1. General characteristics of laxatives
There are several classifications of laxatives. The general classification includes two groups:
1) inorganic substances – saline laxatives, magnesium and sodium sulfate, Karlovy Vary salt;
2) Organic substances consist of three subgroups, such as:
a) vegetable oils – castor and almond;
b) preparations containing antraglycosides (buckthorn extract, rhubarb tablets), preparations of senna (leaves of senna, kofiol, cubes regululaks, senade, glaxene);
c) preparations containing synthetic agents (bisacodil, guttalax, forlax, fortans), synthetic disaccharides (lactulose), liquid paraffin.
The modern classification of laxative drugs by the mechanism of action includes 4 groups of drugs.
The first group. Chemicals that cause a laxative effect by chemical irritation of the receptor apparatus of the colon and thus stimulate its peristalsis. These drugs act at the level of the colon, as a rule, cause a single bowel movement 6-10 hours after ingestion. These include anthraquin derivatives (preparations of rhubarb root, buckthorn bark, fruits of Zhoster, leaves of the seine), diphenylmethane (phenolphthalein, bisacodyl, guttalax, dulcolax), castor oil.
The second group. Osmotic agents with the ability to retain water in the intestinal lumen, which leads to an increase in volume and softening of the fecal masses. These are sodium and magnesium sulfate, citrate, magnesium hydroxide, Karlovy Vary salt, non-adsorbable polysaccharide lactulose (duphalac), acting at the level of the large intestine. The onset of laxative action – 8-12 hours. Lactulose in the small intestine is not split and enters the colon in unchanged form. In the colon, it is broken down by the action of the intestinal flora. Lactulose cleavage products have a stimulating effect on colon motility, their fecal masses soften, and their volume also increases.
Third group Bulk laxatives, or bulking agents that help increase intestinal contents, such as bran, agar-agar, methylcellulose, seaweed.
Fourth group. Laxative oils (detergents) that promote the softening of hard stool masses and facilitate their gliding – vaseline, almond, fennel oil, liquid paraffin. Classification by localization of action. Drugs, mainly acting in the small intestine (vegetable oils, liquid paraffin, salt laxatives). Drugs that act mainly in the colon (synthetic means, bisacodil, guttalax. Means that act throughout the intestine (saline laxatives, castor oil and hydrophilic colloids).
Chemical laxative drugs.
Senna leaves (Folium sennae).
Application:: in the form of infusion of 1 tbsp. l or 1 tsp. 1-3 times a day.
Release form: whole and sliced leaves of 50 g each; dry extract in tablets of 0.03 no. 25; briquettes of 75 g each. Prepared drugs: senade No. 10 in tablets, glyxene No. 10 in tablets.
Dry standardized drug buckthorn bark.
Application: take as a laxative for 0.2 g at night.
Release form: tablets of 0.05 to number 30.
Synonym: Dutcolah. Mechanism of action: irritates the intestinal receptors, and also enhances the secretion of mucus and the dilution of the intestinal contents.
Application: chronic constipation of various etiologies.
Mode of application: prescribe per os and per rectum. Adults take 1–3 drops for a night or 1–2 suppositories rectally. Children – depending on age.
Side effects: possible spasms of the gastrointestinal tract.
Contraindications: acute inflammatory diseases and varicose veins of the rectum.
Release form: Bean on 0,005 № 30, candles on 0,01 № 12.
It has a quick and strong laxative effect by directly stimulating the colon. The stomach passes unchanged, stands out with a stool, is not addictive.
Application: all types of constipation, hemorrhoids, anal fissures, in the postoperative period.
Mode of application: adults from 5 to 10 drops, you can up to 15 drops. Children from 2 to 12 years old – from 2 to 5 drops. Accept or in the morning, or before going to bed. The effect occurs after 6-10 hours.
Contraindications: acute abdomen, pregnancy.
Release form: vials of 10 ml of the drug.
Castor oil (Oleum ricini).
Application: take as a laxative – 15-30 g each, children – 5-10 g.
Contraindications: poisoning with male fern extract and fat-soluble substances (phosphorus, benzene), outwardly used to treat burns, ulcers.
Release form: bottles of 25 g. Capsules of 1.0 No. 15.
Karlovy Vary artificial salt (Sal carolinum fastitium).
Application: as a laxative take in the morning on an empty stomach and 1 tbsp. l (children 2–6 years old – 1 tsp.) for 0.5 glass of water; as a choleretic for 1 tsp. for a glass of warm water 30–45 minutes before meals, 2-3 times a day.
Release form: in a package of 125 g. Natural Karlovy Vary salt is also sold in geysers of 100 g in a package.
Release form: powder for oral administration in bags of 10 g No. 10, syrup of 200, 500 and 1000 ml (in 100 ml – 67 g of lactulose). Adults for the treatment of constipation – 10-30 g per day in the first 2 days; maintenance dose – 10–20 g per day. Children 7-14 years of age, the initial dose – 10 g per day, supporting – 7-10 g per day; from 1 g to 6 years the initial and maintenance doses are the same – 3–7 g per day; Children up to 1 year old – 3 g per day. This drug is contraindicated in case of intestinal obstruction. With caution – patients with diabetes. The drug can interfere with the release of the active substance from enteric-soluble drugs.