What kind of treatment is a laxative a day?

Laxative Treatment: Types and Recommendations

Laxative a day (Lax a day) is a polyethylene glycol (PEG) osmotic laxative that draws water into the intestine to soften stool and increase bowel movements, making it an effective first-line treatment for chronic constipation. 1, 2

Types of Laxatives and Mechanisms

Laxatives are classified into several categories based on their mechanism of action:

1. Osmotic Laxatives

   • Polyethylene glycol (PEG) - Draws water into the intestine to soften stool

     • Initial dose: 17g daily
     • Cost: $10-$45 monthly
     • No clear maximum dose
     • Durable response over 6 months 1

   • Other Osmotic Options

     • Magnesium oxide (400-500mg daily)
     • Lactulose (15g daily)
     • Sorbitol 1, 2

2. Stimulant Laxatives

   • Senna (8.6-17.2mg daily)
   • Bisacodyl (5mg daily, max 10mg)
   • These stimulate intestinal contractions 1, 3

3. Bulk-Forming Laxatives

   • Psyllium (fiber supplement)
   • Recommended intake: 14g/1,000 kcal per day
   • Acts by trapping water in intestine and increasing stool bulk 1, 4

4. Intestinal Secretagogues

   • Lubiprostone (24μg twice daily)
   • Linaclotide (72-145μg daily, max 290μg) 1, 2

Evidence-Based Recommendations

First-Line Treatment

PEG (Lax a day) is recommended as the first-line laxative for chronic constipation, particularly in elderly patients, due to its:

• Favorable safety profile
• Proven efficacy
• Minimal side effects compared to other options 2

Treatment Algorithm

1. Start with PEG 17g daily

   • Titrate dose based on symptom response
   • Ensure adequate hydration (at least 2L daily) 1, 2

2. If inadequate response:

   • Add stimulant laxative (bisacodyl 5-10mg or senna 8.6-17.2mg)
   • Goal: one non-forced bowel movement every 1-2 days 1, 2

3. For persistent constipation:

   • Consider adding or switching to magnesium oxide, lactulose, or sorbitol
   • For severe cases, consider intestinal secretagogues 1, 2

Important Considerations

Safety Warnings

• Stimulant laxatives like senna should not be used for longer than one week unless directed by a doctor 3
• Avoid laxative use with undiagnosed abdominal pain, nausea, vomiting, or recent changes in bowel habits 3
• Stop use and consult a doctor if rectal bleeding occurs or if no bowel movement occurs after use 3

Special Populations

• Renal insufficiency: Use magnesium-based products with caution 2
• Elderly: Start with lower doses and monitor for dehydration and electrolyte disturbances 2
• Pregnancy/breastfeeding: Consult healthcare provider before use 3

Non-Pharmacological Approaches

• Adequate dietary fiber (25g daily)
• Physical activity when appropriate
• Optimized toileting schedule (attempt defecation 30 minutes after meals)
• Adequate fluid intake 2

Monitoring and Follow-Up

Monitor for:

• Frequency and consistency of bowel movements
• Side effects (bloating, abdominal discomfort, cramping)
• Electrolyte disturbances, especially with prolonged use
• Need for dose adjustments based on response 1, 2

PEG laxatives like Lax a day have shown durable response over 6 months, making them suitable for longer-term management of chronic constipation when necessary 1.