not secondary to an underlying undiagnosed complaint. Use only if really necessary - not for long term use. | |
1.6.1 Bulk-forming laxatives |
May be required when fibre cannot be increased in the diet. Of value in those with small hard stools, need an adequate |
fluid intake and may take a few days for full effect to develop. |
|
GREEN Ispaghula husk granules 3.5g/sachet |
GREEN Methylcellulose tablets 500mg |
AMBER Normacol Plus® (post gastrointestinal surgery) |
|
1.6.2 Stimulant laxatives |
Increase intestinal motility, often cause abdominal cramp, should not be used in intestinal obstruction. |
|
GREEN Bisacodyl |
tablets e/c 5mg |
suppositories 5mg, 10mg |
GREEN Senna [Consider OTC/Self care] |
tablets 7.5mg |
syrup 7.5mg/5mL |
GREEN Sodium picosulfate |
elixir 5mg/5mL |
GREEN Docusate sodium |
capsules 100mg |
syrup 12.5mg/5mL, 50mg/5mL |
|
*Co-danthramer and co-danthrusate are licensed for use in palliative care only* |
GREEN Co-danthramer (dantron /poloxamer ‘188’) |
suspension 25/200 per 5mL, |
strong suspension 75/1000 per 5mL |
GREEN Co-danthrusate (dantron /docusate sodium) |
capsules 50/60 |
|
Rectal stimulant |
GREEN Glycerol suppositories 1g, 2g, 4g |
|
1.6.3 Faecal softeners |
Lubricate and soften impacted faeces and promote a bowel movement. |
GREEN Arachis oil enema |
|
1.6.4 Osmotic laxatives |
Retain fluid in the bowel and change the pattern of water distribution in the faeces. They commonly cause bloating, |
flatulence and cramping and are unpalatable for some patients. They must be taken regularly for up to three days before |
an effect is seen, making them unsuitable for rapid relief of constipation or for ‘as required’ dosing. |
|
First Line |
GREEN Lactulose solution 3.35g/5mL [Consider OTC/Self care] |
Second line |
Oral route: |
GREEN Laxido® for adults |
Laxido paediatric® sachets |
Movicol paediatric® sachets |
|
Rectal Route: |
GREEN Phosphate enema [Cleen® [formally Fleet®] Ready-to-use Enema - prescribe by brand] |
GREEN Relaxit® or Micralax® micro enema |
|
1.6.5 Bowel cleansing solutions |
Bowel cleansing solutions are for use only before colonic surgery, colonoscopy, or radiological examination to ensure the |
bowel is free of solid contents. They are not treatments for constipation. |
RED Citramag® sachets |
RED Klean-Prep® sachets |
RED Picolax® sachets |
RED Moviprep® sachets |
RED Plenvu® sachets |
|
1.6.7 5HT4 receptor agonists and guanylate cyclase-C receptor agonists |
Prucalopride (Resolor®) for the treatment of chronic constipation in women (NICE TA211) |
|
1. Prucalopride is recommended as an option for the treatment of chronic constipation only in women for whom |
treatment with at least two laxatives from different classes, at the highest tolerated recommended doses for at least |
6 months, has failed to provide adequate relief and in whom invasive treatment for constipation is being considered. |
2. If treatment with prucalopride is not effective after 4 weeks, the woman should be re-examined and the benefit of |
continuing treatment reconsidered. |
3. Prucalopride should only be prescribed by a clinician with experience of treating chronic constipation, who has |
carefully reviewed the woman’s previous courses of laxative treatments specified in point 1. |
|
AMBER Prucalopride tablets f/c 1mg, 2mg |
|
Linaclotide (Constella®) treatment of moderate to severe irritable bowel syndrome with constipation in adults who have |
not responded to conventional treatment. |
Linaclotide can be considered as an option (specialist initiation only) for the treatment of persistent constipation in adults |
with IBS who have not responded to conventional treatment based on suggested treatment pathway: |
1. Follow irritable bowel syndrome in adults NICE CG61 (2008) and manage constipation with a range of osmotic and |
stimulant laxatives with the long-term use of soluble fibre |
2. Where antispasmodics and laxatives are ineffective for pain relief, NICE suggests the use of tricyclic |
antidepressants (unlicensed use) |
3. Assess patient at 4 weeks (in secondary care) and if no improvement discontinue use |
4. If continued beyond 4 weeks, re-assess at 6 months for continued benefit |
|
AMBER Linaclotide capsules 290 micrograms |
|
|
NICE TA318 - Lubiprostone for treating chronic idiopathic constipation - Guidance withdrawn because Takeda has |
discontinued lubiprostone [Amitiza] |
|
Naloxegol (Moventig®) is recommended, within its marketing authorisation, as an option for treating opioid induced |
constipation in adults whose constipation has not adequately responded to laxatives |
|
An inadequate response is defined as opioid‑induced constipation symptoms of at least moderate severity in at least 1 of |
the 4 stool symptom domains (that is, incomplete bowel movement, hard stools, straining or false alarms) while taking at |
least 1 laxative class for at least 4 days during the prior 2 weeks. NICE TAG345. |
|
GREEN Naloxegol (Moventig®) tablets 12.5mg, 25mg |
|