TABLE 40.1 Classification and Comparison of Representative Laxatives: Type, Cathartic Effect, and Latency
Softening of Formed Stool (1-3 d)
Soft, Semifluid Stool (6-12 hr)
Watery Stool (2-6 hr)
Bulk-forming agents Dietary fiber Methylcellulose Psyllium
Calcium polycarbophil Docusate salts
Sodium, potassium, or calcium salts of dioctyl sulfosuccinate Lactulose Sorbitol
Saline laxatives (low dose) Milk of magnesia Magnesium sulfate Diphenylmethane derivatives Phenolphthalein Bisacodyl Anthraquinone derivatives Senna
Saline laxatives (high dose) Magnesium citrate Magnesium sulfate Sodium phosphates Castor oil
Polyethylene glycol-electrolyte preparations
Adapted with permission from AMA Drug Evaluations (6th Ed.). Chicago: American Medical Association, 1986.
in increased water content in the feces, the patient should be advised to drink adequate amounts of water; otherwise dehydration may result.
The use of high-fiber diets has recently received a great deal of publicity, and many claims have been made for the value of such diets. Fiber in the diet is derived entirely from plant material, either from fruit and vegetables or from cereals, the latter being known as bran. The fiber content in each case is a complex carbohydrate in the form of cellulose, pectin, and lignin. These fibers pass through the human GI tract relatively unaltered by enzymes.
Since clear advantages accrue from a high-bran diet (a reduction in both constipation and diverticulitis) and since there is no associated toxicity, a bulk-forming laxative is the laxative of choice for constipated patients.
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