This document discusses drugs used to treat constipation. It begins by classifying laxatives into four main groups - bulk forming, stool softeners, stimulant purgatives, and osmotic purgatives. Key drugs from each group like ispaghula, docusate, bisacodyl, and magnesium salts are described. Their mechanisms of action, indications, dosages and side effects are summarized. The document emphasizes the importance of monitoring patients for fluid and electrolyte imbalance when using purgatives, especially with prolonged or overuse. It concludes with nursing responsibilities like assessing for abdominal symptoms and ensuring proper mixing of bulk forming laxatives.

1. DRUGS FOR CONSTIPATION
PRESENTED BY
ABHILASHA VERMA
LECTURER
JHALAWAR NURSNG COLLEGE 1

2. ABHILASHA VERMA 2

3. ABHILASHA VERMA 3

4. INTRODUCTION
Drugs that promote bowel evacuation are –
1) Laxative or Aperient-
• Milder action, elimination of soft stools.
2) Purgative or cathartics-
• They have stronger action and there is more fluid
evacuation in faeces.
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5. CLASSIFICATION
1. BULK FORMING DRUGS
(Contain dietary fibers)
2. STOOL SOFTENERS
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• Ispagula
• Methyl cellulose
• Liquid paraffin
• Docusate

6. 4. OSMOTIC PURGATIVES3. STIMULENT PURGATIVES
• Diphenyl methane
• Sodium picosulfate
• Bisacodyl
• Anthraquinone
• Senna
• Cascara sagrada
• 5 HT4 agonist
• tegaserod
• Fixed oil
• Castor oil
• Magnesium salts
– Sulfate , hydroxide
• Sodium salts
– Sulfate, phosphate
• Sodium pot. Tartrate
• Lectulose
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4. OSMOTIC PURGATIVES

7. INDICATION/USES
Spastic constipation. ( Irritable Bowel)
Bedridden patients.
To avoid straining at stool
Preparation of bowel before surgery, colonoscopy, abdominal x-ray.
Food/drugs poisoning.
Osmotic laxatives are used to rapid evacuation following anti helminthic
therapy to rid body of dead parasite
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8. MECHANISM OF ACTION OF PURGATIVES
 All drugs increase water content of faeces by:
Hydrophilic or osmotic action-
 Retaining water and electrolyte in intestinal lumen
 Increase volume of colon and this way making it easy to
propelled out.
Acting on intestinal mucosa and enhance the forward
movement of fluid bulk.
Increasing propulsive activity as primary action.
Allow more fluid to penetrate faces, producing softer
fecal mass.
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9. BULK PURGATIVES (ISPAGULA)
 It contain dietary fiber, which when mixed with water form gel like
mass that work as mild laxatives.
 It makes stool soft by increasing water content.
 It lubricate intestine which help in transit of stool.
 It increase stool bulk, thus stimulate bowel movements.
 Uses:
• Use with water or milk, should not taken dry because it can cause
esophageal impaction.
• It is useful in prevention of constipation but not for treating already
constipated patient.
• Relieve symptoms of irritable bowel syndrome ( IBS)
 Contraindication: Dose:
• Gut ulceration 3-12 gram freshly mixed with water or
• Stenosis milk, taken daily, acts in 1-3 days.
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10. STOOL SOFTENER (DOCUSATE)
• Also called as DOSS (Doctyl sodium sulfo succinate.
• It soften the stool by net water accumulation in the lumen by an
action on the intestinal mucosa.
• It allowing water and lipids to penetrate stool. This helps to
hydrate and soften stool and facilitating natural defecation.
 Side effects-
• Cramps abdominal pain may occur.
• Bitter taste , liquid preparation may cause nausea.
• Hepatotoxicity on prolonged use.
 Dose-
 100 mg-400 mg /day (capsule form)
 Acts in 1-3 days.
 As enema 50-150 mg in 50-100 ml.
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11. STIMULANT PURGATIVES
• They are powerful purgatives.
• They irritate intestinal mucosa and stimulate motor activity
( peristasis)
• They accumulate water and electrolyte in intestinal lumen.
 BISACODYL
• They irritate mucosa, produce mild inflammation and secretion.
• One or two semi formed motion occur after 6-8 hours.
• It can cause inflammation and mucosa damage.
• Suitable for constipation in pregnancy.
• Dose-: 5 -15 mg
i. 5 mg tab. , 10 mg adult tab, 5 mg child suppository
(Evacuation occur in 20-40 min)
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12. Other Stimulant purgatives
1) Sodium picosulfate – 5-10 mg at bed time
2) Anthroquinones – Senna; 12 mg tab.
3) 5 ht4 agonist- Tegasterod 2-6 mg BD before meals.
4) Fixed oil – Caster oil, 15 – 25ml adult, 5 -10 ml child.
 Caster oil site of action small intestine.
 Purgation occur in 2-3 hour
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13. OSMOTIC PURGATIVES
• Increase peristalsis indirectly,
retain water osmotically and
distend bowel
• Preferred for preparation of
bowel before surgery and
colonoscopy.
 Magnesium salt –
• Magnesium sulfate 5-15 gms
• Magnesium hydroxide 30 ml
 Sodium salt-
• Sodium sulfate 10-15 gms
• Sodium phosphate 6-12 gms.
 Lectulose-
• It is synthetic disaccharide of
fructose and lactose.
• It is neighter digested nor
absorbed in intestine.
• It breaks down in large intestine
and then draws water into the
intestine, this soften stool.
• Lacsan, Mt-lac 10gms/15 ml
liquid.
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14. SIDE EFFECTS OVER & PROLONGED USE
Fluid and electrolyte imbalance ( mainly hypokalaemia)
Rupture of inflamed appendix.
Steatorrhoea
Malabsorption syndrome
Spastic colitis.
Protein losing enteropathy.
Rectal burning sensation.
Laxative dependance.
Nutritional deficiencies.
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15. DRUG INTERACTION
Laxatives decrease intestinal
transit time and reduce
absorption of orally
administered drugs.
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16. NURSING RESPONSIBILITY
Assess for abdominal pain, distention,
nausea/ vomiting bowel sound.
Monitor patient for fluid and
electrolyte imbalance.
Evaluate stool for frequency and
consistence.
Mix bulk forming laxatives in full of
water or juice.
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17. THANK
YOU
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