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References: Laxative

Eur J Clin Pharmacol. 2000 Jan;55(10):765-71.
Drug utilisation in Dutch nursing homes.

van Dijk KN, de Vries CS, van den Berg PB, Brouwers JR, de Jong-van den Berg LT.

Department of Social Pharmacy and Pharmacoepidemiology, University Centre for Pharmacy, Groningen Institute for Drug Studies (GIDS), A. Deusinglaan 2, 9713 AW Groningen, The Netherlands.

OBJECTIVE: To quantify and evaluate drug utilisation in a sample of Dutch nursing homes. METHODS: A retrospective analysis of computerised medication data of 2355 residents aged 65 years and over from six nursing homes in the Netherlands was performed. For each therapeutic drug group, the number of users was determined. The ten therapeutic groups used most frequently were investigated further. For these, patient characteristics, use of therapeutic subgroups, the average daily dosages and the chronicity of drug use were determined. Chronicity was expressed as the percentage of treatment days divided by the number of residents' days in the nursing home. RESULTS: During the study period, 89%, 77% and 56% of the study population used a drug from the anatomical therapeutic chemical (ATC) main group N (nervous system), A (alimentary tract and metabolism) and C (cardiovascular system), respectively. Eight of the ten therapeutic drug groups prescribed most frequently were used for more than 50% of the time. In particular, psycholeptic drugs, diuretics and laxatives were used chronically (83%, 81%, and 80% of the nursing home stay, respectively). Except for a few drug groups, such as laxatives and diuretics, the prescribed daily dosages were relatively low. Twenty-eight percent of the residents received loop diuretics; these were prescribed in relatively high dosages. CONCLUSION: Drug utilisation in the nursing homes was high and many drugs were used chronically. In view of the risk of possible adverse effects and drug-drug interactions, the prescribing and dosage of psycholeptic drugs, laxatives, loop diuretics and ulcer-healing drugs should be re-evaluate

Int J Pharm. 2000 Feb 25;196(1):11-20.
Is bisacodyl absorbed at all from suppositories in man?

Flig E, Hermann TW, Zabel M.

Department of Physical Chemistry, K. Marcinkowski University of Medical Sciences, 6 Swiecickiego Street, 60 781, Poznan, Poland.

A HPLC procedure was developed to determine free BHPM in human plasma and urine after prior deconjugation of its glucuronides with glucuronidase. A single dose administration of a 10 mg bisacodyl suppository from Glaxo Wellcome, Poznan (Poland) to 16 volunteers each resulted in its low active metabolite (BHPM) plasma levels (10-55 microgram l(-1)) according to general assumptions. Its prompt laxative effect appeared within 56.6+/-10.8 min. The calculated serum half-life time of BHPM glucuronide excretion in urine was approximately 7.32+/-0.99 h. BHPM was excreted in urine in only 3. 36+/-0.52% if compared with the above bisacodyl rectal dose administered. Any relationship between BHPM plasma and/or urine levels and its laxative action does not occur. These results confirm the thesis that the laxative action of bisacodyl suppositories is initiated through a direct interaction of the drug in the rectum.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10675703&dopt=Abstract constipation laxative

Dis Colon Rectum. 2000 Feb;43(2):188-92.
Evaluation and outcome of the delorme procedure in the treatment of rectal outlet obstruction.

Liberman H, Hughes C, Dippolito A.

Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 68131-2197, USA.

PURPOSE: This study was designed to assess the results of the Delorme procedure in the treatment of patients with rectal outlet obstruction. METHODS: A descriptive retrospective study from October 1989 to October 1997 was undertaken. Thirty-four patients with an abnormal defecography documenting rectal outlet obstruction caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele were included in the study. RESULTS: Thirty-four patients (33 females) ages 35 to 82 (mean, 61.4) years were followed up for the duration of the study (mean follow-up, 43 months). Twenty-six patients (76.4 percent) reported a good to excellent overall result after the Delorme procedure. Eight patients (23.6 percent) reported fair to poor results. Symptomatic improvement was observed in 89.7 percent for patients who had incomplete evacuation, and in 88.5 percent of patients who had constipation. There was improvement in 78.6 percent of patients with bleeding per rectum, in 92.9 percent of patients with straining, and in 82.4 percent of patients with the need to manually assist in defecation by pushing in the perineum or vagina. Discontinuation of laxative use after the procedure was reported by 66.7 percent of patients. Improvement in the patients with some degree of incontinence was seen in 33.3 percent. Twelve patients (35.3 percent) experienced one or more complications. The procedure was performed in an outpatient setting in 71 percent of the patients. CONCLUSIONS: The Delorme procedure for the treatment of rectal outlet obstruction can be done with minimal morbidity, short hospital stay often in an outpatient setting, with good functional results, and with an overall patient satisfaction above 75 percent.

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