Laxative (Oral)

Laxative medications provide relief to patients who are constipated by encouraging bowel movements with different stimulation techniques.

Overview

Patients experience constipation as the result of different medications, being bedridden or during pregnancy. Whatever the circumstances, oral laxative medications are available that provide a solution to this uncomfortable problem. Depending on the circumstances and the patient's health, there are different formats to choose from that can provide relief quickly and in a safe manner.

The following conditions may cause constipation or require the use of a laxative medication:

  • Pregnancy
  • Giving birth
  • Colorectal examination
  • Being bedfast
  • Certain medication side effects
  • Surgery
  • Poor eating or exercise habits
  • Overdose of drugs or reaction causing foods
  • Sample of stool for diagnosis

Other medical conditions may make it necessary for the patient to avoid straining while trying to have a bowel movement. These conditions may require the use of a laxative medication:

  • Straining following surgery
  • Heart disease
  • Hernias or ruptures in the abdomen
  • Repair of hernias or ruptures
  • Hemorrhoids
  • Elevated blood pressure
  • Stroke history

Oral laxative medication is available in the following formats:

  • Liquid filled capsules
  • Capsules
  • Liquid solution
  • Chewable tablets
  • Tablets to swallow
  • Oil
  • Oral syrup
  • Flakes
  • Suspension
  • Powder to be made into a suspension
  • Wafers
  • Granules
  • Powder to be made into a solution
  • Emulsions
  • Kits
  • Gum
  • Coated tablets
  • Delayed or time released tablets
  • Packets

Depending on your condition and other factors, you may receive a recommendation of one or more types of these oral laxatives to assist with your condition. The following brand name laxatives are available on the market:

  • Alocass
  • A-3 Revised
  • Benefiber
  • Amitiza
  • CeraLyte 70
  • Black-Draught
  • Citrate Of Magnesia
  • Cholan-HMB
  • Colace
  • Citrucel
  • Doc-Q-Lax
  • Colyte
  • Dulcolax
  • Docucal
  • Fleet Mineral Oil
  • Fibercon
  • GaviLyte-N with Flavor Pack
  • GaviLAX
  • Kristalose
  • GlycoLax
  • Metamucil
  • Mag-Gel 600
  • Phillips Milk of Magnesia
  • Nulytely
  • Prepopik
  • Phospho-Soda
  • Reglan
  • Purge
  • Rite Aid Senna
  • Resource Benefiber
  • Senokot
  • Senna-S
  • Unifiber
  • Suprep Bowel Prep Kit

There are different types of laxatives available and each type is appropriate to a different type of requirement, depending on how they operate. You may be recommended one of the following types of laxatives and it is important to know how each can work on your condition.

Bulk Formers include the following characteristics:

  • Are not digested but move into the intestines where they absorb water.
  • Fully swollen, they form a bulky stool, which stimulates the bowel.
  • Polycarbophil or psyllium may be used for diarrhea treatment.

Hyperosmotics are primarily characterized by the following:

  • These laxative types draw water from the body tissues surrounding the bowel.
  • This water softens a stool mass already present in the bowel and increases bowel action.
  • Saline types of hyperosmotics or salts rapidly empty the lower intestine and bowel.
  • Saline types are not long-term solutions for constipation.
  • Saline types may be used as antacids in low dosage formats.
  • Lactulose types of hyperosmotics are similar in operation to saline or salt types.
  • Lactulose operates slower than saline or salt types.
  • Lactulose may be used for long-term treatments or to reduce ammonia in the blood.
  • Lactulose is only available via prescription from a doctor.
  • Polymer type hyperosmotics are also known as polyethylene glycol.
  • Polymer types cause water retention in the stool to soften it, which increases bowel movement.
  • Polymer types are only used for short durations.

Lubricant laxative types work by coating the bowel and the mass of stool in the bowel with a film, which keeps the stool moist so that it remains soft and easier to pass. One type of oral lubricant laxative is mineral oil.

Stimulant types of laxatives increase muscle contractions in the intestinal wall to move the stool along through the bowel. Stimulant laxatives are the main choice for patients when treating their own constipation, but they often cause unpleasant health effects in addition to being effective relief for constipation.

Emollient types of laxatives are more commonly known as stool softeners and they perform just as their name suggests. They encourage liquids to mix with the stool, preventing hard masses in the bowel that are painful and difficult to pass. While an emollient type of laxative doesn't cause a bowel movement in and of itself, it does help a patient relieve their own constipation without straining to do so.

Combination laxatives are available that contain more than one type of stimulus. A stimulant type of laxative that includes a stool softener is a combination that many patients find easy to take and effective. These types of laxatives are, however, more likely to cause unwanted health effects due to the increased number of ingredients they contain. They may also not be as advantageous as their marketing material claims that they are, so be educated on the right solution for your condition and the potential risks.

While laxatives are useful in certain medical circumstances and provide relief when nothing else works, a good diet is paramount to good bowel health and movements. Make sure you eat fiber-rich foods such as those containing bran, fruits, green leafy vegetables and whole grain pastas, cereals and breads. Consume six to eight full glasses of water each day and get plenty of exercise to maintain your bowel health and function. People who have chronic constipation should avoid sugary, carbohydrate laden foods such as pudding, pastry, candy, cake as well as cheese so that their condition doesn't become worse.

Before taking any laxative therapy, notify your doctor what your choice of laxative type and brand will be and the details of your diet, especially if it is low sugar or low sodium. Some laxatives contain high amounts of sugar or sodium that could interfere with your other health conditions such as diabetes or high blood pressure.

Conditions Treated

Type Of Medicine

  • Ammonia detoxicant
  • Gastrointestinal agent

Side Effects

Oral laxatives may cause unwanted health effects, especially those with long lists of ingredients that work in a combined way to cause a bowel movement through more than one means. Should you experience any of the following ill health symptoms after taking a laxative, report them to your physician right away:

Bulk Former types

  • Trouble breathing or swallowing
  • Blocked intestines
  • Skin that itches or has a rash

Hyperosmotic types

  • Confused demeanor
  • Lightheaded or dizzy sensations
  • Irregular heart rhythm
  • Cramps in muscles
  • Fatigue
  • Muscle weakness

Stimulant types

  • Confused demeanor
  • Rapid heart rhythm
  • Cramps in muscles
  • Urine coloration is odd, pink, red, violet or brown
  • Rash on skin
  • Fatigue
  • Weak muscles

Emollient types

  • Rash on skin

Other bothersome symptoms may occur after you take an oral laxative, but these will typically resolve themselves over time and use of the medication. If you have any questions about them, however, consult your physician:

Hyperosmotic types

  • Cramps
  • Bloating
  • Nausea
  • Excess gas
  • Diarrhea
  • Thirst increases

Lubricant types

  • Irritation of skin near rectal area

Stimulant types

  • Cramps
  • Diarrhea
  • Nausea
  • Excess gas

Emollient types

  • Intestine or stomach cramps
  • Irritation in throat

It is in the best interest of your continued good health to report any adverse symptoms you experience after taking an oral laxative, so let your doctor decide if you need further treatment.

Dosage

If your laxative was received as the result of a prescription, follow the instructions your doctor has given for the pharmacist to communicate to you. Read and review the patient information brochure that comes with your prescription and ask any questions you need to prior to taking your laxative.

Over-the-counter laxative medications will have specific information on how to take them as well as other information that patients need to be educated about their dose.

With either type of laxative, prescription or non-prescription, be sure you are aware of any symptoms that can occur to your health as the result of taking this medication as well as understand how it will work to resolve your constipation.

All laxatives should be accompanied by six to eight full glasses (8 ounce size) per day of liquids, which will help to soften the stool and make it easier to pass.

Patients taking bulk type laxatives:

  • Dry forms of this laxative should be mixed with liquid before swallowing.
  • Drink the indicated amount of fluids to accompany the laxative and prevent blocking your intestines. Each dose should be taken with eight ounces or more of water or juice followed by a second eight ounce glass.
  • Expect results of the laxative as quickly as 12 hours after taking your dose, with some people taking up to two or three days to respond to the medication.

Emollient type laxatives:

  • Liquid formulas can be mixed with milk or juice to disguise the flavor.
  • This type typically gives results in one to two days after taking the medication, possibly up to three to five days.

Hyperosmotic type laxatives:

  • Take your dosage with an 8 ounce glass of water or juice, followed by a second full glass of water or juice alone.
  • Saline type laxatives may dehydrate you, so these types should be taken with plenty of fluids.
  • If you experience an unpleasant taste in your mouth after your dose, drink citrus fruit juices or citrus-flavored carbonated beverages to combat this.
  • Lactulose containing laxatives may not give results for one or two days.
  • Polyethylene glycol containing laxatives may not work for two to four days.
  • Saline types of laxatives are faster acting, producing results in 30 minutes to three hours after taking your dose. If a large dose is taken on an empty stomach, expect faster results. On the opposite end, a slower result will be experienced if a smaller dose is taken with food. It would be highly unusual, therefore, to take a saline type of laxative late in the day on an empty stomach.

Lubricant type laxatives:

Avoid taking these types of laxatives within two hours of consuming a meal, which can interfere with digestion and absorption of essential vitamins and nutrients.

These types of laxatives are suitable for use prior to going to bed as they require six to eight hours to fully work on your constipation.

Stimulant type laxatives:

  • Take these types of laxatives on an empty stomach for rapid relief. Results will be slower if you have eaten a meal recently.
  • Some stimulant brands will instruct you to take just before bed as they promise to work the next morning. Others require 24 hours or more, which will be indicated on the label.
  • Castor oil has an average effectiveness of two to six hours and is usually not taken during late hours. As castor oil has a notoriously unpleasant taste, place the bottle in the refrigerator and mix it with orange juice just prior to taking it if you aren't getting a flavored variety.
  • If you are purchasing Bisacodyl tablets, be sure to swallow them whole without crushing, chewing or taking with milk or antacid medication. These tablets contain a coating that protects them from causing irritation and nausea that can be damaged if you void it in any way.

Your personal health condition and your doctor's recommendation will help decide which format of oral laxative is right for you to take. Your dosage of the medication is specifically designed for safe, effective treatment of your condition. Do not take more of the medication than you are supposed to and do not take it more often than you have been instructed. Chronic constipation may require other forms of treatment, so consult your doctor if you have to take oral laxatives more than is indicated to be safe in the patient information.

Interactions

If you've had other laxative brands or types in the past and had sensitive reactions to them, let your doctor know of this condition prior to taking any laxative he recommends or prescribes to you. It is best to alert your physician of any other sensitivity you have including animals, dyes, perfumes, foods or preservatives, as some medications could contain ingredients that trigger your reaction.

Children younger than six should not be given laxatives unless their physician specifically prescribes it for them. Young children may not communicate all their symptoms correctly and therefore require a doctor's examination prior to being dosed with any laxative ingredients. Prevent any danger to your child and have a doctor's recommendation before giving a laxative that may harm their condition further.

Do not give mineral oil type laxatives to children younger than six, as a risk of a certain form of pneumonia exists if children inhale oil droplets. Similarly, bisacodyl tablets should not be used on young children due to the fact that they will chew them, causing severe stomach irritation.

Geriatric patients who are bedridden should not be given mineral oil as a laxative to avoid a dangerous form of pneumonia possible if they inhale this medication. Stimulant laxatives, taken too frequently, may make uncoordinated, weak, dizzy feelings that are age-related worse if taken by elderly patients. Elderly patients in nursing homes should not take Polyethylene glycol if they have diarrhea symptoms.

Laxatives are often required by pregnant women and some types are more beneficial with fewer side effects than other types. Pregnant women should look for emollient type laxatives or bulk former type laxatives, as these are most often the best types for their condition. Some things to keep in mind during pregnancy with regard to laxatives are:

  • Bulk forming types contain elevated amounts of sugar or sodium, which may increase your blood pressure or cause you to retain water.
  • Saline types may contain potassium, magnesium or phosphate ingredients, which should be avoided if your kidneys are not functioning normally.
  • Mineral oil should not be taken during pregnancy as it interferes with the absorption of vitamins and nutrients by the mother's body and may cause severe bleeding in newborns.
  • Stimulant type laxatives may cause unwanted symptoms, with castor oil in particular linked to causing contractions in the womb.

Women who are breastfeeding should avoid laxatives that contain danthron and cascara, as these are known to pass through breast milk to the infant. Discuss your use of laxatives with your doctor prior to doing so if you are breastfeeding.

Oral laxative medications may be used to treat conditions caused by other medications and, therefore, used in combination with other drugs. The following drugs should not be used along with laxative medications for any reason, so alert your physician if you are taking:

  • Amantadine
  • Amisulpride
  • Amifampridine
  • Belladonna Alkaloids
  • Atropine
  • Bepridil
  • Belladonna
  • Benztropine
  • Cisapride
  • Biperiden
  • Darifenacin
  • Clidinium
  • Dronedarone
  • Dicyclomine
  • Fesoterodine
  • Eplerenone
  • Hyoscyamine
  • Glycopyrrolate
  • Methscopolamine
  • Mesoridazine
  • Pimozide
  • Oxybutynin
  • Procyclidine
  • Piperaquine
  • Scopolamine
  • Saquinavir
  • Sparfloxacin
  • Solifenacin
  • Thioridazine
  • Terfenadine
  • Trihexyphenidyl
  • Tolterodine
  • Ziprasidone
  • Trospium

While it may be necessary for you to continue taking the following drugs, your doctor may want to adjust the dosage of one or more medications to protect your health. Let your physician know if you are taking:

  • Alfuzosin
  • Alacepril
  • Amiodarone
  • Amiloride
  • Amoxapine
  • Amitriptyline
  • Amygdalin
  • Amphetamine
  • Apomorphine
  • Anagrelide
  • Arsenic Trioxide
  • Aripiprazole
  • Astemizole
  • Asenapine
  • Azithromycin
  • Azathioprine
  • Benazepril
  • Bedaquiline
  • Canrenoate
  • Buserelin
  • Chloroquine
  • Captopril
  • Cilazapril
  • Chlorpromazine
  • Citalopram
  • Ciprofloxacin
  • Clomipramine
  • Clarithromycin
  • Crizotinib
  • Clozapine
  • Cyclosporine
  • Cyclobenzaprine
  • Dasatinib
  • Dabrafenib
  • Degarelix
  • Deferoxamine
  • Delapril
  • Delamanid
  • Deslorelin
  • Desipramine
  • Disopyramide
  • Digoxin
  • Dolasetron
  • Dofetilide
  • Donepezil
  • Domperidone
  • Efavirenz
  • Droperidol
  • Elvitegravir
  • Eliglustat
  • Enalapril Maleate
  • Enalaprilat
  • Escitalopram
  • Erythromycin
  • Flecainide
  • Fingolimod
  • Fluoxetine
  • Fluconazole
  • Gatifloxacin
  • Fosinopril
  • Gemifloxacin
  • Gefitinib
  • Goserelin
  • Gonadorelin
  • Halofantrine
  • Granisetron
  • Histrelin
  • Haloperidol
  • Hydroxychloroquine
  • Hyaluronidase
  • Ibutilide
  • Hydroxyzine
  • Imidapril
  • Iloperidone
  • Indomethacin
  • Imipramine
  • Ketoconazole
  • Ivabradine
  • Ledipasvir
  • Lapatinib
  • Levofloxacin
  • Leuprolide
  • Licorice
  • Levomethadyl
  • Lopinavir
  • Lisinopril
  • Mefenamic Acid
  • Lumefantrine
  • Memantine
  • Mefloquine
  • Methadone
  • Mercaptopurine
  • Mifepristone
  • Metronidazole
  • Moxifloxacin
  • Moexipril
  • Mycophenolic Acid
  • Mycophenolate Mofetil
  • Nilotinib
  • Nafarelin
  • Nortriptyline
  • Norfloxacin
  • Ofloxacin
  • Octreotide
  • Paliperidone
  • Ondansetron
  • Pasireotide
  • Panobinostat
  • Pentopril
  • Pazopanib
  • Perindopril
  • Perflutren Lipid Microsphere
  • Pimavanserin
  • Phenytoin
  • Pitolisant
  • Piperaquine
  • Procainamide
  • Posaconazole
  • Promethazine
  • Prochlorperazine
  • Protriptyline
  • Propafenone
  • Quinapril
  • Quetiapine
  • Quinine
  • Quinidine
  • Ramipril
  • Raltegravir
  • Rilpivirine
  • Ranolazine
  • Sevoflurane
  • Salmeterol
  • Solifenacin
  • Sodium Polystyrene Sulfonate
  • Sotalol
  • Sorafenib
  • Spironolactone
  • Spirapril
  • Sulpiride
  • St John's Wort
  • Tacrolimus
  • Sunitinib
  • Telithromycin
  • Telavancin
  • Tetrabenazine
  • Temocapril
  • Toremifene
  • Tizanidine
  • Trazodone
  • Trandolapril
  • Trifluoperazine
  • Triamterene
  • Triptorelin
  • Trimipramine
  • Vardenafil
  • Vandetanib
  • Vinflunine
  • Vemurafenib
  • Voriconazole
  • Vismodegib
  • Zuclopenthixol
  • Zofenopril

Avoid alcoholic beverages during treatment with an oral laxative, as combining alcohol with the water-drawing effects of some laxative types can create dehydrated conditions in your body's cells. Check with your doctor to determine if there are other things you should avoid such as certain foods or tobacco products while you require an oral laxative medication.

As there is an extensive list of interactivity with oral laxatives, it is best to avoid other medications during your treatment, if possible. Notify your physician of all medications that you are taking and include any non-prescription, vitamin, holistic or herbal supplements as well.

If you have the following medical conditions, be aware that oral laxatives could make them worse or could cause unwanted symptoms when taken. Alert your physician if you have been diagnosed with:

  • Appendicitis symptoms
  • Rectal bleeding
  • Intestinal blockage
  • Colostomy
  • Ileostomy
  • Diabetes type two
  • Hypertension
  • Heart disease
  • Difficulty swallowing
  • Kidney disease

Warnings

If you are experiencing signs of inflammation of the bowel or appendicitis such as cramps in your abdomen or lower stomach area, bloating, vomiting, soreness or nausea, do not take an oral laxative unless you have consulted your physician.

Do not exceed one week of medication with oral laxatives unless specifically prescribed to do so by your doctor. This includes patients who have not experienced any results from the laxative. Stop taking it and call your doctor right away to determine the recommended next steps for you.

Missing a dose of this medication, if it is prescribed for you to prepare you for a medical imaging test of your colorectal area, should prompt you to make up the missed dose if you aren't close to your next dosing time. Do not double your dosage unless you first consult your medical doctor or the imaging team performing your test.

Avoid taking other medications for a two hour window before or after taking an oral laxative, as the medication will not be effective for you.

Do not take laxatives unless you have a genuine need to do so; this does not include those who want a tonic or to have their system cleaned out.

Missing a bowel movement for one or two days is normal; re-evaluate your diet, exercise and intake of liquids to see if you can improve your bowel health naturally.

Patients who experience a rash on their skin during treatment with oral laxatives may be sensitive to some of the ingredients they contain. Stop taking the medication and consult your physician if you develop a rash on your skin.

Before turning to an oral laxative for relief, if you have a sudden change in your bowel function that is longer than two weeks in duration or that keeps returning, check with your doctor. You may have an underlying condition that should be diagnosed before it becomes more serious.

Many people have found laxatives to become habit-forming and overuse the medication or rely on it to counteract the effects of a bad diet. This often leads to dependency on the oral laxative medication to have a bowel movement. There are documented cases of nerve damage, muscle damage and tissue damage in the bowel and intestines due to overuse of oral laxatives. Consult your doctor before you begin to form a habit of use with this or any other medication.

Mineral oil has been known to build up in the tissues of the body if taken over an extended period of time, which creates other adverse health issues. Mineral oil also interferes with the body's ability to absorb vitamins and nutrients essential to good health such as vitamins K, E, D and A. Avoid continued use of mineral oil as a laxative and seek alternatives or consult your doctor for a recommendation.

Some patients have reported anal leakage after large doses of mineral oil. Decrease your dosage if you experience this unwanted effect and wear absorbent pads to protect clothing and surfaces from damage.

Avoid taking mineral oil within two hours of taking an emollient type laxative, as the stool softener may increase the amount of mineral oil absorbed.

Patients taking stimulant type laxatives should be aware that:

  • This is the most over-used, habit forming type of laxative
  • Stimulant laxatives cause rashes on the skin
  • Taking this type of laxative causes intestinal and stomach cramps
  • Stimulant laxatives deplete potassium levels in the body, causing unwanted health issues

Storage

Keep this and all medications out of sight and reach of children and pets. Retain the original packaging and store it at room temperature away from sources of heat and light and excessive moisture. Outdated, unused oral laxative medication should be disposed of according to the manufacturer's directions on the packaging or instructions given to you by your doctor or pharmacist.

Summary

Millions of people suffer from constipation and may need an oral laxative, especially those that should not strain while having a bowel movement for medical reasons, experience hard stools, or those that have fewer than three bowel movements in a seven day period. Laxatives are commonly required by pregnant women, women who have just given birth, patients who take medications that cause constipation, and those who need medical testing requiring a clear view of the colorectal area. Patients who have ingested drugs or foods they are sensitive to may be candidates for treatment with an oral laxative as well.

Different types of oral laxatives are available, which should be chosen based on the way the condition of the patient. Bulk forming or fiber types of laxatives build up stool mass over time, stimulating the bowels to move. Hyperosmotic laxatives conduct water to the bowel from the tissues surrounding the area, softening the mass and increasing the movement. Hyperosmotic types include saline or salt ingredient laxatives, lactulose or sugar ingredient laxatives and polymer ingredient laxatives. Another main type of laxative is a lubricant type, which eases bowl movements by coating the stool mass and bowel for easier passage. Stimulant laxatives create muscle contractions in the intestinal walls, moving the stool mass along. Emollient types, or stool softeners, encourage liquids to mix with the solids in the stool, providing an easier passage through the bowel. Finally, a combination type of laxative may contain ingredients that provide different types of relief.

Due to their combined relieve, combination laxatives can cause more unwanted effects on health than the other types, but are popular relief choices in many patients. Patients are cautioned about combination laxatives that contain stimulant style laxatives and stimulant style laxatives themselves, as these types can become habit-forming and abused by patients who grow to rely on them for bowel movements. Before taking an oral laxative, it is encouraged that patients practice good eating habits, with plenty of fiber in their diets from foods that naturally contain it such as fruits, green leafy vegetables and whole grain breads or bran. Patients should also get plenty of exercise and stay hydrated by drinking plenty of fluids throughout the day.

Unwanted health effects may occur when taking laxatives, so this medication should be avoided by people with symptoms related to bowel blockage or appendicitis. Report any symptoms such as difficulty breathing, bloating, dizziness, cramping, weak muscles or fatigue to your physician right away along with any rashes on your skin that could indicate sensitivity to the medication.

Pregnant women should avoid bulk forming types of oral laxatives, as these can contain elevated amounts of sugars and salts, leading to other health problems if taken. This group should also avoid mineral oil, as it can cause harm to their unborn child. Stimulant laxatives are also not recommended, as those that contain castor oil can cause contractions in the womb. Breastfeeding women and children under 5 years old should also avoid oral laxatives of certain types as should bedridden geriatric patients. If in doubt about taking a laxative, consult your physician for a recommendation appropriate to your condition.

Sudden changes of any kind to your overall health, including your bowel movements, or odd symptoms that last over two weeks or keep recurring should be reported to your doctor with the interest of protecting your long-term health in mind.