What are the medications used as needed for constipation?

From the Guidelines

Medications for Constipation Constipation can be managed with as-needed medications, including osmotic laxatives such as polyethylene glycol (PEG) 3350, administered at a dose of 17-34 grams per day 1, or stimulant laxatives like bisacodyl, given at a dose of 5-10 mg per day 1. Stool softeners, such as docusate, may also be used at a dose of 100-300 mg per day 1.

Key Medications

• Polyethylene glycol (PEG) 3350: 17-34 grams per day 1
• Bisacodyl: 5-10 mg per day 1
• Docusate: 100-300 mg per day 1
• Magnesium hydroxide: 30-60 mL daily 1
• Lactulose: 30-60 mL daily 1
• Sorbitol: 30 mL every 2 hours x 3 then as needed 1 The duration of treatment should be limited to the shortest duration necessary to relieve constipation, typically not exceeding 1-2 weeks for stimulant laxatives 1. It is essential to assess the cause and severity of constipation, rule out obstruction, and treat other causes before initiating medication therapy 1.

From the FDA Drug Label

Uses for prevention of dry, hard stools for relief of occasional constipation This product generally produces a bowel movement within 12 to 72 hours. ACTIVE INGREDIENT (IN EACH DOSE) (Bottle Only) Polyethylene Glycol 3350,17 g (cap filled to line) (Packet Only) Polyethylene Glycol 3350,17 g PRINCIPAL DISPLAY PANEL Oncor Pharmaceuticals NDC 83720-550-25 12 Suppositories 10 mg each Bisacodyl Suppositories Fast Acting Smulant Laxative

The medications used as needed for constipation are:

• Polyethylene Glycol 3350 2
• Bisacodyl 3
• Docusate 4

From the Research

Medications Used as Needed for Constipation

The following medications are used as needed for constipation:

• Milk of Magnesia, used on approximately 10% of days/patient 5
• Bisacodyl suppository, used on 2% to 4% of days/patient 5
• Fleet enema, used only on 3 occasions 5
• Osmotics, prescribed as needed by 83.0% of respondents 6
• Stimulants, prescribed as needed by 35.6% of respondents 6
• Senna-based laxatives, can be used as a long-term treatment for constipation in children 7
• Conventional laxatives, considered a first-line option for opioid-induced constipation (OIC) in the elderly, but evidence is lacking to support their effectiveness 8
• Cholinesterase inhibitors, may be used in case of constipation, but remains poorly prescribed 9
• Enteral opioid antagonists, may be a promising strategy for patients treated with high posology of opioids during sedation 9

Key Findings

• The use of additional laxatives is infrequent, with Milk of Magnesia and bisacodyl suppository being used on a small percentage of days/patient 5
• Osmotics and stimulants are commonly prescribed as needed for constipation 6
• Senna-based laxatives are safe for long-term use in children, but may cause perineal blistering in rare cases 7
• Conventional laxatives may not be effective for OIC in the elderly, and new pharmacologic agents may provide more effective treatment options 8
• Cholinesterase inhibitors and enteral opioid antagonists may be used to treat constipation in critically ill patients, but more research is needed to determine their effectiveness 9