Summ06.pub

Summer 2006
By Hedva Barenholtz Levy, PharmD, BCPS, Director, HbL PharmaConsulting What Are Laxatives?
axatives are medications that are used to prevent or treat constipation. Consumers spendmore than $734 million dollars a year on laxatives. Constipation is estimated to occur inup to 40% of patient 65 years and older living in the community and is a common concern in older adults. Constipation is defined as having 2 or more of thefollowing symptoms at least 25% of the time: Straining to have a stool,Passage of lumpy or hard stools,Sensation of incomplete evacuation,Sensation of blockage, Requiring manual maneuvers to facilitate defecation, or Unfortunately, many people use laxatives for what they believe is constipation, for example, if they do not have at least one bowel movement a day. In reality, being “regular” can range from having a couple bowel movements daily to a couple bowel movements weekly. When used properly, laxatives help the passage and elimination of fecal matter from the colon and rectum.
What causes constipation? Constipation can be caused or worsened by certain medical
conditions, like hypothyroidism, diabetes, and depression; some medications (see table 1); and lifestyle characteristics. Lifestyle characteristics include not eating enough fiber, notdrinking enough water, not getting enough physical activity, and avoiding or not being Caregiver Memory Kits
activities of ordinary living. Finding activities contact Karen Bono at 314-368-7969 or P.O.
that a person with dementia can do can be a 2006 HbL PharmaConsulting. All rights reserved.
Table 1. Examples of medications that cause or contribute to
What types of laxatives are there to choose
constipation
from? There are 5 different types of laxatives
amitriptyline
iron supplements
that are available without a prescription. Thisalone can be a source of confusion. In addition, antacids with calcium or
oxybutynin
other laxatives are available only with a pre- aluminum
scription. The several types of laxatives are de- diltiazem (Cardizem, Tiazac)
pain medicines like codeine
or morphine
choices, be sure to talk with your health care diphenhydramine
simvastatin (Zocor)
professional to know which product to try andhow you should take it.
fluoxetine (Prozac)
verapamil (Calan)
How do you use laxatives safely? Your doctor
or pharmacist can help you decide which laxative aware of the urge to empty the bowel. When is the best for you. Current medications and constipation lasts for more than 3 weeks or when health conditions may influence the choice of accompanied by pain or bleeding, a physician treatment. For self-treatment of constipation, lax- atives in general should be used for no longerthan one week because of the potential for ad- How can you prevent constipation? Patients
verse effects. Overuse sometimes can worsen the should drink 4 to 10 glasses of water a day, espe- problem. If constipation has lasted for 3 weeks or cially when increasing the amount of fiber in their if you have pain or bleeding associated with con- diet. Standard recommendations for fiber sug- gest 20 to 30 grams of fiber a day. Good sourcesof fiber include fresh fruits and vegetables, cere- Are There Other Issues? When constipation is
als, bran products, dried fruits, and beans. It is a side effect of a medication, it is recommended recommended to increase the amount of fiber in to use the strategies described above to prevent your diet gradually to avoid side effects like constipation. When those are not enough, and if bloating and gas. Walking and other types of the medication cannot be stopped or changed, a physical activity increase muscle tone and im- prove bowel movements. Do not rush your timeon the toilet and do not strain. Try sitting on the Contact Dr. Hedva Levy at HbL PharmaConsult- toilet after meals, especially breakfast.
ing if you have additional questions on this topic Zelapar ® is a new
Parkinson’s Disease are in the news.
formulation of selegiline that dissolves
Rasagiline (Azilect®) was approved
drug class as selegiline, but rasagiline has a lower risk of side effects. It works by inhibiting dopamine in the brain (there also is an MAO-A enzyme). Thus, both selegiline and rasagiline work to increase the amount of dopamine available in the and increase “on” time throughout the brain. Rasagiline is given once daily and can be used alone in early stages of Parkinson’s or combined with Table 2. Types of laxatives
Examples
How it works
Comments
Fiber or Bulk-
Stool softeners
Lubricant
older adults; do not use at bedtime;available without prescription Osmotic or Saline
Stimulant
About HbL PharmaConsulting
consultations to patients who take multiple medications. The goals of each consult include increases bulk in the stool, retains water, preventing and correcting medication-related problems, improving patient quality of life, and identifying ways to digestive tract. It is important to drink reduce drug costs. For more information, contact Dr. Levy.
fiber, and be sure to increase your daily subscription requests to the address below. PharmaNotes is published by HbL PharmaConsulting as a client
service. Content is informational only and is not intendedto guide therapy without supervision by a health care Address: HbL PharmaConsulting
9648 Olive Blvd, Ste. 309
St. Louis, MO 63132
Phone/fax: 314-994-9409
professional. For a list of fiber content in E-mail: [email protected]
foods, contact HbL PharmaConsulting.
Website:
PharmaNotesHbL PharmaConsulting9648 Olive Blvd., #309St. Louis, MO 63132-3002

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