Bulk Producing Drugs


Isapgol (at Isabgol), Agar-agar (Agarol), Methyle celluslose.
These drugs absorb water to increase the bulk in the intestines and make the stools soft. The onset of their action is slow, about 12 to 24 hours. They are the safest purgatives for the treatment of chronic constipation. Of the three, isapgol is most commonly used in our country.


Isapgol is given preferably with warm milk in a dose of 4 to 5 g once or twice a day. Agar-agar is given in a dose of 4 to 16 g and methyl cellulose in 1 to 6 g in divided doses, for children in the age group of 12-] 5 years. For younger children the dose should be half.

Adverse Effects

Those agents which are derived from vegetable sources are devoid of toxic effects. Occasionally flatulence may occur, but, this can be relieved by increasing the fluid intake. The chronic use of isapgol may decrease plasma cholesterol by interfering with the absorption of bile acids but it does not cause any harm and may rather do good to an obese patient.

Precaution

Always take plenty of fluids along with these drugs to obtain maximum benefit and to avoid the possibility of intestinal obstruction which has been reported to occur in rare cases.
Stool Softeners Dioctyle Sodium Sulfosuccinate
This is an effective stool softener for the treatment of constipation in some cases. It is a detergent which absorbs water
by reducing the surface tension of fluids in the stools.

. Dosage

The daily dose varies from 50 to 500mg depending on (he severity of the condition. The action starts after 24 to 48 hours.

Adverse Effects

Adverse effects of this drug are quite rare. It has been reported to interact with mineral oils to increase their absorption.
Precaution
It should not be taken with mineral oils.


Liquid Paraffin (Cremaffin)

This is a traditional remedy for constipation. It is an inert oil which lubricates the intestines and forms a film or coating around the stools to make its passage smooth and comfortable. It softens the stool by preventing the absorption of water into the intestines. It is often recommended to patients of piles, heart attack, and to pregnant women, as well as after surgery on the rectum or abdomen and in cases in which straining to evacuate may be harmful. It is quite popular as it allows the stool to pass through the intestines with a minimum of friction.

Dosage

Liquid paraffin is given in a dose of 15 to 45 ml. Its action starts after 12 to 24 hours.


Adverse Effects

If taken regularly, it may cause deficiency of fat soluble Vitamins such as A, D and K. It may at times leak through the gastrointestinal tract and cause not only annoying but embarrassing situation. Its presence in the rectum inhibits the stimulatory reflexes to the intestines and prevents complete evacuation of bowels. On aspiration, liquid paraffin has also been reported to cause lipoid pneumonia in elderly and weak persons. Although it promotes and facilitates the passage of stools, it delays healing and, therefore, its use is not preferred after surgery for piles.