Action

Stimulates lining of colon, increasing peristalsis and water absorption of stool and promoting evacuation

Availability

Chewable pieces: 1.7 g/piece, 3.4 g/piece

Granules: 2.5 g/tsp, 4.03 g/tsp

Powder: 3.3 g/tsp, 3.4 g/tsp, 3.5 g/tsp, 4.94 g/tsp

Powder (effervescent): 3.4 g/packet, 3.7 g/packet

Wafers: 3.4 g/2 wafers

Indications and dosages

➣ Chronic constipation; ulcerative colitis; irritable bowel syndrome

Adults and children ages 12 and older: 30 g daily in divided doses of 2.5 to 7.5 g/dose P.O. in 8 oz of water or juice

Contraindications

• Hypersensitivity to drug

• Intestinal obstruction

• Abdominal pain or other appendicitis symptoms

• Fecal impaction

Precautions

Use cautiously in:

• phenylketonuria

• pregnant patients.

Administration

• Mix powder with 8 oz of cold liquid (such as orange juice) to mask taste.

• Give diluted drug immediately after mixing, before it congeals. Follow with another glass of fluid.

Adverse reactions

GI: nausea; vomiting; diarrhea (with excessive use); abdominal cramps with severe constipation; anorexia; esophageal, gastric, small-intestine, or rectal obstruction (with dry form)

Respiratory: asthma (rare)

Other: severe allergic reactions including anaphylaxis

Interactions

None significant

Patient monitoring

• Monitor patient's bowel movements.

• Check for signs and symptoms of severe (but rare) allergic reactions, such as anaphylaxis and asthma.

Patient teaching

• Tell patient to dissolve in 8 oz of cold beverage and drink immediately, followed by another glass of liquid.

• Caution patient not to take without dissolving in liquid.

• Instruct patient to take after meals if drug decreases his appetite.

• Tell patient drug usually causes bowel movement within 12 to 24 hours but may take as long as 3 days.

See Instruct patient to immediately stop taking drug and notify prescriber if signs and symptoms of allergic reaction occur.

• Advise diabetic patient to use sugar-free drug form.

• Instruct patient with phenylketonuria to avoid forms containing phenylalanine.

• As appropriate, review all other significant and life-threatening adverse reactions.