From the Guidelines
Polyethylene glycol (PEG) is the recommended first-line laxative for managing constipation, due to its efficacy in increasing spontaneous bowel movements (SBMs) and complete spontaneous bowel movements (CSBMs), as well as its relatively low cost and availability over-the-counter 1. The use of PEG as a first-line treatment is supported by its mechanism of action as an osmotic laxative, which helps to soften stool and increase bowel movements.
- Key benefits of PEG include:
- Efficacy in increasing SBMs and CSBMs
- Low cost and availability over-the-counter
- Relatively mild side effect profile, with most events being mild or moderate
- Can be used in combination with fiber supplementation When using PEG, it is essential to stay well-hydrated and start with the lowest effective dose, typically 17g dissolved in 8oz of water daily.
- Additional considerations for managing constipation include:
- Lifestyle modifications, such as increased fiber intake (25-30g daily), adequate hydration (6-8 glasses of water daily), and regular physical activity
- Monitoring for side effects, such as bloating, flatulence, and diarrhea, and adjusting the dose or treatment plan as needed
- Seeking medical evaluation if constipation persists beyond two weeks despite using laxatives, as recommended by the american gastroenterological association 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
First-Line Laxatives for Constipation
- The first-line laxatives for managing constipation include dietary fiber and medicinal bulk 2.
- Bulk-forming laxatives, such as psyllium, bran, or methylcellulose, are often recommended as the initial treatment for constipation 3.
- Osmotic laxatives, like polyethylene glycol, lactulose, or lactitol, can be used as a second-line treatment if bulk-forming laxatives are not effective 2, 3.
- In palliative care patients, macrogol is often preferred as the first-line laxative due to its high effectiveness and good tolerance 4.
Specific Laxatives
- Polyethylene glycol is a safe and effective laxative that can be used as an initial or second-line agent for chronic constipation 2, 5.
- Lactulose is a commonly used osmotic laxative, but it can cause side effects like flatulence, bloating, and abdominal cramping 4, 3.
- Senna and bisacodyl are stimulant laxatives that can be used if osmotic laxatives are not effective 2, 6, 3.
- Lubricating agents, such as docusate, are still used in palliative care patients for prophylactic treatment or therapy of constipation 4, 6.
Treatment Approaches
- The treatment of constipation should start with dietary and lifestyle changes, followed by the use of laxatives if necessary 3.
- A laxative ladder approach has been proven successful in palliative care patients 4.
- The management of opioid-induced constipation (OIC) typically involves the use of laxatives and stool softeners, with newer agents available for patients who do not respond to first-line therapies 6.