What laxative is suitable for an elderly patient with constipation?

From the Guidelines

For elderly patients, polyethylene glycol (PEG) 17g/day is a recommended laxative option due to its efficacy and good safety profile. This is based on the most recent and highest quality study available 1. The use of PEG as a laxative has been shown to be effective in increasing bowel movements and improving stool form, with minimal side effects 1.

Key Considerations

• PEG is an osmotic laxative that works by drawing water into the colon to soften stool, making it a gentle and effective option for elderly patients 1.
• Other laxative options, such as docusate sodium or senna, may also be considered, but PEG is generally well-tolerated and has a good safety profile 1.
• It is essential to individualize laxative treatment for elderly patients, taking into account their medical history, comorbid conditions, and potential drug interactions 1.
• Regular monitoring of chronic kidney or heart failure is necessary when using laxatives, especially in patients with concomitant treatment with diuretics or cardiac glycosides 1.

Additional Recommendations

• Adequate hydration (6-8 glasses of water daily) and dietary fiber (fruits, vegetables, whole grains) should accompany any laxative regimen to prevent impaction and promote regular bowel movements.
• Bulk-forming laxatives like psyllium (Metamucil) can also be effective but require sufficient fluid intake to prevent impaction.
• Stimulant laxatives, such as senna, can be used for more stubborn constipation, but their long-term use should be avoided due to the risk of dependence and electrolyte imbalances 1.

From the FDA Drug Label

PURPOSE Osmotic Laxative Purpose Fiber laxative The options for a laxative for an elderly patient are:

• Polyethylene glycol (PO), an osmotic laxative 2
• Psyllium (PO), a fiber laxative 3

From the Research

Laxatives for Elderly Patients

• Polyethylene glycol (PEG) is a commonly recommended laxative for elderly patients with chronic constipation, as it has been shown to be effective with minimal side effects 4, 5, 6.
• Psyllium, a soluble fiber, is also a recommended option, as it can help increase stool frequency and improve stool consistency 4, 5, 7.
• The combination of psyllium and PEG may be an effective therapeutic option for patients with chronic constipation, as it combines the advantages of fiber and isotonic solutions 4.
• Other laxatives, such as senna, lactulose, and magnesium salts, may also be effective, but the evidence is not as strong 5, 6.
• Stimulant laxatives, such as bisacodyl, may be effective, but their use should be approached with caution in elderly patients due to the potential for adverse effects 6.

Considerations for Elderly Patients

• Elderly patients may be more susceptible to the adverse effects of laxatives, such as diarrhea, nausea, and abdominal pain 6.
• The choice of laxative should be individualized based on the patient's medical history, medication use, and personal preferences 4, 5.
• It is essential to ensure that elderly patients have an adequate intake of dietary fiber and water to help prevent constipation 4.