page89
Glycerol suppositories act as a rectal stimulant by virtue
of the mildly irritant action of glycerol.
The parasympathomimetics bethanechol,
distigmine,
neostigmine,
and pyridostigmine (see section 7.4.1 and
section 10.2.1) enhance parasympathetic activity in the
gut and increase intestinal motility. They are rarely used
for their gastro-intestinal effects. Organic obstruction of
the gut must first be excluded and they should not be
used shortly after bowel anastomosis.
BISACODYL
Indications
see under Dose
Cautions
see notes above
Contra-indications
see notes above, acute surgical
abdominal conditions,
acute inflammatory bowel
disease,
severe dehydration
Pregnancy
see Pregnancy,
p.
67
Side-effects
see notes above;
nausea and vomiting;
colitis also reported;
suppositories
,
local irritation
Dose
. Constipation, by mouth, 5–10 mg at night, increased if
necessary to max.
20 mg at night;
CHILD
(but see
section 1.6) 4–18 years 5–20 mg once daily,
adjusted
according to response
By rectum in suppositories,
10 mg in the morning;
CHILD
(but see section 1.6) 2–18 years 5–10 mg once
daily,
adjusted according to response
. Before radiological procedures and surgery, by mouth,
10 mg in the morning and 10 mg in the evening on the
day before procedure, and by rectum in suppositories,
10 mg 1–2 hours before procedure the following day;
CHILD
4–18 years see
BNF for Children
Note
tablets act
in 10–12 hours;
suppositories act
in 20–60
minutes
Bisacodyl
(Non-proprietary)
Tablets
,
e/c,
bisacodyl 5 mg.
Net price 100 = £3.27.
Label:
5,
25
Suppositories
, bisacodyl 10 mg. Net price 12 = £1.11
Paediatric suppositories
, bisacodyl 5 mg. Net price 5
= 94p
Note
The brand name
Dulcolax
c
D (Boehringer Ingelheim) is
used for bisacodyl tablets, net price 10-tab pack = 74p;
suppositories (10 mg), 10 = £1.57; paediatric suppositories (5 mg),
5 = 94p
The brand names
Dulcolax
c
Pico Liquid
and
Dulcolax
c
Pico
Perles
are used for sodium picosulfate preparations
DANTRON
(Danthron)
Indications
only for constipation in terminally ill
patients of all ages
Cautions
see notes above;
rodent
studies indicate
potential carcinogenic risk;
avoid prolonged contact
with skin (as in incontinent patients or infants wearing
nappies)—risk of irritation and excoriation
Contra-indications
See notes above
Pregnancy
manufacturers of co-danthramer and co-
danthrusate advise avoid—no information available
Breast-feeding
manufacturers of co-danthramer and
co-danthrusate advise avoid—limited information
available
Side-effects
see notes above;
urine may be coloured
red
Dose
. See under preparations
With poloxamer ‘188’ (as co-danthramer)
Note
Co-danthramer suspension 5 mL = one co-danthramer
capsule,
but strong co-danthramer suspension 5 mL = two
strong co-danthramer capsules
Co-danthramer
(Non-proprietary) A
Capsules
,
co-danthramer 25/200 (dantron 25 mg,
poloxamer ‘188’
200 mg). Net price 60-cap pack =
£12.86.
Label:
14,
(urine red)
Dose
1–2 capsules at bedtime;
CHILD 1 capsule at bedtime
(restricted indications,
see notes above)
Strong capsules
,
co-danthramer 37.5/500 (dantron
37.5 mg,
poloxamer ‘188’
500 mg). Net price 60-cap
pack = £15.55.
Label:
14,
(urine red)
Dose
ADULT and CHILD over 12 years, 1–2 capsules at bedtime
(restricted indications,
see notes above)
Suspension
, co-danthramer 25/200 in 5 mL (dantron
25 mg,
poloxamer ‘188’
200 mg/5 mL).
Net price
300 mL = £11.27,
1 litre = £37.57.
Label:
14,
(urine
red)
Dose
5–10 mL at night;
CHILD 2.5–5 mL (restricted indications,
see notes above)
Brands include
Codalax
c
D,
Danlax
c
Strong suspension
, co-danthramer 75/1000 in 5 mL
(dantron 75 mg, poloxamer ‘188’ 1 g/5 mL). Net price
300 mL = £30.13.
Label:
14,
(urine red)
Dose
ADULT and CHILD over 12 years, 5 mL at night (restricted
indications, see notes above)
Brands include
Codalax Forte
c
D
With docusate sodium (as co-danthrusate)
Co-danthrusate
(Non-proprietary) A
Capsules
,
co-danthrusate 50/60 (dantron 50 mg,
docusate sodium 60 mg). Net price 63-cap pack =
£15.87.
Label:
14,
(urine red)
Dose
1–3 capsules at night; CHILD 6–12 years 1 capsule at night
(restricted indications,
see notes above)
Brands include
Normax
c
D
Suspension
,
yellow,
co-danthrusate 50/60 (dantron
50 mg,
docusate sodium 60 mg/5 mL).
Net price
200 mL = £8.75.
Label:
14, (urine red)
Dose
5–15 mL at night;
CHILD 6–12 years 5 mL at night
(restricted indications,
see notes above)
Brands include
Normax
c
DOCUSATE SODIUM
(Dioctyl sodium sulphosuccinate)
Indications
constipation,
adjunct in abdominal radi-
ological procedures
Cautions
see notes above; do not give with liquid
paraffin;
rectal preparations not indicated if
haemorrhoids or anal fissure
Contra-indications
see notes above
Pregnancy
not known to be harmful—manufacturer
advises caution
Breast-feeding
present in milk following oral admin-
istration—manufacturer advises caution; rectal
administration not known to be harmful
Side-effects
see notes above
Dose
. By mouth, chronic constipation, up to 500 mg daily in
divided doses;
CHILD
(but see section 1.6) 6 months–2
years 12.5 mg 3 times daily,
adjusted according to
response (use paediatric solution); 2–12 years 12.5–
25 mg 3 times daily,
adjusted according to response
(use paediatric oral solution)
Note
Oral preparations act within 1–2 days
With barium meal,
ADULT
and
CHILD
over 12 years,
400 mg
BNF 61
1.6.2 Stimulant laxatives
69
1
Gastro-intestinal system