Symptom Management in Palliative Care
Constipation​
Laxatives​
Stimulants​
Stimulate motility through accumulation of water and electrolytes.
| Preparation | Dose | Onset of action |
|---|---|---|
| Danthron | 15 mg ON - 22.5 mg TDS | 6 - 12 hours |
| Senna | 1 - 4 tablets BD | 8 - 12 hours |
| Bisacodyl | 5 - 10 mg ON/BD 10 - 20 mg OD | 10 - 12 hours 20 - 60 mins |
| Glycerol | 2 suppositories | 1 - 6 hours |
| Phosphate | 1 enema | 20 minutes |
caution
Avoid stimulant laxatives in bowel obstruction as they can exacerbate colic.
Softeners​
Attract and retain water in intestines.
| Preparation | Dose | Onset of action |
|---|---|---|
| Milpar * | 10 - 20 mL BD | 24 - 48 hours |
| Docusate | 100 mg BD - 200mg BD/TDS | 24 - 48 hours |
| Arachis oil ** | 130 mL enema overnight | 24 - 48 hours |
* Liquid paraffin + magnesium hydroxide
** Contraindicated in nut allergy
Mixed stimulants and softeners​
| Preparation | Dose | Onset of action |
|---|---|---|
| Co-danthramer Co-danthrusate | 10 - 20 mL BD 1 - 4 capsules BD | 6 - 12 hours |
| Docusate | 100 mg BD - 200mg BD/TDS | 24 - 48 hours |
Osmotic laxatives​
| Preparation | Dose | Onset of action |
|---|---|---|
| Lactulose | 15 mL BD (starting dose) | 48 hours |
Can cause bloating, flatulence and abdominal discomfort.
Management​
- Stool in rectum (hard or soft): Give stimulant
- Hard stool: Give softener
- Infrequent stool: Give stimulant
note
If the above measures fail for opioid-induced constipation, consider methylnaltrexone under specialist guidance.