lPREGNANCYNot known to be harmful—manufacturer
advises caution.
lBREAST FEEDING
▶With oral usePresent in milk following oral
administration—manufacturer advises caution.
▶With rectal useRectal administration not known to be
harmful.
lDIRECTIONS FOR ADMINISTRATIONFor administrationby
mouth, solution may be mixed with milk or squash.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral solution
▶Docusate sodium (Non-proprietary)
Docusate sodium 2.5 mg per 1 mlDocusate 12. 5 mg/ 5 ml oral
solution sugar free sugar-free| 300 mlp£ 7. 79 DT = £ 7. 79
Docusate sodium 10 mg per 1 mlDocusate 50 mg/ 5 ml oral solution
sugar free sugar-free| 300 mlp£ 7. 99 – £ 8. 01 DT = £ 8. 01
▶Docusol(Typharm Ltd)
Docusate sodium 2.5 mg per 1 mlDocusol Paediatric 12. 5 mg/ 5 ml
oral solution sugar-free| 125 mlp£ 4. 46
Enema
▶Norgalax(Essential Pharma Ltd)
Docusate sodium 12 mg per 1 gramNorgalax 120 mg/ 10 g enema|
6 enemap£ 28. 00
Capsule
▶Dioctyl(UCB Pharma Ltd)
Docusate sodium 100 mgDioctyl 100 mg capsules| 30 capsulep
£ 2. 09 DT = £ 2. 09 | 100 capsulep£ 6. 98
▶DulcoEase(Sanofi)
Docusate sodium 100 mgDulcoEase 100 mg capsules|
30 capsuleG£ 3. 20 DT = £ 2. 09
Combinations available:Co-danthrusate,p. 46
LAXATIVES›STIMULANT LAXATIVES
Bisacodyl
lINDICATIONS AND DOSE
Constipation
▶BY MOUTH
▶Child 4–17 years: 5 – 20 mg once daily, adjusted
according to response, dose to be taken at night
▶BY RECTUM
▶Child 2–17 years: 5 – 10 mg once daily, adjusted
according to response
Bowel clearance before radiological procedures and
surgery
▶INITIALLY BY MOUTH
▶Child 4–9 years: 5 mg once daily for 2 days before
procedure, dose to be taken at bedtime and (by rectum)
5 mg if required, dose to be administered 1 hour before
procedure
▶Child 10–17 years: 10 mg once daily for 2 days before
procedure, dose to be taken at bedtime and (by rectum)
10 mg if required, dose to be administered 1 hour
before procedure
PHARMACOKINETICS
▶Tablets act in 10 – 12 hours; suppositories act in
20 – 60 minutes.lCONTRA-INDICATIONSAcute abdominal conditions.acute
inflammatory bowel disease.intestinal obstruction.
severe dehydration
lCAUTIONSExcessive use of stimulant laxatives can cause
diarrhoea and related effects such as hypokalaemia.risk of
electrolyte imbalance with prolonged use
lSIDE-EFFECTS
▶Common or very commonGastrointestinal discomfort.
nausea
▶UncommonHaematochezia.vomiting
▶Rare or very rareAngioedema.colitis.dehydration
lPREGNANCYMay be suitable for constipation in
pregnancy, if a stimulant effect is necessary.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, suppository, enema
Gastro-resistant tablet
CAUTIONARY AND ADVISORY LABELS5, 25
▶Bisacodyl (Non-proprietary)
Bisacodyl 5 mgBisacodyl 5 mg gastro-resistant tablets|
60 tabletp£ 5. 13 DT = £ 5. 13 | 100 tabletp£ 5. 40 | 500 tabletp
£ 25. 73 – £ 50. 00 | 1000 tabletp£ 51. 45 – £ 100. 00
▶Dulco-Lax (bisacodyl)(Sanofi)
Bisacodyl 5 mgDulcolax 5 mg gastro-resistant tablets| 40 tabletp
£ 2. 44 | 100 tabletp£ 3. 60
Enema
▶Bisacodyl (Non-proprietary)
Bisacodyl 333.333 microgram per 1 mlFleet Bisacodyl 10 mg/ 30 ml
enema| 1 enemaPsDT = £ 30. 38
Suppository
▶Bisacodyl (Non-proprietary)
Bisacodyl 10 mgBisacodyl 10 mg suppositories| 12 suppositoryp
£ 3. 53 DT = £ 3. 53
▶Dulco-Lax (bisacodyl)(Sanofi)
Bisacodyl 5 mgDulcolax 5 mg suppositories for children|
5 suppositoryp£ 1. 04 DT = £ 1. 04
Bisacodyl 10 mgDulcolax 10 mg suppositories| 12 suppositoryp
£ 2. 35 DT = £ 3. 53Co-danthramer
lINDICATIONS AND DOSE
Constipation in terminally ill patients (standard strength
capsules)
▶BY MOUTH USING CAPSULES
▶Child 6–11 years: 1 capsule once daily, dose should be
taken at night
▶Child 12–17 years: 1 – 2 capsules once daily, dose should
be taken at night
Constipation in terminally ill patients (strong capsules)
▶BY MOUTH USING CAPSULES
▶Child 12–17 years: 1 – 2 capsules once daily, dose should
be given at night
Constipation in terminally ill patients (standard strength
suspension)
▶BY MOUTH USING ORAL SUSPENSION
▶Child 2–11 years: 2. 5 – 5 mL once daily, dose should be
taken at night
▶Child 12–17 years: 5 – 10 mL once daily, dose should be
taken at night
Constipation in terminally ill patients (strong suspension)
▶BY MOUTH USING ORAL SUSPENSION
▶Child 12–17 years: 5 mL once daily, dose should be taken
at night
DOSE EQUIVALENCE AND CONVERSION
▶Co-danthramer (standard strength) capsules contain
dantron 25 mg with poloxamer‘ 188 ’ 200 mg per
capsule.
▶Co-danthramer (standard strength) oral suspension
contains dantron 25 mg with poloxamer‘ 188 ’ 200 mg
per 5 mL.
▶Co-danthramerstrongcapsules contain dantron
37. 5 mg with poloxamer‘ 188 ’ 500 mg.
▶Co-danthramerstrongoral suspension contains
dantron 75 mg with poloxamer‘ 188 ’ 1 g per 5 mL.
▶Co-danthramer suspension 5 mL = one co-danthramer
capsule,butstrong co-danthramer suspension 5 mL =
two strong co-danthramer capsules.BNFC 2018 – 2019 Constipation 45
Gastro-intestinal system1