Stimulant laxatives

• the stimulant group of laxatives stimulate intestinal motility and as a result may cause abdominal cramp
• the laxative effect is seen within 6-12 hours and therefore oral stimulant laxatives are taken at night to produce a morning bowel motion
• in general, stimulant laxatives are reserved for short-term or intermittent use
• danthron containing laxatives are no longer indicated for the general management of constipation in the elderly. These laxatives only should be used in the short term where bowel motion must be free of strain or in analgesic -induced constipation in palliative care
• glycerol or bisacodyl suppositories can be used for rapid evacuation (typically within 1–2 hours after administration).
• most common side effect with stimulant laxatives is abdominal cramp, and they should not be used if there is a possibility of intestinal obstruction
  • caution is required in long-term use, as excessive use may result in diarrhoea and related metabolic effects, such as hypokalaemia
  • there is no convincing evidence that chronic use of stimulant laxatives significantly affects colonic function (2)

Stimulant laxatives include:

• bisacodyl
• sodium Docusate, e.g. Dioctyl, Fletchers' Enemette, Norgalax Micro-enema
• co-danthrusate, e.g. danthron and docusate
• glycerol
• senna, e.g. Senokot, Manevac
• sodium picosulphate - Picolax
• oxyphenisatin - Veripaque

Note:

• sodium docusate is also a faecal softener

The summary of product characteristics must be consulted before prescribing any of the laxatives mentioned in this GPnotebook page.

Reference:

1. MeReC Bulletin 1999;10 (9): 33-36
2. MeReC Bulletin 2004; 14(6):21-4.