section name header

Evidence summaries

Laxatives for the Management of Constipation in Palliative Care Patients

There is insufficient evidence on the effect of laxatives and their differences in the treatment of patients in palliative care. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 5 studies with a total of 370 subjects. All participants were at an advanced stage of disease and were cared for within a palliative care setting. All participants had a cancer diagnosis, apart from four participants (5% of sample) in one study. The laxatives studied were lactulose, senna, co-danthramer, misrakasneham, docusate and magnesium hydroxide with liquid paraffin.

Studies either compared the effectiveness of two different laxatives, or compared the laxative with an active control.No differences in effectiveness were demonstrated in:lactulose compared with senna;senna plus lactulose compared with magnesium hydroxide plus liquid paraffin;misrakasneham compared with senna;docusate plus senna compared with placebo plus senna. There was a significant difference (P value <0.01) in the subgroup of 17 participants receiving strong opioid analgesia that favoured senna plus lactulose compared with co-danthramer plus poloxamer in stool frequency and overall participants took fewer rescue medications (9/51 in senna plus lactulose group compared with 19/51 in co-danthramer plus poloxamer group). However, there was no difference between the laxatives in participants' overall assessment of their bowel function.Four studies report that a few (one to three) participants experienced adverse effects. The most common adverse effects were nausea, vomiting, diarrhoea and abdominal pain. In the study comparing senna plus lactulose with magnesium hydroxide plus liquid paraffin, one participant from each group withdrew because of intolerable nausea and gripping abdominal pain.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), by indirectness (studies only measured effects in the short term) and by imprecise results (few patients).

    References

    • Candy B, Jones L, Larkin PJ et al. Laxatives for the management of constipation in people receiving palliative care. Cochrane Database Syst Rev 2015;(5):CD003448. [PubMed].

Primary/Secondary Keywords