the smooth intestinal muscle, (2) there is no relation between long-term administration of a senna extract and the appearance of gastrointestinal tumors or any other type in rats, (3) senna is not carcinogenic in rats even after a two-year daily dose of up to 300 mg/kg/day, and (4) the current evidence does not show that there is a genotoxic risk for patients who take laxatives containing senna extracts or sennosides.
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Shin, Jeong Eun, Kyoung Sup Hong, Kee Wook Jung, Tae Hee Lee, Bong Eun Lee, Seon-Young Park, Sung Noh Hong, Seong-Eun Kim, Kyung Sik Park, and Suck Chei Choi. "Guidelines for the Use of Laxatives: Which Laxatives, When?" Korean Journal of Medicine 88, no. 1 (2015): 22. http://dx.doi.org/10.3904/kjm.2015.88.1.22.
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Balekuduru, Avinash, and Manoj Kumar Sahu. "Expert opinion on the habit forming properties of laxatives in patients with constipation." F1000Research 11 (July 19, 2022): 803. http://dx.doi.org/10.12688/f1000research.123407.1.
Abstract:
Constipation is a commonly reported disorder in many patients. Constipation treatment using laxatives on a regular and long term basis can lead to patient dependence, especially among the elderly. However, there is scanty data on the habit-forming potential of laxatives in Indian constipated patients. This review has explored literature evidence and expert opinion on patients’ experience regarding habit-forming attributes of stimulant and osmotic laxatives. Additionally, structured face-to-face discussions were conducted with 2 key opinion leaders to understand their clinical experience on the habit-forming aspects stimulant and osmotic laxatives in patients with constipation. Based on literature evidence, lactulose is not known to lead to any habit-forming behaviors in patients. Furthermore, experts pointed out that dependence on stimulant laxatives is common, but not on osmotic laxatives, and emphasized that milk of magnesia is not habit forming. In conclusion, no habit-forming characteristics or dependence was observed with the use of osmotic laxatives in India. Nevertheless, real-world, studies exploring patient and physician perspectives are warranted to establish the dependence and habit forming attributes of laxatives.
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Ибрагимова, Л. Н., М. Ж. Наурызгалиева, З. Б. Сакипова, and О. В. Сермухамедова. "ANALYSIS OF LAXATIVE DRUGS IN THE PHARMACEUTICAL MARKET OF THE REPUBLIC OF KAZAKHSTAN." Farmaciâ Kazahstana, no. 3 (July 16, 2021): 26–31. http://dx.doi.org/10.53511/pharmkaz.2021.53.45.007.
Abstract:
В статье представлен обзор рынка слабительных лекарственных за 2020 г., установлены основные особенности развития данного сегмента фармацевтического рынка Казахстана. Проведен анализ слабительных препаратов по соотношению стран-производителей, лекарственных форм, цен. The article provides an overview of the market for laxative drugs for 2020 and identifies the main features of this segment of the pharmaceutical market in Kazakhstan. The analysis of laxatives according to the ratio of manufacturing countries, dosage forms, prices was carried out.
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Torii, Akira. "V. Osmotic Laxatives." Nihon Naika Gakkai Zasshi 108, no. 1 (January 10, 2019): 36–39. http://dx.doi.org/10.2169/naika.108.36.
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Shannon, Michael, Susan S. Fish, and Frederick H. Lovejoy. "Cathartics and Laxatives." Medical Toxicology 1, no. 4 (August 1986): 247–52. http://dx.doi.org/10.1007/bf03259841.
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Hong, Sung Noh, Jeong Eun Shin, Kyoung Sup Hong, Kee Wook Jung, Tae Hee Lee, Bong Eun Lee, Sun-Young Park, Seong-Eun Kim, Kyung Sik Park, and Suck Chei Choi. "New Generation Laxatives." Korean Journal of Medicine 88, no. 1 (2015): 9. http://dx.doi.org/10.3904/kjm.2015.88.1.9.
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Johnson, C. D., M. Chir, J. Budd, and A. J. Ward. "Laxatives after hemorrhoidectomy." Diseases of the Colon & Rectum 30, no. 10 (October 1987): 780–81. http://dx.doi.org/10.1007/bf02554626.
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Hale, Martin E., James E. Wild, Tadaaki Yamada, Takaaki Yokota, Jan Tack, Viola Andresen, and Asbjørn Mohr Drewes. "Naldemedine is effective in the treatment of opioid-induced constipation in patients with chronic non-cancer pain who had a poor response to laxatives." Therapeutic Advances in Gastroenterology 14 (January 2021): 175628482110323. http://dx.doi.org/10.1177/17562848211032320.
Abstract:
Background: Two studies demonstrated the efficacy and safety of naldemedine in adult patients with chronic non-cancer pain and opioid-induced constipation (OIC). However, no studies have compared the efficacy of peripherally acting µ-opioid receptor antagonists in patients with adequate and inadequate responses to prior OIC therapy with laxatives. This post hoc analysis of integrated data from the two previous studies compared the efficacy of naldemedine in patients who were unsuccessfully treated with laxatives [poor laxative responders (PLRs)] with those who either did not receive laxatives >30 days prior to screening or those who only received rescue laxative at or after screening (non-PLRs). Methods: Patients with OIC were randomized to once-daily treatment with naldemedine 0.2 mg or placebo. The primary efficacy endpoint was the proportion of responders [⩾3 spontaneous bowel movements (SBMs)/week and an increase from baseline of ⩾1 SBM/week for ⩾9 weeks of the 12-week treatment period and ⩾3 weeks of the final 4 weeks of the 12-week treatment period]. Additional endpoints included change in SBM frequency, change in frequency of SBMs without straining, proportion of complete SBM (CSBM) responders, change in CSBM frequency, and time to first SBM. Treatment-emergent adverse events (TEAEs) were assessed. Results: The analysis included 538 (317 PLRs, 221 non-PLRs) and 537 (311 PLRs, 226 non-PLRs) patients in the naldemedine and placebo arms, respectively. There were significantly more responders in the naldemedine PLR (46.4%; p < 0.0001) and non-PLR (54.3%; p = 0.0009) subgroups versus the placebo groups (30.2% and 38.9%, respectively). In both the PLR and non-PLR subgroups, naldemedine treatment was superior to placebo on all additional endpoints. Overall incidence of TEAEs in the PLR subgroups treated with naldemedine or placebo was similar. Conclusion: This integrated analysis further supports the efficacy and tolerability of naldemedine in the treatment of OIC and demonstrates a consistent effect in both PLR and non-PLR subgroups. [ ClinicalTrials.gov identifier: NCT01965158 and NCT01993940]
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&NA;. "Combat laxative abuse by stopping stimulant laxatives and establishing healthy gastrointestinal function." Drugs & Therapy Perspectives 27, no. 3 (March 2011): 12–14. http://dx.doi.org/10.2165/11206580-000000000-00000.
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Vasudev, A., I. Mohamed, H. Jacques, and P. Nicolson. "135 A Quality Improvement Project Aimed to Reduce the Number of Patients on Bournville Ward Suffering with Constipation." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.96.
Abstract:
Abstract Introduction Constipation is exceedingly common on geriatric wards, with 20–50% prevalence. It is associated with complications; including pain, delirium and obstruction. Laxatives, often considered the solution, introduce their own side effects and increase polypharmacy especially in elderly populations. Queen Elizabeth Hospital Birmingham guidelines advocate use of conservative measures, including adequate fluid and fibre intake and increasing exercise, to prevent and treat constipation prior to use of laxatives. However, we had observed that these methods were frequently underutilised, and cause of constipation was rarely considered. We aimed to reduce the prevalence of inpatient constipation and associated complications through the introduction of teaching sessions and multidisciplinary team (MDT) discussions, focusing on staff and patient education on the recognition and conservative managements of constipation. Method We audited notes weekly for the recognition of constipation, appropriate bowel examination, use of conservative management including patient education and any complications. Baseline data was collected from Bournville Ward over 4 weeks (n = 44), after which, teaching sessions for all regular ward staff and weekly MDT discussion for patients recognised as constipated were introduced. Patients having not opened bowels for >2 days were targeted for early simple non-laxative interventions. A further 4-week cycle of data was collected (n = 43). Results Constipation was recognised in 57% of patients studied, of which 64% developed constipation during inpatient stay and 20% experienced associated complications. The introduction of teaching session and MDT reviews increased patient education, cause recognition and non-laxative methods use by 19%, 27% and 30% respectively. Constipation developed during inpatient stay and associated complications decreased by 6% and 4% respectively. Conclusion Despite increased patient education, cause recognition and utilisation of conservative non-laxative approaches, only a small impact was made in reducing inpatient constipation prevalence and associated complications occurring.
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McClung, H. Juhling, Linda J. Boyne, Thomas Linsheid, Leo A. Heitlinger, Robert D. Murray, John Fyda, and B. U. K. Li. "Is Combination Therapy for Encopresis Nutritionally Safe?" Pediatrics 91, no. 3 (March 1, 1993): 591–94. http://dx.doi.org/10.1542/peds.91.3.591.
Abstract:
Chronic constipation accounts for 3% to 5% of pediatric primary care outpatient visits. The most severely affected of this group develop a flaccid colon insensitive to distention, and encopresis. Laxatives and lubricants have been the standard therapeutic agents during the bowel decompression phase of encopretic therapy. Fiber has been the cornerstone of maintenance programs. Each of these agents is accompanied by considerable anxiety in the lay literature. This study evaluates the safety of combined high-fiber, laxative, and lubricant therapy on bowel movement frequency, fecal soiling, and nutritional status over a 6-month period. Blood chemistry values, dietary fiber intake, defecation pattern, and a psychological profile were evaluated before and after the 6-month study. Biochemical and anthropometric indicators of nutritional status were not adversely affected by the therapy. Seventy-five percent of the children were able to remain free of soiling and the remaining 4 of 16 had soiling episodes reduced to a frequency of less than once a week. This study confirms that children with encopresis can respond to a combined program of increased fiber intake, laxatives, and mineral oil following a complete bowel cleanout, without experiencing deleterious effects.
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Attard, Azizah, Andrew Iles, Stephen Attard, Nathan Atkinson, and Anita Patel. "Clozapine: why wait to start a laxative?" BJPsych Advances 25, no. 6 (June 14, 2019): 377–86. http://dx.doi.org/10.1192/bja.2019.42.
Abstract:
SUMMARYClozapine, the antipsychotic of choice for treatment-resistant schizophrenia, has a number of side-effects, some of which are potentially life-threatening. Historically viewed as a relatively minor side-effect, there is increasing awareness of the potentially severe sequalae of constipation secondary to clozapine-induced gastrointestinal hypomotility (CIGH). These include ileus, intestinal obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death. CIGH is significantly more common than clozapine-induced blood dyscrasias and has a higher mortality rate. Although strict criteria must be followed to assertively monitor, detect and treat blood dyscrasias in patients taking clozapine, no such framework exists for CIGH. We recommend that prescribing guidelines, regulatory agencies and information from manufacturers should more clearly highlight the risks identified in the literature. Furthermore, we recommend that, in people taking clozapine, constipation should be prevented by prophylactic treatment with laxatives rather than treated only when clinically identified.LEARNING OBJECTIVES:After reading this article you will be able to: •understand the mechanism of gastrointestinal hypomotility in those taking clozapine•improve the monitoring of clozapine-induced constipation•understand prophylactic laxative treatment and the use of less commonly prescribed laxatives in patients who experience clozapine-induced constipation.
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44
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Anton, Christopher. "Adverse effects of laxatives." Adverse Drug Reaction Bulletin &NA;, no. 212 (February 2002): 811–14. http://dx.doi.org/10.1097/00012995-200202000-00001.
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Bateman, D. N., and J. M. Smith. "A policy for laxatives." BMJ 297, no. 6661 (December 3, 1988): 1420–21. http://dx.doi.org/10.1136/bmj.297.6661.1420.
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Hopper, A. H. "A policy for laxatives." BMJ 298, no. 6669 (February 4, 1989): 323. http://dx.doi.org/10.1136/bmj.298.6669.323-d.