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Constipation: a Parent's Guide
CONSTIPATION: A PARENT’S GUIDE Twenty Questions About Constipation: Answers to Guide Parents and Professionals Constipation is the abnormally delayed or infrequent passage of hard stools. Most children, and many adults, too, become constipated from time to time. Often, the duration is short; occasionally it persists for months, even years. Although constipation can be uncomfortable, may create worry, and sometimes seem serious, fortunately it does not have long-term, troubling effects in most healthy children. This Booklet is designed to help you deal with childhood constipation by answering several questions and outlining management instructions for you to follow. Questions answered are: 1. What are the normal 11. What can we learn from patterns of bowel physical exam results? movements at 12. What is our treatment different ages? program for constipation? 2. What makes up bowel 13. How is the colon movements and how do cleaned out? they travel? 14. How are stools softened? 3. What is constipation? 15. Why is trying to have 4. When is constipation most bowel movements twice likely to occur? a day so important? 5. Why does constipation 16. What are the expected persist in some children? results of the treatment 6. Why would a child hold program? back stool and what 17. What do we do if the happens then? cleansing regimen is 7. How can proper toilet not successful? training help? 18. What is the long-term 8. Why would stool back up program for children in the colon? prone to constipation? 9. Why do some children 19. Does a special diet help have soiling accidents? resolve constipation? 10. -
Ferring Pharmaceuticals Inc. Page 1 of 13 HIGHLIGHTS OF
HIGHLIGHTS OF PRESCRIBING INFORMATION ---------------------DOSAGE FORMS AND STRENGTHS---------------------- CLENPIQ oral solution: Each bottle contains 10 mg of sodium picosulfate, These highlights do not include all the information needed to use ® 3.5 g of magnesium oxide, and 12 g of anhydrous citric acid in 160 mL of CLENPIQ safely and effectively. See full prescribing information for solution (3) CLENPIQ. -------------------------------CONTRAINDICATIONS------------------------------ ® • Patients with severe reduced renal impairment (creatinine clearance less CLENPIQ (sodium picosulfate, magnesium oxide, and anhydrous citric than 30 mL/minute) (4, 5.3, 8.6) acid) oral solution • Gastrointestinal (GI) obstruction or ileus (4) Initial U.S. Approval: 2012 • Bowel perforation (4) • ----------------------------RECENT MAJOR CHANGES-------------------------- Toxic colitis or toxic megacolon (4) Indications and Usage (1) 08/2019 • Gastric retention (4) Dosage and Administration (2.1) 10/2019 • Hypersensitivity to any of the ingredients in CLENPIQ (4) Dosage and Administration (2.2) 08/2019, 10/2019 Dosage and Administration, Day-Before Dosage Regimen (2.3) -----------------------WARNINGS AND PRECAUTIONS------------------------ Removed 10/2019 • Risk of fluid and electrolyte abnormalities, arrhythmia, seizures, and renal Warnings and Precautions (5.1) 08/2019 impairment: Encourage adequate hydration, assess concurrent medications, and consider laboratory assessments prior to and after use. (5.1, 5.2, 5.3, 5.4, ----------------------------INDICATIONS AND USAGE--------------------------- 7.1) CLENPIQ® is a combination of sodium picosulfate, a stimulant laxative, and • Use in patients with renal impairment or taking concomitant medications magnesium oxide and anhydrous citric acid, which form magnesium citrate, that affect renal function: Use caution, ensure adequate hydration, and an osmotic laxative, indicated for cleansing of the colon as a preparation for consider testing. -
Laxatives for the Management of Constipation in People Receiving Palliative Care (Review)
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by UCL Discovery Laxatives for the management of constipation in people receiving palliative care (Review) Candy B, Jones L, Larkin PJ, Vickerstaff V, Tookman A, Stone P This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2015, Issue 5 http://www.thecochranelibrary.com Laxatives for the management of constipation in people receiving palliative care (Review) Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 4 METHODS ...................................... 4 RESULTS....................................... 7 Figure1. ..................................... 8 Figure2. ..................................... 9 Figure3. ..................................... 10 DISCUSSION ..................................... 13 AUTHORS’CONCLUSIONS . 14 ACKNOWLEDGEMENTS . 14 REFERENCES ..................................... 15 CHARACTERISTICSOFSTUDIES . 17 DATAANDANALYSES. 26 ADDITIONALTABLES. 26 APPENDICES ..................................... 28 WHAT’SNEW..................................... 35 HISTORY....................................... 35 CONTRIBUTIONSOFAUTHORS . 36 DECLARATIONSOFINTEREST . 36 SOURCESOFSUPPORT . 36 DIFFERENCES -
3.2.2 Misuse of Stimulant Laxatives
Medicines Adverse Reactions Committee Meeting date 10/06/2021 Agenda item 3.2.2 Title Misuse of stimulant laxatives Submitted by Medsafe Pharmacovigilance Paper type For advice Team Active ingredient Product name Sponsor Bisacodyl Bisacodyl Laxative (Pharmacy Health) PSM Healthcare Limited trading as API tablet Consumer Brands Dulcolax tablet Sanofi-Aventis New Zealand Limited Dulcolax Suppository Sanofi-Aventis New Zealand Limited *Lax-Suppositories Bisacodyl AFT Pharmaceuticals Limited *Lax-Tab tablet AFT Pharmaceuticals Limited Docusate sodium *Coloxyl tablet Pharmacy Retailing (New Zealand) Limited trading as Healthcare Logistics Docusate sodium + Coloxyl with Senna tablet Pharmacy Retailing (New Zealand) sennosides Limited trading as Healthcare Logistics *Laxsol tablet Pharmacy Retailing (New Zealand) Limited trading as Healthcare Logistics Glycerol *Glycerol Suppositories PSM Healthcare Limited trading as API Consumer Brands Sennosides *Senokot tablet Reckitt Benckiser (New Zealand) Limited Sodium picosulfate Dulcolax SP Drops oral solution Sanofi-Aventis New Zealand Limited PHARMAC funding *Pharmaceutical Schedule Lax-Tab tablets, Lax-Suppositories Bisacodyl, Coloxyl tablets and Glycerol Suppositories are fully-funded only on a prescription. Senokot tablets are part- funded. Previous MARC Misuse of stimulant laxatives has not been discussed previously. meetings International action Following a national safety review published in August 2020, the MHRA in the UK has introduced pack size restrictions, revised recommended ages for use -
1: Gastro-Intestinal System
1 1: GASTRO-INTESTINAL SYSTEM Antacids .......................................................... 1 Stimulant laxatives ...................................46 Compound alginate products .................. 3 Docuate sodium .......................................49 Simeticone ................................................... 4 Lactulose ....................................................50 Antimuscarinics .......................................... 5 Macrogols (polyethylene glycols) ..........51 Glycopyrronium .......................................13 Magnesium salts ........................................53 Hyoscine butylbromide ...........................16 Rectal products for constipation ..........55 Hyoscine hydrobromide .........................19 Products for haemorrhoids .................56 Propantheline ............................................21 Pancreatin ...................................................58 Orphenadrine ...........................................23 Prokinetics ..................................................24 Quick Clinical Guides: H2-receptor antagonists .......................27 Death rattle (noisy rattling breathing) 12 Proton pump inhibitors ........................30 Opioid-induced constipation .................42 Loperamide ................................................35 Bowel management in paraplegia Laxatives ......................................................38 and tetraplegia .....................................44 Ispaghula (Psyllium husk) ........................45 ANTACIDS Indications: -
Assessment Report on Ricinus Communis L., Oleum Final
2 February 2016 EMA/HMPC/572973/2014 Committee on Herbal Medicinal Products (HMPC) Assessment report on Ricinus communis L., oleum Final Based on Article 10a of Directive 2001/83/EC as amended (well-established use) Herbal substance(s) (binomial scientific name Ricinus communis L., oleum (castor oil) of the plant, including plant part) Herbal preparation Fatty oil obtained from seeds of Ricinus communis L. by cold expression Pharmaceutical forms Herbal preparation in liquid or solid dosage forms for oral use Rapporteur C. Purdel Peer-reviewer B. Kroes 30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5555 Send a question via our website www.ema.europa.eu/contact An agency of the European Union © European Medicines Agency, 2016. Reproduction is authorised provided the source is acknowledged. Table of contents Table of contents ................................................................................................................... 2 1. Introduction ....................................................................................................................... 4 1.1. Description of the herbal substance(s), herbal preparation(s) or combinations thereof .. 4 1.2. Search and assessment methodology ..................................................................... 6 2. Data on medicinal use ........................................................................................................ 6 2.1. Information about products on the market ............................................................. -
Chronic Constipation: an Evidence-Based Review
J Am Board Fam Med: first published as 10.3122/jabfm.2011.04.100272 on 7 July 2011. Downloaded from CLINICAL REVIEW Chronic Constipation: An Evidence-Based Review Lawrence Leung, MBBChir, FRACGP, FRCGP, Taylor Riutta, MD, Jyoti Kotecha, MPA, MRSC, and Walter Rosser MD, MRCGP, FCFP Background: Chronic constipation is a common condition seen in family practice among the elderly and women. There is no consensus regarding its exact definition, and it may be interpreted differently by physicians and patients. Physicians prescribe various treatments, and patients often adopt different over-the-counter remedies. Chronic constipation is either caused by slow colonic transit or pelvic floor dysfunction, and treatment differs accordingly. Methods: To update our knowledge of chronic constipation and its etiology and best-evidence treat- ment, information was synthesized from articles published in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Levels of evidence and recommendations were made according to the Strength of Recommendation taxonomy. Results: The standard advice of increasing dietary fibers, fluids, and exercise for relieving chronic constipation will only benefit patients with true deficiency. Biofeedback works best for constipation caused by pelvic floor dysfunction. Pharmacological agents increase bulk or water content in the bowel lumen or aim to stimulate bowel movements. Novel classes of compounds have emerged for treating chronic constipation, with promising clinical trial data. Finally, the link between senna abuse and colon cancer remains unsupported. Conclusions: Chronic constipation should be managed according to its etiology and guided by the best evidence-based treatment.(J Am Board Fam Med 2011;24:436–451.) copyright. Keywords: Chronic Constipation, Clinical Review, Evidence-Based Medicine, Family Medicine, Gastrointestinal Problems, Systematic Review The word “constipation” has varied meanings for was established in 1991 by Drossman et al, primar- different individuals. -
ACR Manual on Contrast Media
ACR Manual On Contrast Media 2021 ACR Committee on Drugs and Contrast Media Preface 2 ACR Manual on Contrast Media 2021 ACR Committee on Drugs and Contrast Media © Copyright 2021 American College of Radiology ISBN: 978-1-55903-012-0 TABLE OF CONTENTS Topic Page 1. Preface 1 2. Version History 2 3. Introduction 4 4. Patient Selection and Preparation Strategies Before Contrast 5 Medium Administration 5. Fasting Prior to Intravascular Contrast Media Administration 14 6. Safe Injection of Contrast Media 15 7. Extravasation of Contrast Media 18 8. Allergic-Like And Physiologic Reactions to Intravascular 22 Iodinated Contrast Media 9. Contrast Media Warming 29 10. Contrast-Associated Acute Kidney Injury and Contrast 33 Induced Acute Kidney Injury in Adults 11. Metformin 45 12. Contrast Media in Children 48 13. Gastrointestinal (GI) Contrast Media in Adults: Indications and 57 Guidelines 14. ACR–ASNR Position Statement On the Use of Gadolinium 78 Contrast Agents 15. Adverse Reactions To Gadolinium-Based Contrast Media 79 16. Nephrogenic Systemic Fibrosis (NSF) 83 17. Ultrasound Contrast Media 92 18. Treatment of Contrast Reactions 95 19. Administration of Contrast Media to Pregnant or Potentially 97 Pregnant Patients 20. Administration of Contrast Media to Women Who are Breast- 101 Feeding Table 1 – Categories Of Acute Reactions 103 Table 2 – Treatment Of Acute Reactions To Contrast Media In 105 Children Table 3 – Management Of Acute Reactions To Contrast Media In 114 Adults Table 4 – Equipment For Contrast Reaction Kits In Radiology 122 Appendix A – Contrast Media Specifications 124 PREFACE This edition of the ACR Manual on Contrast Media replaces all earlier editions. -
Assessment Report on Cassia Senna L
European Medicines Agency Evaluation of Medicines for Human Use London, 27 April 2007 Doc. Ref. EMEA/HMPC/51868/2006 Corr. COMMITTEE ON HERBAL MEDICINAL PRODUCTS (HMPC) ASSESSMENT REPORT ON CASSIA SENNA L. AND CASSIA ANGUSTIFOLIA VAHL, FOLIUM Herbal substance Cassia senna L. (C. acutifolia Delile) [Alexandrian or Khartoum senna] or Cassia angustifolia Vahl [Tinnevelly senna], folium (senna leaf) or a mixture of the two species Herbal preparation dried leaflets, standardised; standardised herbal preparations thereof Pharmaceutical forms Herbal substance for oral preparation Rapporteur Dr C. Werner Assessor Dr B. Merz Superseded 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 75 23 70 51 E-mail: [email protected] http://www.emea.europa.eu ©EMEA 2007 Reproduction and/or distribution of this document is authorised for non commercial purposes only provided the EMEA is acknowledged TABLE OF CONTENTS I. Introduction 3 II. Clinical Pharmacology 3 II.1 Pharmacokinetics 3 II.1.1 Phytochemical characterisation 3 II.1.2 Absorption, metabolism and excretion 4 II.1.3 Progress of action 5 II.2 Pharmacodynamics 5 II.2.1 Mode of action 5 • Laxative effect 5 II.2.2 Interactions 7 III. Clinical Efficacy 7 III.1 Dosage 7 III.2 Clinical studies 8 III.2.1 Constipation 8 III.2.2 Irritable bowel syndrome 10 III.2.3 Bowel cleansing 11 III.3 Clinical studies in special populations 15 III.3.1 Use in children 15 III.3.2 Use during pregnancy and lactation 16 III.4 Traditional use 17 IV. -
Oral Lactulose Vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: a Randomized Controlled Study
Open Access Original Article DOI: 10.7759/cureus.14363 Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study Jagdeep Jagdeep 1 , Gaurish Sawant 1 , Pawan Lal 1 , Lovenish Bains 1 1. Department of Surgery, Maulana Azad Medical College, New Delhi, IND Corresponding author: Lovenish Bains, [email protected] Abstract Background Colonoscopy is the method of choice to evaluate colonic mucosa and the distal ileum, allowing the diagnosis and treatment of many diseases. Appropriate bowel preparation necessitates the use of laxative medications, preferentially by oral administration. These include polyethylene glycol (PEG), sodium picosulfate, and sodium phosphate (NaP). Lactulose, a semi-synthetic derivative of lactose, undergoes fermentation, acidifying the gut environment, stimulates intestinal motility, and increases osmotic pressure within the lumen of the colon. Methods In this prospective randomized controlled study, we analyzed 40 patients who presented with symptomatic bleeding per rectum and underwent bowel preparation either with lactulose or polyethylene glycol for colonoscopy. The quality of bowel preparation and other variables like palatability, discomfort, and electrolyte levels were analyzed. Results The majority of the patients (90%) were comfortable with the taste of lactulose solution, whereas the PEG group patients (55%) were equally divided on its palatability. On lactulose consumption, 40% of patients reported nausea/vomiting and around 10% of patients complained of abdominal discomfort. Serum sodium levels showed insignificant changes from 4.33 ± 0.07 mEq/L to 4.21 ± 0.18 mEq/L while potassium also remained similar from 4.26 ± 0.03 mEq/L to 4.22 ± 0.17 mEq/L. The mean Boston Bowel Preparation Score (BBPS) in patients who received lactulose solution was 6.25 ± 0.786 and in those who received PEG solution, it was 6.35 ± 0.813 (P-value = 0.59). -
Bowel Protocol for Hemodialysis
Clinical Dialysis/Patient Care/Bowel Protocol Hemodialysis Bowel Protocol for Hemodialysis Application: Constipation is a common problem for people on dialysis in part due to fluid restrictions and a low potassium diet which limits the types and amount of fiber in their diets. Medications such as phosphorus binders and opioids also contribute to constipation. Goal: The focus of the Bowel Protocol for Hemodialysis is to relieve and prevent constipation. Policy: 1. All patients on hemodialysis will be evaluated for constipation and given the appropriate recommendation. Bowel Protocol orders will be entered using ICD-10 K59.00. Procedure: 1. RD will interview patients on bowel movements as part of comprehensive assessments. 2. If a patient has mild constipation or Type 3 on the Bristol Stool Form Scale start option a, b or c one at a time, if effective, continue for maintenance: a. 1-3 tablespoons of cellulose fiber (Unifiber), ground flax or wheat bran daily. Start with 1 tablespoon per day, increasing by 1 tablespoon only as often as every 3 days. Do not exceed 3 tablespoons per day. b. 2 prunes per day. Limit to 2 per day to avoid high potassium. c. If patient has gastroparesis and/or fiber and prunes are not effective use docusate sodium (DOSS or Colace) 100mg/day increasing to up to 300mg/day. If no improvement move to number 3. Page 1 of 2 Northwest Kidney Centers Clinical Dialysis/Patient Care/Bowel Protocol Hemodialysis 3. If a patient has moderate constipation or Type 2 on the Bristol Stool Form Scale recommend: a. Polyethylene glycol (Miralax), 17gm powder in 4-8 ounces fluid daily. -
Managing Opioid-Induced Constipation
Visual summary MODIFY PAIN RELIEF Managing opioid-induced constipation Is the current dose of opioid needed to control pain? Constipation affects many patients using opioids Could pain be relieved in other ways? to relieve pain associated with advanced cancer Non-opioid analgesics Interventional pain management or terminal disease. Constipation is often multifactorial in such patients, Could an opioid with less constipating effect be used? and opioids may be one of several causes. As well Buprenorphine Transdermal fentanyl as direct treatment of the constipation, adjusting medication regimens and treating exacerbating factors may help to provide relief from bowel transit Is a referral to other specialists needed? symptoms. Palliative care Neuro-gastroenterology Pain clinic ADDRESS EXACERBATING FACTORS DIRECTLY TREAT CONSTIPATION Drugs Non-pharmacological options 5HT3 antagonists Anticholinergics Opioids Increase fluid consumption Increase dietary fibres Antipsychotics Diuretics Iron Increase physical activity (within patients’ capabilities) Calcium supplements Calcium channel blockers Privacy and comfort during defecation Chemotherapies Complementary therapy Thalidomide Vinca alkaloids Positioning on toilet (to relax the puborectalis muscle) knees higher than hips, leaning forward Busulfan Carboplatin with elbows on knees, straightened spine Manual removal Nutritional and if the constipation is severe and refractory to other therapies metabolic issues Pharmacological management Dehydration Reduced food and fluids intake Oral laxatives Poor