Bulk-Forming Laxatives

Drug class: Antineoplastic Agents

Usage of Bulk-Forming Laxatives

Constipation

Relief of occasional constipation; restore bowel movement regularity.

Initial treatment of choice for simple constipation caused by a low-fiber and/or low-fluid diet.

Bulk-forming laxatives, stool softeners, or mineral oil preferred in conditions in which straining at defecation should be avoided (e.g., MI, vascular diseases, diseases of the anus or rectum, hernias, recent rectal surgery).

Treatment of constipation that occurs following prolonged bed rest or hospitalization.

Treatment of choice for constipation resulting from diminished colonic motor response in geriatric patients; condition is usually due to psychological or physical laxative dependence.

Bulk-forming laxatives or stool softeners are the preferred treatment for constipation occurring during pregnancy or the puerperium.

Not for use when prompt or thorough bowel evacuation is necessary (e.g., poisonings, radiologic examination, bowel surgery).

Diarrhea

Increase the bulk of stools in patients with chronic, watery diarrhea; subjective improvement noted but the total water content of the stool was unchanged.

GI Pain

Reduce intraluminal rectosigmoid pressure and pain in diverticular disease.

Hypercholesterolemia† [off-label]

Psyllium preparations have been used as an adjunct to dietary therapy to reduce elevated serum total cholesterol, LDL cholesterol, apolipoprotein B (apo B) concentrations and the ratio of LDL-cholesterol to HDL-cholesterol in adults with mild to moderate hypercholesterolemia† [off-label].

Relate drugs

How to use Bulk-Forming Laxatives

Administration

Oral Administration

Administer orally, in conjunction with adequate fluid intake.

For treatment of constipation, administer ≥1 full glass (250 mL) of liquid with each dose. Some manufacturers recommend another full glass of liquid after dose.

When used to increase the bulk of stools in chronic, watery diarrhea, one manufacturer suggests administering 1/3 of a glass (80 mL) of liquid with each dose.

Administer as infrequently as possible at the lowest effective dosage level. Do not use for >1 week unless directed by a clinician.

In patients receiving large dosages, administer in divided doses instead of a single daily dose to reduce the risk of esophageal obstruction.

To minimize side effects, initially administer 0.5–1 dose daily; increase as needed up to 3 doses daily.

Methylcellulose Powder

Fill glass with ≥240 mL (8 ounces) of cold water; level powder and add to water; stir briskly and drink promptly. Chocolate powder may be mixed with milk.

Psyllium Powder

Place dose in empty glass; fill with ≥240 mL of water or other beverage; stir briskly and drink promptly. If mixture thickens, add additional liquid and stir.

Psyllium Capsule

Swallow 1 capsule at a time.

Dosage

Available as calcium polycarbophil; dosage expressed in terms of polycarbophil.

Pediatric Patients

Constipation Oral (Calcium Polycarbophil Caplet)

Children ≥12 years of age: Initially, 1 g once daily. May increase gradually as needed up to 4 times daily.

Oral (Methylcellulose Caplet)

Children 6–12 years of age: 500 mg (1 caplet) 1–6 times daily.

Children >12 years of age: 1 g (2 caplets) 1–6 times daily.

Oral (Methylcellulose Powder)

Children 6–11 years of age: 1 g 1–3 times daily.

Children ≥12 years of age: 2 g 1–3 times daily.

Oral (Malt Soup Extract)

Children 2–5 years of age: 3–8 g 1–3 times daily.

Children 6–11 years of age: 3–16 g 1–3 times daily.

Children ≥12 years of age: 3–32 g 1–3 times daily.

Oral (Psyllium Capsule)

Children ≥12 years of age: 2.6 g (5 capsules) 1–3 times daily.

Oral (Psyllium Powder)

Children 6–11 years of age: Usually, 1.7 g 1–3 times daily.

Children 6–11 years of age (Hydrocil): 3.5 g; maximum 14 g daily in divided doses.

Children 6–11 years of age (Konsyl): 3 g 1–3 times daily.

Children ≥12 years of age: Usually, 3.4 g 1–3 times daily.

Children ≥12 years of age (Hydrocil): 3.5–7 g; maximum 28 g daily in divided doses.

Children ≥12 years of age (Konsyl): 6 g 1–3 times daily.

Oral (Psyllium Wafer)

Children 6–11 years of age: 1.7 g (1 wafer) 1–3 times daily.

Children ≥12 years of age: 3.4 g (2 wafers) 1–3 times daily.

Adults

Constipation Oral (Calcium Polycarbophil Caplet)

1 g once daily. May increase gradually as needed up to 4 times daily.

Oral (Methylcellulose Caplet)

1 g (2 caplets) 1–6 times daily.

Oral (Methylcellulose Powder)

2 g 1–3 times daily.

Oral (Malt Soup Extract)

3–32 g 1–3 times daily.

Oral (Psyllium Capsule)

2.6 g (5 capsules) 1–3 times daily.

Oral (Psyllium Powder)

Usually, 3.4 g 1–3 times daily.

Hydrocil: 3.5–7 g; maximum 28 g daily in divided doses.

Konsyl: 6 g 1–3 times daily.

Oral (Psyllium Wafer)

3.4 g (2 wafers) 1–3 times daily.

Hypercholesterolemia† [off-label] Oral (Psyllium Capsule)

3.2 g (6 capsules) 3 times daily.

Oral (Sugar-Free Psyllium Powder)

3.4 g 3 times daily before meals.

Prescribing Limits

Pediatric Patients

Constipation Oral (Calcium Polycarbophil Caplet)

Children ≥12 years of age, as self-medication: Maximum 4 g (8 caplets) daily; maximum of 7 days.

Oral (Malt Soup Extract)

Children 2–5 years of age: Maximum 16 g daily.

Children 6–11 years of age: Maximum 32 g daily.

Children ≥12 years of age: Maximum 64 g daily.

Oral (Psyllium Powder)

Children 6–11 years of age (Hydrocil): Maximum 14 g daily.

Children ≥12 years of age (Hydrocil): Maximum 28 g daily.

Adults

Constipation Oral (Calcium Polycarbophil Caplet)

Self-medication: Maximum 4 g (8 caplets) daily; maximum of 7 days.

Oral (Malt Soup Extract)

Maximum 64 g daily.

Oral (Psyllium Powder)

Hydrocil: Maximum 28 g daily.

Special Populations

No special population dosage recommendations at this time.

Warnings

Contraindications

  • Known hypersensitivity to bulk-forming laxatives or any ingredient in the formulation.
  • Acute abdominal pain, nausea, vomiting, or other symptoms of appendicitis or undiagnosed abdominal pain.
  • Partial obstruction of the bowel.
  • Esophageal obstruction, dysphagia, or problems of the throat. (See Obstruction under Cautions.)
  • Sudden change in bowel habits that lasts >2 weeks.

    • Warnings/Precautions

    Warnings

    Obstruction

    Bowel and/or esophageal obstruction, swelling or blockage of the throat, choking, or asphyxiation reported when insufficient liquid (e.g., <250 mL) administered with some bulk-forming laxatives. Administer each dose with ≥1 full glass (250 mL) of liquid. (See Administration under Dosage and Administration and also see Contraindications under Cautions.)

    Sensitivity Reactions

    Psyllium Hypersensitivity

    Serious hypersensitivity reactions possible to inhaled or ingested psyllium.

    Do not inhale psyllium hydrophilic mucilloid particles. Severe hypersensitivity reactions (e.g., rhinoconjunctivitis, acute bronchospasm, anaphylaxis) may occur in susceptible individuals (e.g., those with psyllium sensitivity or suffering from respiratory disorders) following inhalation of psyllium dust particles.

    One manufacturer suggests that health-care personnel dispense powdered psyllium preparations with a spoon instead of pouring them directly from the container to minimize exposure and sensitization to airborne particles of psyllium.

    Milk Hypersensitivity

    Citrucel Fiber Shake, Chocolate Flavor, contains dry milk powder; hypersensitivity reactions possible in patients sensitive to milk.

    Phenylketonuria

    Metamucil Smooth Texture Sugar Free Orange Flavor contains aspartame (NutraSweet), which is metabolized in the GI tract to provide 25 mg phenylalanine per 3.4 g dose.

    Metamucil Sugar Free Berry Burst Flavor contains aspartame (NutraSweet), which is metabolized in the GI tract to provide16 mg phenylalanine per 3.4 g dose.

    Citrucel Sugar Free Orange Flavor contains aspartame (NutraSweet), which is metabolized in the GI tract to provide 52 mg per 10.2 g dose.

    Citrucel Fiber Shake, Chocolate Flavor contains aspartame (NutraSweet), which is metabolized in the GI tract to provide 49 mg per 10.7 g dose.

    Specific Populations

    Pregnancy

    Psyllium: Category B.

    Pediatric Use

    Safety and efficacy of methylcellulose not established in children <6 years of age.

    Safety and efficacy of malt soup extract not established in children <2 years of age.

    Safety and efficacy of psyllium powders and wafers not established in children <6 years of age.

    Safety and efficacy of calcium polycarbophil and psyllium capsules not established in children <12 years of age.

    Avoid use of laxatives in infants and children.

    Renal Impairment

    Use with caution and monitor electrolytes (e.g., magnesium, potassium) in patients with impaired renal function.

    Common Adverse Effects

    Psyllium: Changes in bowel habits, minor bloating.

    What other drugs will affect Bulk-Forming Laxatives

    GI Absorption of Other Drugs

    By increasing intestinal motility, can potentially decrease transit time of concomitantly administered oral drugs and thereby decrease their absorption.

    Administer ≥2–3 hours before or after other medications.

    Specific Drugs

    Drug

    Interaction

    Comments

    Digitalis

    May bind digitalis in the GI tract and decrease absorption

    Administer laxative at least 3 hours before or after digitalis

    Nitrofurantoin

    May bind nitrofurantoin in the GI tract and decrease absorption

    Administer laxative at least 3 hours before or after nitrofurantoin

    Salicylates

    May bind salicylate in the GI tract and decrease absorption

    Administer laxative at least 3 hours before or after salicylate

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