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References: Laxative

Chem Pharm Bull (Tokyo). 1992 May;40(5):1280-8.
Pharmacoepidemiological study on adverse reactions of antiepileptic drugs.

Ieiri I, Hirata K, Higuchi S, Kojima K, Ikeda M, Yamada H, Aoyama T.

Department of Hospital Pharmacy, Kyushu University Hospital, Fukuoka, Japan.

The relationship between the occurrence of side effects (SEs) and drug factors, such as antiepileptic drugs (AEDs), daily dose, duration of treatment, drug combination pattern, total and free serum concentrations, metabolite per parent level ratio as an index of metabolism ability, and co-medicated drugs except AEDs were evaluated in 227 outpatients with epilepsy. The possible influences of certain physiological and/or the pathophysiological factors were also evaluated. SEs with 19 clinical signs were observed in 66.1% of all patients. There was no definite dose- or serum concentration-dependent increase in the incidence of SEs. Stepwise discriminant function analysis revealed that benzodiazepines (BZN) polytherapy with AEDs produced a higher incidence of somnolence and general fatigue than did any other AED or drug combination. The effects of various drug combination patterns on the incidence of SEs were also evaluated on the basis of observed frequencies. The incidence of somnolence was significantly higher in patients taking phenytoin (PHT) plus carbamazepine (CBZ) therapy, and in patients taking BZN plus either PHT, phenobarbital (PB) or CBZ therapy compared with patients taking either PHT, PB or CBZ therapy. Other responsible drug combination patterns were PHT plus valproic acid (VPA) therapy for mental function impairment, acetazolamide (AZM) polytherapy with PB or PHT for dry mouth, and CBZ plus BZN therapy for constipation. In this study, the stratifying points (occurrence limits) of SEs were detected in various variables such as the number of prescribed drugs, daily dose and serum concentrations. Interestingly, these limits are within the commonly accepted "therapeutic range" or "usual daily dose," and som

Anaesthesist. 1993 Aug;42(8):545-56.
[Morphine tablets for chronic non-tumor-induced pain. Which factors modify the success or failure of a long-term therapy?]

[Article in German]

Schulzeck S, Gleim M, Maier C.

Klinik fur Anasthesiologie und Operative Intensivmedizin im Klinikum der Christian-Albrechts-Universitat zu Kiel.

In a prospective study 60 patients receiving morphine for treatment of mostly neuropathic and musculoskeletal pain of non-malignant origin were investigated. The aim of the study was to determine the characteristics of responders to morphine therapy and the frequency and severity of side effects. METHODS. Eligible patients suffered from chronic pain that had not been relieved despite all current therapy. All of them received controlled-release morphine tablets. Dose was increased in case of insufficient pain relief. Before morphine treatment and at the follow-ups pain intensity was rated on a numeric analogous scale, analgesia and side effects on a four-stage verbal rating scale. Intake of the prescribed and other drugs was randomly controlled by urine analysis. The patients were divided in three groups retrospectively: group I, non-responders who ceased the morphine therapy within 1 month due to weak analgesia or severe side effects; group II, patients in whom the therapy was stopped within the following months despite persisting pain; group III, patients who continued therapy. STATISTICS. ANOVA, chi-squared test, non-parametric tests (Kruskal-Wallis, Wilcoxon). Results were accepted as significant at p < 0.05. RESULTS. Twenty-three patients were non-responders. Fourteen other patients stopped the therapy after initial response because the side effects exceeded the benefit of analgesia (group II). Only 10 of the remaining 23 responders had good analgesia and minor side effects during the observation time. Constipation, despite prophylactic laxatives, and nausea were the most frequently reported events causing cessation of therapy. Analgesia and side effects

J Epidemiol Community Health. 1993 Feb;47(1):23-6.
Factors associated with constipation in a community based sample of people aged 70 years and over.

Campbell AJ, Busby WJ, Horwath CC.

University of Otago Medical School, Dunedin, New Zealand.

STUDY OBJECTIVE--The aim was to determine the prevalence and factors associated with constipation in elderly people. DESIGN--The study was a survey involving administration of a structured questionnaire, an interview, and a dietary assessment. SETTING--The survey was community based and the population studied was drawn from the practice records of all five general practitioners serving a rural township of 13,500 people. PARTICIPANTS--778 (91.8%) of the 856 people aged 70 years and over registered with the five practitioners took part. MAIN RESULTS--174 subjects had symptoms of infrequent bowel motions or frequent straining at stool or used laxatives regularly. Of this group, 34 had a bowel motion only every 3 d or less frequently and were considered to have constipation. Analysis of this subgroup showed that constipation was more common in women than men, increased with age, and was associated with the use of constipating drugs. Those whose bowels moved infrequently were a more frail group who were less physically active. Low intakes of dietary fibre, fruit, vegetables, bread and cereals, or fluid were not associated with an increased occurrence of constipation. There were 151 subjects who felt they were moderately constipated, but who had a bowel motion at least every 2 d. These people were more likely than the rest of the sample to use laxatives (55.6%), were more likely to take food for their bowels, to take hynoptics, and to regard their health as poor. CONCLUSIONS--About one third of people aged 70 years and over have some bowel problem such as infrequency, straining at stool, or frequent laxative use. Most modify their diet accordingly but laxative use remains high.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8382251&dopt=Abstract constipation laxative colon cleansing

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