Laxatives (Oral)

Before Using This Medicine

Importance of diet, fluids, and exercise to prevent constipation - Laxatives are to be used to provide short-term relief only, unless otherwise directed by a doctor. A proper diet containing roughage (whole grain breads and cereals, bran, fruit, and green, leafy vegetables), with 6 to 8 full glasses (8 ounces each) of liquids each day, and daily exercise are most important in maintaining healthy bowel function. Also, for individuals who have problems with constipation, foods such as pastries, puddings, sugar, candy, cake, and cheese may make the constipation worse.

If you are taking this medicine without a prescription, carefully read and follow any precautions on the label. For oral laxatives, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to laxatives. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet - Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. Some laxatives have large amounts of sodium or sugars in them.

Pregnancy - Although laxatives are often used during pregnancy, some types are better than others. Stool softeners (emollient) laxatives and bulk-forming laxatives are probably used most often. If you are using a laxative during pregnancy, remember that:

• Some laxatives (in particular, the bulk-formers) contain a large amount of sodium or sugars, which may have possible unwanted effects such as increasing blood pressure or causing water to be held in the body.
• Saline laxatives containing magnesium, potassium, or phosphates may have to be avoided if your kidney function is not normal.
• Mineral oil is usually not used during pregnancy because of possible unwanted effects on the mother or infant. Mineral oil may interfere with the absorption of nutrients and vitamins in the mother. Also, if taken for a long time during pregnancy, mineral oil may cause severe bleeding in the newborn infant.
• Stimulant laxatives may cause unwanted effects in the expectant mother if improperly used. Castor oil in particular should not be used as it may cause contractions of the womb.

Breast-feeding - Laxatives containing cascara and danthron may pass into the breast milk. Although the amount of laxative in the milk is generally thought to be too small to cause problems in the baby, your doctor should be told if you plan to use such laxatives. Some reports claim that diarrhea has been caused in the infant.

Children - Laxatives should not be given to young children (up to 6 years of age) unless prescribed by their doctor . Since children usually cannot describe their symptoms very well, they should be checked by a doctor before being given a laxative. The child may have a condition that needs other treatment. If so, laxatives will not help, and may even cause unwanted effects or make the condition worse.

Mineral oil should not be given to young children (up to 6 years of age) because a form of pneumonia may be caused by the inhalation of oil droplets into the lungs.

Also, bisacodyl tablets should not be given to children up to 6 years of age because if chewed they may cause stomach irritation.

Older adults - Mineral oil should not be taken by bedridden elderly persons because a form of pneumonia may be caused by the inhalation of oil droplets into the lungs. Also, stimulant laxatives (e.g., bisacodyl or casanthranol), if taken too often, may worsen weakness, lack of coordination, or dizziness and light-headedness.

Polyethylene glycol 3350 should be discontinued if diarrhea occurs, especially in elderly persons in nursing homes.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking oral laxatives, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants, oral (blood thinners you take by mouth) or
• Digitalis glycosides (heart medicine) - The use of magnesium-containing laxatives may reduce the effects of these medicines

• Ciprofloxacin (e.g., Cipro) or
• Etidronate (e.g., Didronel) or
• Sodium polystyrene sulfonate - Use of magnesium-containing laxatives will keep these medicines from working

• Tetracyclines taken by mouth (medicine for infection) - Use of bulk-forming or magnesium-containing laxatives will keep the tetracycline medicine from working

Other medical problems - The presence of other medical problems may affect the use of oral laxatives. Make sure you tell your doctor if you have any other medical problems, especially:

• Appendicitis (or signs of) or
• Rectal bleeding of unknown cause - These conditions need immediate attention by a doctor

• Colostomy or
• Intestinal blockage or
• Ileostomy - The use of laxatives may create other problems if these conditions are present

• Diabetes mellitus (sugar diabetes) - Diabetic patients should be careful since some laxatives contain large amounts of sugars, such as dextrose, galactose, and/or sucrose

• Heart disease or
• High blood pressure - Some laxatives contain large amounts of sodium, which may make these conditions worse

• Kidney disease - Magnesium and potassium (contained in some laxatives) may build up in the body if kidney disease is present; a serious condition may develop

• Swallowing difficulty - Mineral oil should not be used since it may get into the lungs by accident and cause pneumonia; also, bulk-forming laxatives may get lodged in the esophagus of patients who have difficulty in swallowing