From the Guidelines
For NPO patients with constipation, rectal suppositories like bisacodyl (10 mg) or glycerin suppositories are recommended as they can provide relief within 15-60 minutes, as suggested by the most recent and highest quality study 1.
Medication Options
- Rectal suppositories: bisacodyl (10 mg) or glycerin suppositories
- Enemas: Fleet phosphate enemas or mineral oil enemas
- Docusate sodium suppositories for longer-term management
Mechanism of Action
- Bisacodyl stimulates intestinal peristalsis
- Glycerin draws water into the rectum creating a lubricating effect
- Phosphate enemas work by increasing osmotic pressure in the colon
Important Considerations
- Ensure the patient doesn't have contraindications such as rectal bleeding, recent colorectal surgery, or inflammatory bowel conditions before administering these treatments
- Once the patient resumes oral intake, transitioning to oral laxatives may be appropriate based on their condition
Additional Options
- Methylnaltrexone (0.15 mg/kg subcutaneous, every other day, no more than 1 per day) may be considered for patients experiencing constipation that has not responded to standard laxative therapy, as recommended by 1
- Prokinetic agents like metoclopramide (10-20 mg PO qid) may be used if gastroparesis is suspected, as suggested by 1 and 1
From the FDA Drug Label
Use for relief of occasional constipation (irregularity) this product generally produces bowel movement in 15 minutes to 1 hour Purpose Stimulant Laxative The answer to the question is no, there are no medicines mentioned for constipation that are suitable for NPO patients, as the provided drug labels for bisacodyl (PR) do not mention its use in NPO patients 2 2.
From the Research
Medicines for Constipation in NPO Patients
- There are several medicines available for the treatment of constipation, including bisacodyl, sodium picosulfate, and docusate sodium 3, 4, 5, 6.
- Bisacodyl is a stimulant laxative that acts locally in the large bowel to enhance motility, reduce transit time, and increase the water content of the stool 3.
- A network meta-analysis found that bisacodyl showed similar efficacy to other laxatives, such as prucalopride, lubiprostone, and linaclotide, in increasing the number of complete spontaneous bowel movements per week 3.
- Docusate sodium mini-enemas have been shown to be effective in decreasing colonic transit time and bowel evacuation time in individuals with spinal cord injury 6.
- However, the long-term use of stimulant laxatives, such as bisacodyl and sodium picosulfate, has raised concerns about their safety and effectiveness 5.
- The evidence base does not support the use of stimulant laxatives for more than four weeks, and longer-term studies are needed to investigate their effects and safety 5.
Considerations for NPO Patients
- NPO (nil per os) patients, who are not allowed to take anything by mouth, may require alternative routes of administration for constipation medicines, such as suppositories or enemas 6.
- The choice of medicine and route of administration will depend on the individual patient's needs and medical condition, and should be determined by a healthcare professional 7, 4.