1.6. LaxativesLaxatives 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 laxativesBulk-forming laxatives are not the most appropriate choice for opioid-induced constipation.
1.6.2. Stimulant laxatives
Restrictions: Restricted to use in terminally ill patients only
Restrictions: Restricted to constipation in the terminally ill.
1.6.3. Faecal softeners
1.6.4. Osmotic laxatives
Lactulose has a slow onset of action and may cause flatulence or wind.
Restrictions: Restricted to specialist use only.
Laxido Orange is considered the preferred brand of macrogol oral powder in NHSGGC. Movicol is not included in the GGC Formulary.
1.6.5. Bowel cleansing preparations
Restricted to specialist initiation
Restricted to specialist initiation and use as alternative to Picolax® and Moviprep® when they are unavailable.
1.6.6. Peripheral opioid-receptor antagonists
Use for the treatment of opioid induced constipation in adults is restricted to patients who have failed to respond to at least two classes of laxative (given at an adequate dose for a sufficient duration).
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).
Restrictions: Restricted to use in accordance with regional protocol.