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Medications for treatment of constipation

Medications for treatment of constipation
Medication Usual adult dose Onset of action Side effects
Bulk-forming laxatives*
Psyllium Up to 1 tablespoon (≅3.5 grams fiber) 3 times per day 12 to 72 h Impaction above strictures, fluid overload, gas and bloating
Methylcellulose Up to 1 tablespoon (≅2 grams fiber) or 4 caplets (500 mg fiber per caplet) 3 times per day 12 to 72 h
Polycarbophil 2 to 4 tabs (500 mg fiber per tab) per day 24 to 48 h
Wheat dextrin 1 to 3 caplets (1 gram fiber per caplet) or 2 teaspoonsful (1.5 gram fiber per teaspoon) up to 3 times per daily 24 to 48 h
Surfactants (softeners)
Docusate sodium 100 mg 2 times per day 24 to 72 hours Well tolerated, but less effective than other agents. Use lower dose if administered with another laxative. Contact dermatitis reported.
Docusate calcium 240 mg 1 time per day 24 to 72 hours
Osmotic agents
Polyethylene glycol (macrogol) 8.5 to 34 grams in 240 mL (8 ounces) liquids 1 to 4 days Nausea, bloating, cramping
Lactulose 10 to 20 grams (15 to 30 mL) every other day. May increase up to 2 times per day. 24 to 48 hours Abdominal bloating, flatulence
Sorbitol 30 grams (120 mL of 25% solution) 1 time per day 24 to 48 hours Abdominal bloating, flatulence
Glycerin (glycerol) One suppository (2 or 3 grams) per rectum for 15 minutes 1 time per day 15 to 60 minutes Rectal irritation
Magnesium sulfate 2 to 4 level teaspoons (approximately 10 to 20 grams) of granules dissolved in 8 ounces (240 mL) of water; may repeat in 4 hours. Do not exceed 2 doses per day. 0.5 to 3 hours Watery stools and urgency; caution in renal insufficiency (magnesium toxicity)
Magnesium citrate 200 mL (11.6 grams) 1 time per day 0.5 to 3 hours
Stimulant laxatives
Bisacodyl 10 to 30 mg as enteric coated tabs 1 time per day 6 to 10 hours Gastric irritation
10 mg suppository per rectum 1 time per day 15 to 60 minutes Rectal irritation
Senna 2 to 4 tabs (8.6 mg sennosides per tab) or 1 to 2 tabs (15 mg sennosides per tab) as a single daily dose or divided twice daily 6 to 12 hours Melanosis coli
Other
Lubiprostone 24 micrograms 2 times per day 24 to 48 hours Nausea, diarrhea
Linaclotide 145 micrograms 1 time per day 12 to 24 hours Diarrhea, bloating
Plecanatide 3 mg 1 time per day 12 to 24 hours Diarrhea
Prucalopride 2 mg per day 6 to 12 hours Nausea, headache, diarrhea
All doses shown are for oral administration unless otherwise noted. Phosphate containing laxatives are not recommended. Mineral oil (enema and oral liquid) laxatives are not generally recommended except as enema following disimpaction (refer to UpToDate content).
* Initiate at one-half or less of dose shown and gradually increase as needed to minimize gas and bloating. Administer with 180 to 360 mL (6 to 12 ounces) water or fruit juice. Do not administer within 1 hour of other medications. Fiber content per dose may vary. Consult individual product label.
¶ US trade name Benefiber.
Courtesy of Arnold Wald, MD. Additional data from: Lexicomp Online. Copyright © 1978-2023 Lexicomp, Inc. All Rights Reserved.
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