NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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1 Gastro-intestinal system

1.6 Laxatives

Laxatives should generally be avoided, except when straining will exacerbate a medical condition, or increase the risk of bleeding, as in haemorrhoids or following abdominal surgery. They are important for prophylaxis of opioid-induced constipation.

1.6.1 Bulk-forming laxatives

Bulk-forming laxatives are not the most appropriate choice for opioid-induced constipation.

Preferred list

1.6.2 Stimulant laxatives

Preferred list
CO-DANTHRAMER

Restrictions: Restricted to use in terminally ill patients only

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2211.htm

Total Formulary
CO-DANTHRUSATE

Restrictions: Restricted to constipation in the terminally ill.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2212.htm

1.6.3 Faecal softeners

Total Formulary

1.6.4 Osmotic laxatives

Preferred list
LACTULOSE (SOLUTION)

Prescribing Notes:

Lactulose has a slow onset of action and may cause flatulence or wind.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2240.htm

Total Formulary
MACROGOL (LAXIDO ORANGE)

Prescribing Notes:

Laxido Orange is considered the preferred brand of macrogol oral powder in NHSGGC. Movicol is not included in the GGC Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/202431.htm

MAGNESIUM SULPHATE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2250.htm

1.6.5 Bowel cleansing preparations

Preferred list
SODIUM PICOSULFATE (PICOLAX) (SACHETS)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2226.htm

Total Formulary
FLEET PHOSPHO-SODA

Restrictions: Restricted to specialist initiation and use as alternative to Picolax® and Klean-Prep® when they are unavailable.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/40081.htm

KLEAN-PREP

Restrictions: restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2260.htm#_2260

1.6.6 Peripheral opioid-receptor antagonists

Total Formulary
METHYLNALTREXONE

Restrictions: Restricted to use in accordance with regional protocol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201638.htm

NALOXEGOL (tablets)

Restrictions: Restricted to use in patients who have failed to respond to at least two classes of laxative (given at an adequate dose for a sufficient duration).

1.6.7 5HT4-receptor agonists