Most laxative drugs used clinically are over-the-counter drugs and patients can buy and use them on their own. Children, pregnant women, the elderly, internal medicine, surgery, oncology, there are constipation patients everywhere, laxative drugs, are you using them correctly?
I. Classification of laxative drugs
At present, the commonly used laxative drugs in clinic can be divided into the following categories, which take effect through different mechanisms.
1. Lubricating laxatives
Lubricate intestinal wall, soften stool and make stool easy to discharge, such as liquid paraffin wax, glycerin (10-30ml oral administration each time), peanut oil, soybean oil or sesame oil (15-30ml oral administration each time), etc. The main disadvantages of these drugs are poor taste and weak function, and long-term application will cause poor absorption of fat-soluble vitamins.
2. Stool soften
Soften stool and make it easy to excrete. It has better curative effect on patients with constipation due to taking certain prescription drugs or sedentary. The most commonly used drug of this kind is docooxate sodium.
3. Fibres
Natural dietary supplements can absorb water and help patients maintain regular defecation habits, and are suitable for people with insufficient fiber intake in food.
4. Volume laxatives
Such as plantain, magnesium sulfate, etc., because it is not absorbed by the intestinal wall and dissolved in water, it can absorb a large amount of water in the intestine, increase the capacity of stool and play a cathartic role. However, because it cannot increase colon tension, it is not suitable for patients with intestinal retardation.
5. Irritant laxatives
It has fast action and strong efficacy. Drugs or their metabolic products can stimulate the intestinal wall and increase intestinal peristalsis, such as bitacodine and senna leaves. This kind of drugs sometimes cause adverse reactions such as abdominal colic. In addition, drugs stimulate intestinal mucosa and intestinal wall plexus, which may cause permanent damage to intestinal wall, so it is not suitable for long-term use.
6. Permeable laxatives
Keep the intestinal tract moist and make stool easy to discharge. Common laxatives include polyethylene glycol, sorbitol, lactulose, salt laxatives, etc. Permeable laxatives have obvious effects, but excessive use can cause imbalance of water and electrolyte in the body.
Lactulose, which is not absorbed by the human body, is decomposed by bacteria and releases organic acids to act on the colon. It is especially suitable for the elderly, pregnant and lying-in women, children and postoperative constipation patients. It should be used with caution for diabetic patients. The main disadvantage of this drug is that it ferments under the action of bacteria to produce gas, causing discomfort such as abdominal distension.
II. Use of laxative drugs
The choice of laxative drugs should be decided according to the instructions for the use of drugs and the specific conditions of patients. Excessive use can cause serious side effects, and laxative drugs should not be used to lose weight. In January 2014, FDA issued a safety warning on over-the-counter laxative sodium dihydrogen hydrochloride, saying there were rare cases reported that repeated use of such drugs within 24 hours could lead to serious kidney and heart injury and even death. Especially for constipation in special groups, more caution should be exercised.
1. Medication for constipation in the elderly
On the one hand, constipation in the elderly can induce the onset of cardiovascular and cerebrovascular diseases, on the other hand, many therapeutic drugs for elderly patients complicated with diseases can induce constipation. In terms of therapeutic drug selection, permeable laxatives should be selected in long-term treatment, and microecological preparations can also be considered for patients who often use antibiotics.
When constipation occurs in the elderly, organic intestinal diseases should be excluded first, and then laxatives should be correctly selected to relieve the symptoms.
First of all, microecological preparations should be selected. Commonly used are bifidobacterium, lactobacillus, etc. This kind of preparation can remove [garbage] from the body, adjust the balance of intestinal flora, restore intestinal function to normal, and keep stool unobstructed.
Secondly, the elderly can choose oral laxatives according to the system and condition. Maren pills, Tongtai capsules and lactulose should be selected for patients with simple constipation.
Maren pills belong to the medicine of moistening intestines and guiding bowels, 1-2 times a day, 6 grams each time. Tongtai capsule is a natural fiber plant polysaccharide. The first dose is doubled, the maintenance dose is 3 times a day, 1-2 pills each time, when taking it, a large amount of drinking water is needed, and the effect is the best when taking it on an empty stomach. Lactulose is mild in relaxing constipation. It is taken 2-3 times a day, 10-20g each time, once a day after, 7-10g each time.
Constipation occurs in elderly patients with hypertension and heart failure. In addition to hemp pills, lactulose, can also choose liquid paraffin wax to slow down, because liquid paraffin wax can lubricate intestinal tract, soften feces, so have slow down effect. Commonly used amount is 10-20 milliliters, take effect 6-8 hours after medication, it is best to take it before going to bed, but cannot take it for a long time. If you take it orally for a long time, it will affect the absorption of fat-soluble vitamins and stimulate gastrointestinal granulation tissue hyperplasia.
Cisapride should be selected for patients with diabetes and constipation. Cisapride can accelerate gastric and intestinal peristalsis. It should be taken 3-4 times a day with 5-10ml each time. It should be taken before meals, but special attention should be paid to the fact that the drug cannot be taken together with erythromycin, ketoconazole, itraconazole and other drugs.
2. Medication for constipation of pregnant women
Pregnant women due to intestinal peristalsis reduction, intestinal tension weakening, exercise reduction, coupled with uterus and fetal head compression, resulting in defecation difficulties, it is easy to cause constipation, even hemorrhoids. The best way to correct is to pay attention to the diet structure, exercise more, defecate regularly, can’t use laxatives, also should not use Kaisailu.
Lactulose has been proved to be safe and effective by clinical studies in pregnant women in China. Lactulose is a synthetic disaccharide, which will not be absorbed into blood by the small intestine after entering the intestinal tract, and can lead to the formation of osmotic gradient in the intestinal tract, which may retain water to the greatest extent and will not enter milk. Therefore, it can be used during pregnancy and lactation.
3. Constipation medication for psychiatric patients
It is mainly related to the anticholine effect of some antipsychotic drugs. If fundamental treatment is needed, it is necessary to consider dressing change, drugs with weak anticholine effect, or drugs with different mechanisms of action, such as 5-HT reuptake inhibitor, have diarrhea side effects. In addition, reduce combined drugs to reduce side effects. If symptomatic treatment is required, the patient’s diet and living habits should be taken into account.
For patients who need long-term treatment such as constipation with antipsychotic drugs, irritant laxatives are not recommended to prevent intestinal wall damage.