Laxatives - Terminally Ill Patients
- The CSM (Current Problems in Pharmacovigilance volume 26, May 2000) have advised that the indications for danthron containing products has been restricted to constipation in terminally ill patients of all ages. Therefore, co-danthramer and co-danthrusate are included as Specialist Initiated Drugs.
- Most terminally ill patients require both a softening agent and a stimulant laxative, for example, co-danthrusate (or a cheaper alternative, such as lactulose, may suffice) + senna.
- Phosphate enemas and arachis oil enemas have not been included as their use has declined with the availability of polyethylene glycols which are also licensed for the treatment of faecal impaction. Advice should be sought from the continence service. N.B. arachis oil should not be used in patients with a nut allergy.
- Methylnaltrexone is an opioid antagonist licensed for the treatment of opioid induced constipation in advanced illness patients who are receiving palliative care when response to usual laxative therapy has not been sufficient.
- Use of methylnaltrexone is currently restricted to hospices or on the advice of a palliative care physician.
Please note, sample information has been entered into Chapters 1 and 2 only and although fairly clinically accurate, it is not guaranteed. The information was entered during April and May 2017 and drugs will have subsequently been randomly added during telephone demonstrations.
Only for initiation by a physician with expertise in palliative care