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Table 9-2

Medications for the Management of Constipation

InterventionDoseComment
Stimulant laxatives

These agents directly stimulate peristalsis and may reduce colonic absorption of water.

Work in 6-12 h.

Prune juice120-240 mL/d
Senna (Senokot)2-8 tablets PO bid
Bisacodyl5-15 mg/d PO, PR
Osmotic laxativesThese agents are not absorbed. They attract and retain water in the gastrointestinal tract.
Lactulose15-30 mL PO q4-8hLactulose may cause flatulence and bloating.
Magnesium hydroxide (Milk of Magnesia)15-30 mL/d POLactulose works in 1 day, magnesium products in 6 h.
Magnesium citrate125-250 mL/d PO
Stool softeners

These agents work by increasing water secretion and as detergents, increasing water penetration into the stool.

Work in 1-3 days.

Sodium docusate (Colace)300-600 mg/d PO
Calcium docusate300-600 mg/d PO
Suppositories and enemas
Bisacodyl10-15 PR qd
Sodium phosphate enemaPR qdFixed dose, 4.5 oz, Fleet's.