Laxatives and oral bowel preparations

Laxative effect. Seed hull, taken orally by adults at a dose of 7 g/person, increased weekly fecal mass without influencing transit time or frequency . Seedcoat, administered orally to 80 patients at a dose of 6.4 g/person three times daily, was active in a blinded placebo controlled study of efficacy of extract in treatment of irritable bowel syndrome " . Water extract of the dried kernel, administered orally to 40-year-old adults of both sexes, was active . Seed powder, administered orally to adults of both sexes, was active. Biological activity reported has been patented ". Dried seeds, administered orally to adults at a dose of 0.5 g/person, were active. Placing the seeds in water increased their volume, 90% alcohol produced a decrease in volume to normal seed size, and linseed oil had no effect on volume. The seed mucilage remained in gel form and is considered preferable to the solid form because it is more easily digested " . Dried seed powder, administered orally to 35 patients with chronic constipation at a dose of 50 mg/person, was active in a controlled, double-blind study " . Fiber, administered orally to adults, was active. Psyllium fiber and sennosides were prepared into a wafer to be... 

Mannitol is an osmotic diuretic that has been used in acute oliguric renal insufficiency, acute cerebral edema, and the short-term management of glaucoma, especially to reduce intraocular pressure before ophthalmic surgery. Other indications include promotion of the excretion of toxic substances by forced diuresis, bladder irrigation during transurethral resection of the prostate, and oral administration as an osmotic laxative for bowel preparation. Mannitol is used as a diluent and excipient in pharmaceutical formulations and as a bulk sweetener. 

The Austrian Adverse Drug Reactions Advisory Committee received three reports of severe electroljde disturbances associated with an oral bowel-cleansing solution containing sodium phosphate solution (Fleet Phospho-Soda Buffered Saline Laxative Mixture), used as a bowel preparation for colonoscopy (5). Prescribers are advised to be aware of complications of the use of phosphate enemas, particularly in infants, elderly or debilitated patients, patients with congestive heart failure, and patients with impaired renal function. 

Sodium phosphates are considered to be dangerous (1), particularly because of their effects on electrolyte balance. An oral solution of sodium phosphates (dibasic sodium phosphate + monobasic sodium phosphate) is used as a laxative for the relief of occasional constipation and is used as part of a bowel-cleansing regimen in preparing patients for surgery or colonoscopy. 

Bisacodyl is a laxative that is indicated in short-term treatment of constipation evacuation of colon for rectal and bowel evaluation preparation for delivery or surgery. Bisacodyl is the only diphenyhnethane derivative available in the United States. It is marketed as an enteric-coated preparation (Dulcolax, Correctol, others) and as a suppository for rectal administration. The usual oral daily dose of bisacodyl is 10 to 15 mg for adults and 5 to 10 mg for children 6 to 12 years old. The drug requires hydrolysis by endogenous esterases in the bowel for activation, and so the laxative effects after an oral dose usually are not produced in less than 6 hours taken at bedtime, it will produce its effect the next morning. Suppositories work much more rapidly. 

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