| 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 |
| 1.6.6 Peripheral opioid-receptor antagonist |
| NICE TA651 Naldemedine is recommended as an option for treating opioid induce constipation in adults who have previously |
| been treated with a laxative - see full guidance |
| GREEN Naldemedine tosylate (Rizmoic®) tablets 200mg ICS Commissioned |
| |
NICE TA345 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 |
| |
|
| 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] |
| |
|
|
|
| |
