Pharmacologic Profile

General Use

To treat or prevent constipation or to prepare the bowel for radiologic or endoscopic procedures.

General Action and Information

Induce one or more bowel movements per day. Groups include stimulants (bisacodyl, senna), saline laxatives (magnesium salts), stool softeners (docusate), and osmotic cathartics (lactulose, polyethylene glycol). Methylnaltrexone and naloxegol are used to specifically manage opioid-induced constipation. Plecanatide is used to manage chronic constipation that is idiopathic in nature or due to irritable bowel syndrome. ↑ fluid intake, exercising, and adding more dietary fiber are also useful in the management of chronic constipation.

Contraindications

Hypersensitivity. Contraindicated in persistent abdominal pain, nausea, or vomiting of unknown cause, especially if accompanied by fever or other signs of an acute abdomen.

Precautions

Excessive or prolonged use may lead to dependence. Should not be used in children unless advised by a physician or other health care provider.

Interactions

Theoretically may ↓ the absorption of other orally administered drugs by ↓ transit time.

Nursing Implications

Assessment

• Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
• Assess color, consistency, and amount of stool produced.

Implementation

• May be administered at bedtime for morning results.
• Taking oral doses on an empty stomach will usually produce more rapid results.
• Do not crush or chew enteric-coated tablets. Take with a full glass of water or juice.
• Stool softeners may take several days for results.

Patient/Family Teaching

• Advise patients, other than those with spinal cord injuries, that laxatives should be used only for short-term therapy. Long-term therapy may cause electrolyte imbalance and dependence.
• Encourage patients to use other forms of bowel regulation: ↑ bulk in the diet, ↑ fluid intake, and ↑ mobility. Normal bowel habits are individualized and may vary from 3 times/day to 3 times/wk.
• Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
• Advise patient that laxatives should not be used when constipation is accompanied by abdominal pain, fever, nausea, or vomiting.

Evaluation/Desired Outcomes

• A soft, formed bowel movement.
• Evacuation of the colon.