Laxativepurgatives 170713091949

Laxatives
& Purgatives
Dr. Indrajit Banerjee, MBBS, MD

Associate Professor
Department of Pharmacology
Chitwan Medical College
Nepal
 Purgatives & laxatives are drugs that
promote evacuation of bowels, used in
constipation and dyschezia.
Constipation : Delayed passage of faeces

through the intestine.
Dyschezia: Derangement of defaecation

process due to
1. Pain arising from haemorrhoids or fissure
2. Presence of hard dehydrated faecal
matter in the rectum 2
Purgative Stronger action resulting in more
fluid evacuation
Laxative
Milder action, elimination of soft but formed
stools.
Aperients (to get rid off) < Laxatives (to loosen) <
Emolient (to smooth and soften) < Evacuant (to
empty) < Purgatives (to clean)< Cathartic (to
utterly clean)
3
Classification of Drugs
1. Bulk forming
Dietary fibre: Bran*, Psyllium,
Ispaghula*, Methylcellulose
2. Stool softener
Docusates (DOSS)*, Liquid paraffin*
3. Stimulant purgatives
(a) Diphenylmethanes
Phenolphthalein, Bisacodyl*, Sodium
picosulfate
4
(b) Anthraquinones (Emodins)
Senna, Cascara sagrada
(c) 5-HT4 agonist: Prucalopride
(d) Fixed oil: Castor oil
4. Osmotic purgatives
Magnesium salts: sulphate*,
hydroxide*
Sodium salts: sulfate, phosphate
Sod. pot. tartrate
Lactulose*
5
Laxatives/ Purgatives
• Mr Akash is suffering
from Inguinal Hernia. • Mrs. Rita undergoing
abdominal X ray
• Mr. Gurung
• Mr. Ram who is a post
suffering from Tape MI patient suffering
worm infestation is on from constipation.
Niclosomaide. Which • Mr. Alok who is a post
drug should be MI patient. Which drug
combined along with can be used for
it? prophylaxis of
constipation
At the end of this session all of you should be able to address

these conditions confidently 6
LAXATIVES
Laxatives
Laxatives are used
1) To treat constipation
2) To avoid undue straining at defaecation
in cases having hernia, haemorrhoids or
cardiovascular disease
3) Before or after surgery of any anorectal
disease
4) In bedridden patients.
8
 Bulk-Forming Laxatives:
Wheat bran, Psyllium husk, Ispaghula,
Methyl cellulose.
 Osmotic Laxatives:
Lactulose, Glycerine suppositories
 Lubricant Laxatives :Liquid paraffin
 Surfactant Laxatives
Docusate (Dioctyl sodium sulfosuccinate)
9
 Bulk-Forming Laxatives:
Wheat bran consists of 40% dietary fibre
It absorbs water in the intestines, swells,

increases water content of faeces
Stimulate local peristalsis & defecation
reflexes by increasing faecal bulk
Dose : 20-40 g/ day, acts 1-3 days

S/E : Bloating
C/I : GIT ulcerations, adhesions, stenosis10
 Osmotic Laxative:
Lactulose:
It is a semisynthetic disaccharide of
fructose and lactose
neither digested, nor absorbed in the small
intestine- retains water.
Broken down by colonic bacteria-
osmotically active products
Side effects:
Flatulence, cramps
11
Dose of 10 g BD with plenty of water,
It produces soft formed stools in 1-3 days
Lactulose causes reduction of blood NH3

concentration by 25-50% in patients with
hepatic Encephalopathy
Dose : 20 g TDS
12
Lubricant Laxatives
pharmacologically inert mineral, not
palative, but can be given in emulsified
form or with juices.
Liquid paraffin
Dose : 15-30 ml/ hs. Latency period: l-3 days
Side Effects :
 It is not palatable
Frequent use leads to the deficiency of fat
soluble vitamins
Leakage of oil past anal sphincter
13
Forcible
administration can
lead to aspiration
lipid pneumonia.
It also delays the
healing of enteric
fistula.
Foreign body
granulomas in the
intestine
14
Surfactant Laxatives: [STOOL SOFTENER]
Dioctyl sodium sulfosuccinate(Docusate)
It is an anionic detergent which softens the

stool by decreasing the surface tension of
fluids in the bowel.
It also acts as a wetting agent for the

bowel, because by emulsifying the colonic
contents it facilitates the penetration
of water into faeces 15
Dosage : 100-400 mg/day.
Indicated when straining at defaecation is
to be avoided
Side Effects:
Bitter in taste, Nausea, Cramps and
abdominal pain.
Prolonged use leads to Hepatotoxicity
16
PURGATIVES
Purgatives are used for complete colonic
cleansing
1. Prior to gastrointestinal endoscopic
procedure
2. To flush out worms after the use of an
anthelmintic drug
3. To prepare the bowel before surgery or
abdominal X-ray
4. Food/Drug poisoning
5. For post operative or post-Ml bedridden
patient
18
Osmotic Purgatives
Purgatives
lrritant Purgatives
I. Osmotic Purgatives:
a) Saline purgatives : Magnesium sulfate,

Magnesium hydroxide, sodium sulfate,
sod. phosphate, sod. pot. tartarate
b) Electrolyte osmotic purgative

Polyethylene glycol (PEG)- 19
a) Saline purgatives:
Mode of Action:
 Increase the faecal bulk by retaining
water by osmotic effect, thus increasing
peristalsis indirectly.
 Doses : Mag. Sulfate : 5-15 g.
Mag. Hydroxide: 30 ml.
Sod. Sulfate : 10-15 g.
Sod. phosphate: 6-12 g.
Sod. pot. Tartrate : 8-15 g.
Dissolved in 200 ml of water & effects come
with in 2-3 hrs & Latency period is 1-3 hrs
20
Side Effects and Comments:
 Should be ingested with enough water
 Magnesium salts: Should not be used for

prolonged period in patients with renal
insufficiency due to the risk of
hypermagnesemia.
 Sodium salts should be avoided in

hypertensives & CHF
21
22
II. Irritant Purgatives:
(a) Anthraquinone group:

Senna, Cascara sagrada, and Aloe.
(b) Organic irritants:

Phenolphthalein, Bisacodyl,
Sodium picosulfate.
(c) 5 HT4 Agonist: Prucalopride.
(d) Oils: Castor oil. 23

Senna, Cascara sagrada, and Aloe.
 Plant purgatives contain anthraquinone
glycosides [emodins]
 Active principle “anthrol” which acts

locally or is absorbed into circulation
 Acts on the myenteric plexus to increase

peristalsis and decrease segmentation
 Senna Dose: 12-25 mg hs, effects come

with in 6-8 hours, 24
Side Effects:
 Produce abdominal cramps & nausea
 Senna glycosides are secreted through

milk.
 Chronic use leads to brown pigmentation

of the colon known as "melanosis coli".
25
Bisacodyl:
Activated in the intestine by deacetylation
 In the colon it irritate the mucosa,
produce mild inflammation and
secretion
Oral Dose : 5-10 mg hs.
The effect appears with in 8-10 hrs.
Suppositories act with in 20-40 min
Side Effects:
Abdominal cramps and skin rashes.
Higher doses can cause mucosal damage 26
Choice of Drugs /Uses:
Functional Constipation
1. Spastic constipation
Dietary fibre
Bulk forming agents taken over weeks.
Stimulant purgatives are contraindicated.
2.Atonic constipation (sluggish bowel):

Due to old age, debility or laxative abuse
Bulk forming agent, Bisacodyl or senna
given once or twice a week 27
2. Bedridden patients
(MI, stroke, fractures, postoperative):
Prevent- Bulk forming, docusates, lactulose,
liquid paraffin.
3. To avoid straining at stools
(hernia, cardiovascular disease, eye
surgery) and in perianal afflictions (piles,
fissure, anal surgery)
Bulk forming agents, Docusates, lactulose

and liquid paraffin. 28
4. Preparation of bowel for surgery,
colonoscopy, abdominal X-ray
Saline purgative, bisacodyl or senna
5. After anthelmintics:
Saline purgative or senna
6. Food/ drug poisoning:

Saline purgatives
29
30
All laxatives are contraindicated in:
(i) Undiagnosed abdominal pain, colic or

vomiting.
(ii) Stricture or obstruction in bowel,

hypothyroidism, hypercalcaemia,
malignancies
31
Do you know which drugs can
cause constipation?
•Opioids
•Anticholinergics
•Antiparkinsonian,
•Antidepressants and Antihistaminics
•Almunium and Calcium groups of
Antacids
•Oral iron, clonidine, verapamil
Laxative abuse
32
Laxatives/ Purgatives
• Mr Akash is suffering
from Inguinal Hernia. • Mrs. Rita undergoing
abdominal X ray
• Mr. Gurung
• Mr. Ram who is a post
suffering from Tape MI patient suffering
worm infestation is on from constipation.
Niclosomaide. Which • Mr. Alok who is a post
drug should be MI patient. Which drug
combined along with can be used for
it? prophylaxis of
constipation
At the end of this session all of you should be able to address

these conditions confidently 33
34

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Laxatives

Dr. Indrajit Banerjee, MBBS, MD

Constipation : Delayed passage of faeces

Dyschezia: Derangement of defaecation

At the end of this session all of you should be able to address

 Lubricant Laxatives :Liquid paraffin

It absorbs water in the intestines, swells,

Dose : 20-40 g/ day, acts 1-3 days

Lactulose causes reduction of blood NH3

Dioctyl sodium sulfosuccinate(Docusate)

It is an anionic detergent which softens the

It also acts as a wetting agent for the

Prolonged use leads to Hepatotoxicity

a) Saline purgatives : Magnesium sulfate,

b) Electrolyte osmotic purgative

 Should be ingested with enough water

 Magnesium salts: Should not be used for

 Sodium salts should be avoided in

(a) Anthraquinone group:

(b) Organic irritants:

(c) 5 HT4 Agonist: Prucalopride.

(d) Oils: Castor oil. 23

 Active principle “anthrol” which acts

 Acts on the myenteric plexus to increase

 Senna Dose: 12-25 mg hs, effects come

 Produce abdominal cramps & nausea

 Senna glycosides are secreted through

 Chronic use leads to brown pigmentation

2.Atonic constipation (sluggish bowel):

Bulk forming agents, Docusates, lactulose

Saline purgative, bisacodyl or senna

Saline purgative or senna

6. Food/ drug poisoning:

(i) Undiagnosed abdominal pain, colic or

(ii) Stricture or obstruction in bowel,

At the end of this session all of you should be able to address

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