BNF for Children 2011-2012

BNFC 2011–2012 1.6.2 Stimulant laxatives 591.6.2 Stimulant laxativesStimulant laxatives include bisacodyl, sodium picosulfate,and members of the anthraquinone group, sennaand dantron. The indications for dantron are limited(see below) by its potential carcinogenicity (based onrodent carcinogenicity studies) and evidence of genotoxicity.Powerful stimulants such as cascara (an anthraquinone)and castor oil are obsolete. Docusate sodiumprobably acts both as a stimulant and as a softeningagent.Stimulant laxatives increase intestinal motility and oftencause abdominal cramp; they should be avoided inintestinal obstruction. Stools should be softened byincreasing dietary fibre and liquid or with an osmoticlaxative (section 1.6.4) before giving a stimulant laxative.In chronic constipation, especially where withholdingof stool occurs, additional doses of a stimulantlaxative may be required. Long-term use of stimulantlaxatives is sometimes necessary (see section 1.6), butexcessive use can cause diarrhoea and related effectssuch as hypokalaemia.Glycerol suppositories act as a lubricant and as a rectalstimulant by virtue of the mildly irritant action of glycerol.BISACODYLCautions prolonged use (risk of electrolyte imbalance)Contra-indications intestinal obstruction, acuteabdominal conditions, acute inflammatory boweldisease, severe dehydrationPregnancy see Pregnancy, p. 57Side-effects see notes above; nausea and vomiting;colitis also reported; suppositories local irritationIndication and doseConstipation (tablets act in 10–12 hours; suppositoriesact in 20–60 minutes). By mouthChild 4–18 years 5–20 mg once daily, adjustedaccording to response. By rectum (suppositories)Child 2–18 years 5–10 mg once daily, adjustedaccording to responseBowel clearance before radiological proceduresand surgery. By mouth and by rectumChild 4–10 years by mouth, 5 mg at bedtime for 2days before procedure and, if necessary, by rectum,5 mg suppository 1 hour before procedureChild 10–18 years by mouth, 10 mg at bedtimefor 2 days before procedure and, if necessary, byrectum, 10 mg suppository 1 hour before procedureBisacodyl (Non-proprietary)Tablets, e/c, bisacodyl 5 mg, net price 100 = £3.27.Label: 5, 25Suppositories, bisacodyl 10 mg, net price 12 = £1.11Paediatric suppositories, bisacodyl 5 mg, net price 5= 94pNote The brand name Dulcolax c D (Boehringer Ingelheim)is used for bisacodyl tablets, net price 10-tab pack =74p; suppositories (10 mg), 10 = £1.57; paediatric suppositories(5 mg), 5 = 94pThe brand names Dulcolax c Pico Liquid and Dulcolax cPico Perles are used for sodium picosulfate preparationsDANTRON(Danthron)Cautions avoid prolonged contact with skin (as inincontinent patients or infants wearing nappies)—riskof irritation and excoriation; rodent studies indicatepotential carcinogenic riskContra-indications see Bisacodyl abovePregnancy manufacturers of co-danthramer and codanthrusateadvise avoid—no information availableBreast-feeding manufacturers of co-danthramer andco-danthrusate advise avoid—limited informationavailableSide-effects see notes above; also urine may becoloured redIndication and doseConstipation in terminally ill children for dosesee under preparationsWith poloxamer ‘188’ (as co-danthramer)Note Co-danthramer suspension 5 mL = one co-danthramercapsule, but strong co-danthramer suspension 5 mL = twostrong co-danthramer capsulesCo-danthramer (Non-proprietary) ACapsules, co-danthramer 25/200 (dantron 25 mg,poloxamer ‘188’ 200 mg). Net price 60-cap pack =£12.86. Label: 14, (urine red)Dose. By mouthChild 6–12 years 1 capsule at night (restricted indications,see notes above)Child 12–18 years 1–2 capsules at night (restrictedindications, see notes above)Strong capsules, co-danthramer 37.5/500 (dantron37.5 mg, poloxamer ‘188’ 500 mg). Net price 60-cappack = £15.55. Label: 14, (urine red)Dose. By mouthChild 12–18 years 1–2 capsules at night (restrictedindications, see notes above)Suspension, co-danthramer 25/200 in 5 mL (dantron25 mg, poloxamer ‘188’ 200 mg/5 mL). Net price300 mL = £11.27, 1 litre = £37.57. Label: 14, (urinered)Brands include Codalax c D, Danlax cDose. By mouthChild 2–12 years 2.5–5 mL at night (restricted indications,see notes above)Child 12–18 years 5–10 mL at night (restricted indications,see notes above)Strong suspension, co-danthramer 75/1000 in 5 mL(dantron 75 mg, poloxamer ‘188’ 1 g/5 mL). Net price300 mL = £30.13. Label: 14, (urine red)Brands include Codalax Forte c DDose. By mouthChild 12–18 years 5 mL at night (restricted indications,see notes above)1 Gastro-intestinal system