Hyperosmotic Laxatives
Hyperosmotic laxatives are a fast acting stimulant laxative. They encourage bowel movements by drawing water into the bowel from surrounding body tissues. This provides a soft stool mass and a rapid increase in bowel action. Action occurs within 1-6 hours and the evacuation is watery.Hyperosmotic laxatives help cause bowel movements by absorbing water into the bowel from body tissues. There are 3 types of hyperosmotic laxatives taken by mouth: the saline, the lactulose, and the polymer types.
• The saline type is often called "salts." They are used for rapid emptying of the lower intestine and bowel. They are not used for long-term or repeated correction of constipation. With smaller doses than those used for the laxative effect, some saline laxatives are used as antacids. The information that follows applies only to their use as laxatives. Sodium phosphate may also be prescribed for other conditions as determined by your doctor.
• The lactulose type is a special sugar-like laxative that works the same way as the saline type. However, it produces results much more slowly and is often used for long-term treatment of chronic constipation. Lactulose may sometimes be used in the treatment of certain medical conditions to reduce the amount of ammonia in the blood. It is available only with your doctor's prescription.
• The polymer type is a polyglycol (polyethylene glycol), a large molecule that causes water to be retained in the stool; this will soften the stool and increase the number of bowel movements. It is used for short periods of time to treat constipation.
Hyperosmotic should not be used if abdominal pain, nausea, or vomiting is present. If any blood appears in the stool, a physician must be consulted because self-care is not appropriate. Excessive use of oral hyperosmotic laxatives may result in dehydration in individuals who do not maintain an adequate intake of daily fluids; this can lead to hospitalization and even death. The very young, the elderly, and generally frail individuals are at greatest risk for dehydration. An 8 ounce (230mL) glass of fluid should be taken with every oral dose of a hyperosmotic drug.
Magnesium citrate solution should be stored in a cold place (refrigerator) to prevent degradation of the drug and to increase its palatability. Most hyperosmotic laxatives have a disagreeable taste, which may limit their usefulness. If the daily dose of magnesium exceeds 600 mg and the individual has kidney disease, a physician should be consulted before use. If the individual has kidney disease, oral phosphate laxatives should not be used without the supervision of a physician. If the daily dose contains more than 115 mg of sodium, a physician should be consulted if the individual is on a low sodium diet. The FDA restricts the packaging of oral phosphate solution to 3 ounces (80 g) to prevent serious adverse effects.
Oral phosphates were recommended frequently by physicians when a thorough bowel cleansing before colonoscopy or bowel surgery was required. The FDA issued a safety alert for both OTC and prescription oral phosphates use for bowel cleansing in December 2008. The FDA received reports of acute phosphate nephropathy and now requires a special warning on all oral phosphate prescription products.25 The FDA alert does not affect the status of rectal phosphate products. Glycerin is restricted to rectal use as a suppository or enema, and it may cause some rectal burning after insertion into the rectum.
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup. You might need to mix the liquid with at least 4 ounces (1/2 cup) of water before you drink it.
• You will need to mix the powder or the contents of the packet with water before using it. Most powders must be mixed with at least 4 ounces (1/2 cup) of water. Make sure you understand how much water to mix the medicine with. Drink the mixture right after you mix it.
• If you using this medicine to empty your bowel before surgery or medical tests, follow your health caregiver's instructions about when to use this medicine. It is important to follow the correct schedule.
• Drink a full glass of water when you take this medicine, unless your health caregiver tells you otherwise. One full glass of water is about 8 ounces or 1 cup. Most people should drink 6 to 8 full glasses of water every day. Doing this will help soften your bowel movements, making them easier to pass.
Warnings While Using This Medicine
• Make sure your doctor knows if you are pregnant or breast feeding, or if you have diabetes or heart disease. Tell your doctor if you have trouble with magnesium, potassium, calcium, or sodium (salt) levels in your blood.
• If you do not have a bowel movement after using this medicine, talk to your doctor. The amount of time before you should have a bowel movement depends on the type of laxative you are using. Some laxatives might cause a bowel movement in 30 minutes, and other laxatives could take as long as 48 hours (2 days).
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.
• Some kinds of laxatives are not for long-term use. Other laxatives might be used over a long time period. Ask your doctor how long it is safe to use this laxative.
• If you are using this medicine for a long time, your doctor may need to check your blood at regular visits. Be sure to keep all appointments.
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