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Discussion

Which laxative to use?

Most of my patients have more than one laxative/cathartic in their prn bowel regimen. Dulcolax, mom, fleets, sennokot, mag citrate, miralax and whatever others. What order might you use them in when they haven't been going? Could someone maybe put them in a list of try this first, then this, then the big guns (whatever that might be- fleets I assume)?

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  • Experts

start with high fiber foods (veggies, then prunes), progress to a stool softener, oil retention enemas. a mild laxative like mom is next. then you go with something like an irritant (sennokot, dulcolax, twe). stuff like miralax and mag citrate are last because they disturb the electrolyte balance.

oral fleets was removed from the market. my last colonoscopy was last month and i was informed of this. golytely is used (miralax is derived from it) and i was prescribed a newer prep on the market called moviprep which tastes much better than golytely.

LOL good q. Well, sennokot is a PO stool softner, probably easiest on system. Then PO dulcolax (PO and PR are kind of a different story, PR is more effective obviously :) Then MOM and miralax, Mag citrate is usually always effective but takes time. Fleets, since it is an enema would be a last ditch effort. My specialty is warm prune juice mixed with MOM. Works like a charm :) Hope that helps!

  • Author

Thanks very much guys. I'm going to write it down and carry it with me always! :D

It also kind of depends on the situation. If it's someone who just had a BM two days ago, has had minimal po intake, and isn't getting narcs routinely, I'll start out with prune juice/colace/MOM. If it's someone who has managed to go for four or five days with no one noticing they haven't had a BM, they are on a lot of narcs, and are not up and moving around, I'll go straight to a suppository plus a stool softener, and leave a nice little note on the chart for the doc about bowel management. And have a side conversation with the nurses who let it go for that long.

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