Laxatives: Over-The-Counter Access For Under-18S?

In the UK, laxatives are available over the counter for adolescents aged 12 to 17 under the supervision of a pharmacist. However, new rules are being implemented to restrict the sale of stimulant laxatives to adults over 18 in small packs with on-pack warnings. This is due to evidence of misuse and overdose, particularly in people with eating disorders, which can lead to serious health consequences and even fatalities. While there are no legal age restrictions on buying medicines in the UK, some retail outlets have policies that restrict the sale of medicines to children. It is important to always read the information leaflet and check if a medicine is suitable for children, as dosage instructions usually differ from those for adults.

Laxatives for children are generally safe but not always the best choice

Laxatives for children are generally safe when used as recommended, but they are not always the best choice. While laxatives can be beneficial in treating chronic childhood constipation, they should not be the first solution you reach for. Instead, it is advisable to first address the underlying issue by making lifestyle changes, such as increasing fibre and fluid intake, physical activity, and optimising toilet posture and bathroom schedules for toddlers.

Laxatives can be potentially dangerous for children and should only be used under the guidance of a healthcare professional. They are meant for the relief of short-term constipation and are not recommended for long-term use. Continuous laxative therapy may be required for a few months until the association between pain and bowel movements is broken. However, stimulant laxatives, in particular, may cause dehydration, flatulence, and cramping, so they are usually reserved for older children and extreme cases.

Furthermore, laxatives are only FDA-approved for adults, as there is insufficient data from large-scale studies on their safety in children. Nevertheless, many healthcare providers still recommend the use of over-the-counter laxatives for children because they are well tolerated. Polyethylene glycol (MiraLAX, Dulcolax Balance) is the first-choice treatment for constipation in children as it is tasteless and generally well-tolerated. Other options include lactulose, magnesium hydroxide (Milk of Magnesia), and lubricant laxatives like mineral oil.

Laxatives for weight control are linked to serious health consequences

Laxatives for weight control are easily accessible to consumers of all ages, and their abuse has been linked to several serious health consequences. These include hypokalemia, hepatic and renal failure, cardiac arrhythmia, metabolic acidosis, and even death.

Research has shown that adolescents who use over-the-counter laxatives for weight control are at a heightened risk of receiving an eating disorder diagnosis in the future. A study by the University of Minnesota School of Public Health found that participants who used laxatives to control their weight had a 177% greater risk of receiving an eating disorder diagnosis compared to those who did not. Similarly, a study by the Harvard T.H. Chan School of Public Health found that 4.2% of participants who used laxatives for weight control received a subsequent eating disorder diagnosis within one to three years, compared to only 0.8% of those who did not.

The use of laxatives for weight control is not recommended by healthcare providers as it can lead to severe health issues, including high blood pressure and liver and kidney damage. Laxatives can also dysregulate normal digestive function and foster dependence on unhealthy and ineffective coping methods.

To protect young people from the dangers of laxative abuse, some states in the US, such as New York, have implemented bans on the sale of over-the-counter weight loss supplements to minors.

Laxatives are available over the counter for children in some countries

In the US, there are no legal age restrictions on buying medicines, but some retail outlets have their own policies that restrict the sale of medicines to children. However, there are calls for an Act prohibiting the sale of non-prescription laxatives to minors, to protect young people from the dangers of laxative misuse.

Laxatives can be a safe and effective solution for children experiencing constipation. They can be administered in various forms, such as chewable tablets, liquids, suppositories, or mixed into drinks. While laxatives can provide relief, they should not always be the first solution. It is recommended that parents first try dietary and lifestyle changes, such as increasing fibre and fluid intake, optimising toilet posture, and improving bathroom schedules for toddlers. If these changes do not help, a healthcare professional may recommend the use of a laxative.

It is important to note that laxatives can be dangerous for children and should only be used under the guidance of a healthcare professional. Before giving a laxative to a child, it is crucial to consult a healthcare provider to ensure the child's safety and well-being.

Laxatives can be sold to children in retail outlets with their own policies

In recognition of these dangers, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) has implemented new guidelines restricting the sale of stimulant laxatives to over-18s only. Pharmacists are permitted to sell laxatives for use by children aged 12 and over, but only under their supervision. These new guidelines also limit the size of packs of stimulant laxatives that can be sold to adults.

Retail outlets with their own policies permitting the sale of laxatives to minors should be aware of the potential health risks and the MHRA guidelines. They should also consider that there may be situations where they cannot sell a medicine to a child because the medicine is not licensed for children of that age. For example, some antacid medications for heartburn are only recommended for children aged 12 and over.

Furthermore, it is important to note that laxatives should not be the first solution for constipation in children. Parents and carers are advised to first try alternatives such as increasing their child's fibre intake, fluid intake, physical activity, and optimising toilet posture and bathroom schedules. If these changes do not help, a healthcare professional may then recommend the use of a laxative as a safe and effective solution.

Stimulant laxatives are now sold in smaller packs with on-pack warnings

In the UK, stimulant laxatives are now sold in smaller packs with on-pack warnings. This change was implemented by the Medicines and Healthcare Products Regulatory Agency (MHRA) to reduce the abuse and overuse of these products. The new packs will be phased in over the summer.

The new packs will include additional warnings about the risk of overuse and will also make clear that stimulant laxatives do not help with weight loss. The MHRA has stated that anyone with regular bouts of constipation should avoid the long-term overuse of stimulant laxatives, as this can lead to damage to the digestive system, including chronic constipation and damage to the nerves and muscles of the colon. Instead, people are advised to try alternative approaches such as diet and lifestyle changes, or to switch to other products such as bulk laxatives.

The new guidelines restrict the use of stimulant laxatives sold in retail outlets to patients over the age of 18. This is in response to concerns about the misuse of laxatives by people with eating disorders, as well as overuse in the elderly and inappropriate use in children. Parents and carers can still purchase stimulant laxatives for short-term use in children aged 12 and over, but they should consult a pharmacist or healthcare professional for advice.

The MHRA's decision was influenced by a review conducted by the Commission on Human Medicines (CHM), which highlighted the potential health risks associated with the overuse and misuse of stimulant laxatives. The new measures aim to balance patient safety with continued access to these medicines for the treatment of short-term constipation.

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