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Stimulant LaxativeAka: Stimulant Cathartic, Diphenylmethane Laxative, Phenolphthalein, Castor oil, Bisacodyl, Senna, Senokot, Cascara, Casanthranol, Peri-Colace, Melanosis coli, Ex-Lax, Correctol, Irritant Laxative, Anthraquinone Laxative

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  1. See Also
    1. Laxative
    2. Constipation
    3. Functional Constipation
    4. Pediatric Constipation
  2. Precautions
    1. Avoid chronic use of these agents
  3. Preparations: Anthraquinone Laxative
    1. Cascara (Casanthranol) Extract
      1. Onset of activity within 6-12 hours
      2. Dose: 325 mg PO qhs
    2. Senna Extract (Senokot)
      1. Onset of activity within 6-12 hours
      2. Adult: 10-15 ml PO qhs or 2-4 tablets PO bid
      3. Child: Senna Syrup (8.8 grams per 5 ml)
        1. Age 2-6 years: 2.5 to 7.5 ml per day divided bid
        2. Age 6-12 years: 5 to 15 ml per day divided bid
      4. Combinations with senna and Docusate
        1. Senekot-S
        2. Peri-Colace (previously contained cascara)
  4. Preparations: Diphenylmethane Laxative
    1. Bisacodyl (Dulcolax)
      1. Onset of activity
        1. Oral: 6-12 hours
        2. Rectal: 60 minutes
      2. Dose
        1. Adult: 10 mg PO/PR per day (PO may be repeated)
        2. Child (6-12 years old): 5 mg PO/PR
      3. Protocol
        1. Start at 1 tablet once daily orally after breakfast
        2. Advance up to 3 tablets orally twice daily
      4. Cost: <50 cents per day
    2. Phenolphthalein (OTC Preparations: Correctol, Ex-Lax)
      1. As an OTC medication, high risk of overuse
      2. Dose: 100 mg tablets, 1-2 PO q8 hours
      3. Associated with Stevens-Johnson Syndrome
  5. Adverse Effects: Long-term use (Laxative abuse)
    1. Colonic denervation and atony (Cathartic colon)
      1. Decreased motility of right colon
      2. Associated with Anthraquinone Laxatives
      3. Results from myenteric plexus injury
    2. Constipation
    3. Electrolyte and nutritional disturbance
      1. Hypokalemia
      2. Sodium overload
      3. Protein-losing enteropathy
    4. Melanosis coli
      1. Benign darkening of colonic mucosa
      2. Macrophage deposition in lamina propria

Bisacodyl (C0005632)

Definition (MSH)A diphenylmethane stimulant laxative used for the treatment of constipation and for bowel evacuation. (From Martindale, The Extra Pharmacopoeia, 30th ed, p871)
Definition (NCI)A synthetic pyridinylmethylene-diacetate ester derivative stimulant laxative, Bisacodyl acts with a parasympathetic effect directly on mucosal sensory nerves, increasing peristaltic contractions. It is used for occasional constipation, in pre- and postoperative treatment, and in conditions that require facilitation of defecation. (NCI04)
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishBisacodyl, BISACODYL PREPARATION
Spanishbisacodilo
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Senna Extract (C0036656)

Definition (PDQ)An extract made from the dried leaflets on the pods of Cassia angustifolia or Cassia acutifolia with laxative properties. Dimeric glycosides in dried senna extract are converted to the active monoanthrones by bacterial action in the colon. Through direct effects on enterocytes, enteric neurons, and muscle, monoanthrones produce giant migrating colonic contractions in addition to water and electrolyte secretion. As do other stimulant laxatives, monoanthrones may induce a limited low-grade inflammation in the colon through activation of prostaglandin/cyclic AMP and nitric oxide/cyclic GMP pathways and perhaps inhibition of Na+, K+-ATPase. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=480408&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=480408&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C61324" NCI Thesaurus)
Definition (NCI)An extract from the leaves of senna plant belonging to the genus Cassia with laxative properties. Senna contains anthraquinone glycosides, which are the main active components of senna. Senna acts on and irritates the lining of the intestine wall, thereby causing increased intestinal muscle contractions leading to vigorous bowel movement. This decreases transit time and reduces the opportunity of fluid absorption from the feces, which enhances the laxative effect.
Definition (MSH)Preparations of Cassia senna and C. angustifolia (see SENNA PLANT). They contain sennosides, which are anthraquinone type CATHARTICS and are used in many different preparations as laxatives.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishSenna, Senna Extract, SENNA EXTRACT PREPARATION, Senna preparation, Senna product
Spanishpreparado de sen, preparado de Senna, sen
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Cascara sagrada (C0205704)

Definition (MSH)Dried aged bark of a buckthorn, Frangula purshiana (FRANGULA), that contains the anthraquinone EMODIN and cascarosides. It is used as a laxative (CATHARTICS).
Definition (NCI)Used as a laxative in constipation and various medical conditions, Cascara (cascara sagrada) is dried bark of Picramnia sp. (Simarubaceae) or Rhamnus purshiana (Rhamnaceae) containing stimulant laxative anthranol glycosides that act on the intestinal wall to increase muscle contractions and encourage bowel movements. (NCI04)
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishCascara, CASCARA PREPARATION, Cascara sagrada, CASCARA SAGRADA EXTRACT, CASCARA SAGRADA EXTRACT PREPARATION, CASCARA SAGRADA PREPARATION, Sacred Bark
Spanishcáscara, cáscara sagrada, cascara, cascara sagrada
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Casanthranol (C0205705)

Definition (NCI)A concentrated mixture of anthranol glycosides from cascara sagrada (dried bark of Rhamnus p.) and used as a laxative in constipation and various medical conditions, stimulant laxative Casanthranol encourages bowel movements by acting on the intestinal wall to increase muscle contractions. (NCI04)
Definition (MSH)A concentrated mixture of anthranol glycosides derived from cascara sagrada.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishCasanthranol, CASANTHRANOL PREPARATION
Spanishcasantranol
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Diphenylmethane laxative (C0304558)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishDiphenylmethane laxative
Spanishlaxante de difenilmetano
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Anthraquinone laxative (C0360063)

ConceptsPharmacologic Substance (T121)
EnglishAnthraquinone laxative, Anthraquinone laxatives
Spanishlaxante de antraquinona
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Phenolphthalein (C0600489)

Definition (MSH)An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic.
Definition (NCI)An organic compound used as a laboratory reagent and pH indicator. Phenolphthalein exerts laxative effects by stimulating the intestinal mucosa and constricting smooth muscles. However, phenolphthalein is no longer used as a laxative due to the suspected carcinogenicity of this compound.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Indicator, Reagent, or Diagnostic Aid (T130)
EnglishPhenolphthalein, PHENOLPHTHALEIN PREPARATION, PHENPOLPHTHALEIN
Spanishfenolftaleína, fenolftaleina
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Senokot (C0699932)

Definition (NCI)A standardized, concentrated preparation, by Purdue, containing the anthraquinone glycosides sennosides extracted from senna leaves with laxative activity. Sennosides act on and irritate the lining of the intestine wall, thereby causing increased intestinal muscle contractions leading to vigorous bowel movement.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishSenokot
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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