Choice of Laxatives
The prescription of laxatives is influenced by marketing, fashion, availability and cost, and there is wide
variation in their use among clinicians and across countries.1,2 With the availability of polyethylene glycols
(macrogols) and the more recently introduced methylnaltrexone, it is even more important that clinicians
understand both the pathophysiology of opioid-induced constipation, and the predominant mechanisms
of action of commonly prescribed laxatives.3,4 Based on this understanding, clinicians should
develop a simple, logical and cost-effective approach which optimizes the dose of a stimulant laxative
and avoids the concurrent prescription of multiple different types of laxatives as far as possible.5e8
Because of its wide availability, low cost and recently published data, the example protocol at the end
of this article recommends the initial use of senna alone.9,10