Bisacodyl, Dantron, Glycerol (Glycerin), Senna, Sodium Picosulfate [This monograph does not cover use of stimulant laxatives for bowel cleansing in preparation for procedures that require a clean bowel] |
Issues for Surgery |
Risk of constipation if omitted, particularly in patients with chronic laxative use, which may further be exacerbated by medication administered perioperatively e.g. opioids.
For bisacodyl, dantron, senna and sodium picosulfate: risk of fluid imbalance and hypokalaemia with chronic or excessive use1, 2, 3, 4, 5, which may further by exacerbated if continued during prolonged periods of fasting. |
Advice in the Perioperative period |
Elective Surgery
Continue, if required (including combination products)
Combination Products: - - Co-danthramer (poloxamer + dantron) – also see Softening Laxatives monograph and under Further Information
- Co-danthrusate (docusate + dantron) – also see Softening Laxatives monograph and under Further Information
EXCEPT: Check electrolytes pre-operatively in patients with chronic or suspected excessive stimulant laxative use. Emergency Surgery
Continue, if required (including combination products) Combination Products: - - Co-danthramer (poloxamer + dantron) – also see Softening Laxatives monograph and under Further Information
- Co-danthrusate (docusate + dantron) – also see Softening Laxatives monograph and under Further Information
EXCEPT: - for patients with suspected bowel obstruction / perforation
- Manevac® product – see Bulk Forming Laxatives monograph
Check electrolytes in patients with chronic or suspected excessive stimulant laxative use. Post-operative Advice
Resume post-operatively, if needed, once enteral intake resumed. If concomitant use of opioids or other medication that may cause constipation, or antibiotics that may cause diarrhoea, monitor response to treatment and adjust dose accordingly. Patients undergoing Colorectal Surgery
Review the need for stimulant laxatives post-operatively. Use of suppositories following certain types of colorectal surgery are not recommended; confirmation should be sought from the Colorectal Team before prescribing if stimulant laxatives are required post-operatively. |
Interaction(s) with Common Anaesthetic Agents |
Hypokalaemia
Stimulant laxatives may cause hypokalaemia (mainly in cases of misuse or overdose)1, 2, 3, 4, 5. Concomitant use with medications that prolong the QT-interval e.g. desflurane, isoflurane, sevoflurane and possibly thiopental increases the risk of torsades de pointes2, 3, 4, 5. Monitor serum potassium and QT-interval with concomitant treatment.
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Interaction(s) with other Common Medicines used in the Perioperative Period |
Hypokalaemia
Stimulant laxatives can cause hypokalaemia (mainly in cases of misuse or overdose)1, 2, 3, 4, 5. Hypokalaemia increases the risk of torsades de pointes with medicines which prolong the QT-interval e.g. antiemetics (haloperidol, ondansetron), antimicrobials (ciprofloxacin, clarithromycin, erythromycin), corticosteroids and loperamide2, 3, 4, 5. Monitor serum potassium and with concomitant treatment. This interaction does not occur with glycerin suppositories6. Hyponatraemia
Concomitant use of the following medicines with sodium picosulfate can increase the risk of hyponatraemia1: - Whilst single doses should not pose a problem, sodium levels should be monitored with continued post-operative treatment of concomitant medication. Antimicrobials
Concurrent administration of antibiotics may reduce the laxative action of sodium picosulfate4. |
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Further Information |
Co-danthramer and Co-danthrusate
Co-danthramer and co-danthrusate are only licensed for constipation in terminally ill patients since dantron is a potential human carcinogen1.
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References |
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed on 10 August 2021]
- Summary of Product Characteristics – Bisacodyl 5 mg, gastro-resistant tablets. Healthcare Pharma Ltd. Accessed via www.medicines.org.uk 03/10/21 [date of revision of the text May 2020]
- Summary of Product Characteristics – Senokot® (senna) 7.5 mg Tablets 12 Years Plus. Reckitt Benckiser Healthcare (UK) Ltd. Accessed via www.medicines.org.uk on 03/10/21 [date of revision of the text December 2020]
- Summary of Product Characteristics – Dulcolax® (sodium picosulfate monohydrate), 5mg / 5ml, oral solution. SANOFI. Accessed via www.medicines.org.uk on 03/10/21 [date of revision of the text March 2020]
- Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed 3rd October 2021]
- Glycerin Suppositories BP 4g Adult Size. Thornton & Rose Ltd. Accessed via www.medicines.org.uk 03/10/21 [date of revision of the text January 2015]
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