Drug used in constipation


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Drug used in constipation

  1. 1. Drug used in constipation Dr.Jannatul Ferdoush Assistant Professor Department Of Pharmacology
  2. 2. • Constipation : Absence of propagating contraction in colon. • Purgatives: They are medicine that promote defecation largely by reducing the viscosity of the content of the lower colon.
  3. 3. Classification of purgatives • Luminally active agent: 1.Bulk forming agent- Several days( at least 3 day) bran ispagula husk methylcellulose 2.Osmotic agent- inorganic salt- (with in 3 hours) magnesium hydroxide Magnesium sulfate.7H2O Lactulose
  4. 4. Stool (fecal) softeners( emollients)(reliefs within 1-2 days) Docusate sodium Liquid paraffin Stimulant purgatives: Bisocodyl ( 6-10 hrs) glycerol sinna(8-12 hrs) Danthron(6-12hr) Prokinetic agent 5HT4 agonist opioid antagonist Enema & suppositories( 1 hrs)
  5. 5. M/A of Bulk & osmotic laxatives Retain water in the intestinal lumen ↓ ↑Bulk of the stool& gives pressure on the lumen ↓ Stimulate enteric nerve plexus ↓ ↑Peristalsis ↓ Evacuation of stool
  6. 6. • Indication: Hemorrhoids Anal fissure Diverticular disease Irritable bowel syndrome A/E: Cathertic colon Malabsorption syndrome Proteinloosing enteropathy Paralytic ileus
  7. 7. Osmotic laxatives • Where a rapid bowel evacuation is required, magnesium sulphate is still used. • This should be used in a dose before breakfast or on an empty stomach, followed by plenty of warm fluid. • This treatment usually causes evacuation within 2 hours
  8. 8. Magnesium sulphate (MgSO4) Epsom salt • MgSO4 dissociate into Mg & SO4. This Mg draws water from intestine causing softer stool & help in evacuation • MgSO4 is usually given in empty stomach It may cause uremia in patients with renal insufficiency
  9. 9. Lactulose • It is a semi synthetic disaccharide of fructose & galactose. • Taken orally, it is unaffected by small intestinal disaccharidase, is not absorbed • In the colon, bacteria convert it to its two component sugars, which are poorly absorbed; when these are fermented, the lactic acid & acetic acid are formed which function as osmotic laxatives. It takes 2-3 days to act
  10. 10. • Indication: –constipation, –hepatic encephalopathy • Contraindications: –galacosaemia, –intestinal obstruction
  11. 11. • Side effects: flatulence, cramps, & abdominal discomfort • Dose: expressed in terms of an eoral solution containing lactulose 3.35 g/5ml • Constipation, adults initially 15 ml twice daily, gradually reduced according to patients needs; child under 1 year 2.5 ml, 1-5 years 5 ml., 6-12 years 10 ml twice daily, gradually reduced • Hepatic encephalopathy, 30-50 ml 3 times daily, subsequently adjusted to produce 2-3 soft stools daily • Avolac (solution, 3.35 mg/5ml), D-Lac (syrup), Laclose (syrup), Osmolax (syrup)
  12. 12. Magnesium hydroxide • Indication: mild constipation (acts in 2-4 hours) • Caution: use only occasionally; the elderly; renal impairment; hepatic impairment • Contraindication: intestinal obstruction • Dose: Aqueous suspension containing about 8% hydrated magnesium oxide, 25-50ml as & when required • Magna milk, milk of magnesia (susp 400 mg/5ml)
  13. 13. Fecal softner • Decusate: Softening the stool by↓ surface tension of stool which allows more water to remain in the feces. It has bowel stimulant property. ↑ Intestinal fluid secretion, It mix with stool & stool become soft.
  14. 14. Liquid paraffin • Chemically inert mineral oil • Not digested • Tasteless • M/A: • Lubricates the intestinal wall • Easy & increase rate of passage of gut contents • Reduce absorption of water in the small intestine • Retain more water in the gut contents • Softening of the stool • Easy evacuation
  15. 15. • Side effects : Anal leakage following large doses of paraffin cause physical & social discomfort. Granulomatous reactions caused by absorption of small quantities of liquid paraffin (especially from the emulsion) Lipoid pneumonia (taken orally for long period, especially at night, may be aspirated & cause chronic lipoid pneumonia)
  16. 16. Stimulant purgatives • Most strong laxatives • Induces low grade inflammation in small & large intestine to promote accumulation of water & electrolyte • Stimulate gut motility.
  17. 17. • Dependence: - Stimulant empty the whole colon. But normal defecation only empties the descending colon . -Cessation of use after a few weeks is followed by a few days constipation to collect significant materials to restore the normal state. -This delay may convince the patient to continued need for purgatives.
  18. 18. • Enema: containing 130 ml of arachis oil (ground-nut oil) would lubricate & soften impacted faeces & promote bowel movement. • For children above 6 years, the dose has to be reduced in proportion to body-weight; not recommended for children under 6 years
  19. 19. Cathartic colon • It is the anatomical and physiological changes in the colon that occurs with chronic use of stimulant laxatives.(> 3times/weeks) for 1 yr • S/S— Bloating Feeling of fullness Abdominal pain Incomplete fecal evacuation
  20. 20. • Typically female patient. • Long standing H/O laxative use • Cause damage to the colonic Nerve. • Rx – surgery.