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Pharmacologic class: Anthraquinone laxative
Therapeutic class: Laxative (stimulant)
Pregnancy risk category C
Causes local irritation in colon, which promotes peristalsis and bowel evacuation. Softens feces by increasing water and electrolytes in large intestine.
Granules: 15 mg/tsp
Liquid: 8.8 mg/5 ml, 25 mg/5 ml, 33.3 mg/ml (concentrate)
Tablets: 8.6 mg, 10 mg, 15 mg, 17 mg, 25 mg
Strips (orally disintegrating): 8.6 mg
Tablets (chewable): 10 mg, 15 mg
Indications and dosages
➣ Acute constipation; preparation for bowel examination
Adults and children ages 12 and older: For acute constipation, 12 to 50 mg P.O. daily or b.i.d. For bowel preparation, 105 to 157.5 mg (concentrate) 12 to 14 hours before scheduled procedure.
Children ages 6 to 11: 50% of adult dosage. Or, two orally disintegrating strips; don't exceed four strips in 24 hours.
Children ages 2 to 5: 33% of adult dosage. Or, one orally disintegrating strip; don't exceed two strips in 24 hours.
• Hypersensitivity to drug or its components
• GI bleeding or obstruction
• Suspected appendicitis or undiagnosed abdominal pain
• Acute surgical abdomen
• Fecal impaction
• Inflammatory bowel disease (such as Crohn's disease)
Use cautiously in:
• pregnant or breastfeeding patients
• Give with a full glass of cold water.
• To prepare patient for bowel examination, give 12 to 14 hours before procedure, followed by a clear liquid diet.
GI: nausea, vomiting, diarrhea, abdominal cramps, nutrient malabsorption, yellow or yellowish-green feces, loss of normal bowel function (with excessive use), dark pigmentation of rectal mucosa (with long-term use), protein-losing enteropathy
GU: reddish-pink discoloration of alkaline urine, yellowish-brown discoloration of acidic urine
Metabolic: electrolyte imbalances (such as hypokalemia)
Other: laxative dependence (with long-term or excessive use)
Drug-diagnostic tests. Calcium, potassium: decreased levels
• Assess bowel movements to determine laxative efficacy.
• In long-term use, monitor fluid balance, nutritional status, and electrolyte levels and watch for laxative dependence.
• Tell patient using drug for constipation to take at bedtime with a glass of water.
• Instruct patient to place orally disintegrating strips on the tongue, allow strip to dissolve, then drink plenty of water.
• In long-term use, advise patient to watch for and report signs and symptoms of nutritional deficiencies and fluid and electrolyte imbalance.
• If patient will undergo bowel examination, advise him to take drug 12 to 14 hours before procedure, followed by a clear liquid diet.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.
Ex-Lax Chocolated(trade name),
Fletchers’ Castoria(trade name),
Maximum Relief Ex-Lax(trade name),
Pharmacologic: stimulant laxatives
- Slow transit time,
- Constipating drugs,
- Irritable or spastic bowel syndrome,
- Neurologic constipation.
Time/action profile (laxative effect)
|PO||6–12 hr†||unknown||3–4 days|
Adverse Reactions/Side Effects
- cramping (most frequent)
- diarrhea (most frequent)
- pink-red or brown-black discoloration of urine
Fluid and Electrolyte
- electrolyte abnormalities (chronic use or dependence)
- laxative dependence
Drug-Drug interactionMay ↓ absorption of other orally administered drugs because of ↓ transit time.
Route/DosageLarger doses have been used to treat/prevent opioid-induced constipation. Consult labeling of individual OTC products for more speceific dosing information
Availability (generic available)Noted as sennoside content
- Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
- Assess color, consistency, and amount of stool produced.
Potential Nursing DiagnosesConstipation (Indications)
Diarrhea (Side Effects)
- Oral: Take with a full glass of water. Administer at bedtime for evacuation 6–12 hr later. Administer on an empty stomach for more rapid results.
- Shake oral solution well before administering.
- Granules should be dissolved or mixed in water or other liquid before administration.
- Advise patient that laxatives should be used only for short-term therapy. Long-term therapy may cause electrolyte imbalance and dependence.
- Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake, and increasing mobility. Normal bowel habits are individualized and may vary from 3 times/day to 3 times/wk.
- Inform patient that this medication may cause a change in urine color to pink, red, violet, yellow, or brown.
- Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
- Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present.
- A soft, formed bowel movement.