Laxatives, bulk products

Laxatives Bulk formers Polycarbophil, psyllium and methylcellulose preparations. Dosage varies consult product labeling Citrucel, Equalactin, Konsyl, Metamucil, Perdiem, various generic The safest laxatives for chronic use include the bulk formers and stool softeners. Saline laxatives and stimulants may be used acutely but not chronically (see text). Bulk formers hold water and expand in stool, promoting peristalsis. 

Active substances that are considered to be most sensitive to interaction with herbal preparations include oral anticoagulants, cardiac glycosides, oral contraceptives, antidepressants and antihypertensives. Typical herbal products that may influence their activity are St John s wort, ginkgo, ginseng, garlic and laxatives (bulk formers and anthraquinones). Note that the composition of the particular herbal preparatirMi should always be considered as the profiles of different extracts from the same plant may vary considerably. 

Patients with the following conditions should use laxatives only under the supervision of a health care provider (1) colostomy (2) diabetes mellitus (some laxatives contain large amounts of sugars such as dextrose, galactose, and/or sucrose (3) heart disease (some products contain sodium (4) kidney disease and (5) swallowing difficulty (bulk-formers may produce esophageal obstruction). 

Some laxatives (e.g., bulk-forming agents) contain significant amounts of sodium or sugar and may be unsuitable for salt-restricted or diabetic patients. When low-sodium or sugar-free products are not used, monitor serum concentrations of sodium and glucose as needed with chronic use. 

For bulk sweeteners, which are often an important and sometimes the most important ingredient, any limitation would be unreasonable and often even render their use impossible. In the EU consumers are alerted of potential laxative effects by labelling of products containing more than 10% by weight of sugar alcohols. 

Bulk-forming laxatives are indigestible, hydrophilic colloids that absorb water, forming a bulky, emollient gel that distends the colon and promotes peristalsis. Common preparations include natural plant products (psyllium, methylcellulose) and synthetic fibers (polycarbophil). Bacterial digestion of plant fibers within the colon may lead to increased bloating and flatus. 

As shown on Table III, the subjects fed 20 g of hemicellulose from purified psyllium fiber excreted significantly more manganese in the feces than when they were fed bread without the hemicellulose supplement. Unlike wheat bran, purified psyllium fiber (sold commercially as a bulk laxative) contains no manganese or phytates hence, any change in fecal manganese excretion when psyllium fiber is added to human diets can probably be credited to the mixture of hemicellulose comprising this product. 

Carboxymethylcellulose sodium is used in oral, topical, and some parenteral formulations. It is also widely used in cosmetics, toiletries, and food products, and is generally regarded as a nontoxic and nonirritant material. However, oral consumption of large amounts of carboxymethylcellulose sodium can have a laxative effect therapeutically, 4-1 Og in daily divided doses of the medium- and high-viscosity grades of carboxymethylcellulose sodium have been used as bulk laxatives. " ... 

Established just a century earlier by William Bristol and John Myers in New York City to produce bulk pharmaceuticals, the company had quickly moved into proprietary-patented (OTC) dmgs, and then into other consumer products. During the 1920s it became a master marketer that, in addition to proprietary OTC dmgs, sold Ipana toothpaste, Sal Hepatica laxatives, Vitalis hair tonic, and the like through the radio shows of leading entertainers Fred Allen and Eddie Cantor. ... 

The first imports of carob gum into this country were made in the late 1920 s, although this gum had been used as a thickener for textile printing pastes in Germany prior to World War I and, for some time prior to that, in Spain and Portugal as a starch replacement and as a size for paper and textiles. From Biblical times, the pods had been used in the Mediterranean countries for human and animal feed and as a source of fermentable carbohydrate. It is probable that the independent value of the bean as a source of gum was unearthed by the pharmacists, for one of the early uses of the flour in Europe was as a bulk laxative. Expansion of the American market has stimulated production of seed in Cyprus, Greece, Italy, Portugal, and Spain. Some of the seed is milled in those countries, as well as in England, Holland, Switzerland, and the United States. 

Osmotic laxatives (hyperosmolar) are salts or saline products, lactulose, and glycerin. The saline products are composed of sodium or magnesium, and a small amount is systemically absorbed. They pull water into the colon and increase water in the feces to increase bulk, which stimulates peristalsis. Saline cathartics cause a semiformed-to-watery stool depending on dose. However, they are contraindicated for patients who have congestive heart failure. 

Products and Uses An ingredient in meringues and whipped toppings. Pharmaceutically used in laxative products. It is an emulsifier, foaming agent, stabilizer, aerator, and bowel-bulking agent. 

Specific labeling is required in the United States for all over-the-counter drug products containing agar (CFR 2011a) see Bulk-forming laxatives in Appendix 2. 

In this country and in most of the western world there is plenty of food to go round, why then do we have to eat junk The FDA said, in an unlikely turn of phrase, there is more nutrition in the carton than in the contents of a packet of cornflakes so many products sold in our shops seem to be mere vehicles for the addition of more fat and sugar to our diet. It was many years before some of the instant potato powders began to reintroduce the vitamin C lost from what had in the winter been the main provider of vitamin C to the English diet. 1 doubt whether this vitamin C is included in the bulk pack sold to institutions where, with a few exceptions, white bread is invariably given at the beginning of the day and laxative pills at the end of it. In fact some heavily promoted consumer products, are still without added vitamin C. 

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