These agents include magnesium salts, sorbitol, lactulose, and polyethylene glycol (PEG) solutions. They may be used in patients who do not tolerate or respond poorly to fiber. The decision to use a particular laxative is often determined by individual preference, costs, and underlying medical conditions.
Sorbitol and lactulose are poorly absorbed sugars that are hydrolyzed to acidic metabolites by coliform bacteria, which stimulate fluid accumulation in the colon and usually produce soft, well-formed stools. As sorbitol is less expensive and as effective as lactulose, we prefer sorbitol as the low cost choice. Major side effects of these agents are abdominal bloating and flatulence.
Magnesium salts, such as magnesium sulfate or citrate, are an alternative to poorly absorbed sugars. However, they should be used with caution in patients with renal insufficiency.
PEG solutions, with or without electrolytes, have been used to treat chronic constipation. A powdered form that does not contain electrolytes (MiraLax) is more palatable and may be mixed with any fluid. The amount taken daily is adjusted based on clinical response. As colonic bacteria do not hydrolyze PEG, abdominal bloating or flatulence are not as problematic as with fiber or poorly absorbed sugars. This agent is costly and, as with lactulose and sorbitol, available by prescription only.
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