Safe Laxatives For Dialysis Patients: What To Know?

Constipation is a common problem for dialysis patients, and laxatives are typically used to treat it. However, it is important to consult a doctor before taking any laxative, as they can have adverse effects and interact with other medications. Some laxatives that doctors may recommend include polyethylene glycol (found in Miralax and Glycolax), Senna, sorbitol, and lactulose. Doctors may also suggest increasing fibre intake with Benefibre powder.

Polyethylene glycol (e.g. Miralax, Glycolax)

Polyethylene glycol (PEG) is a safe laxative for patients on dialysis. It is available under brand names such as Miralax and Glycolax. PEG is a common treatment for constipation, which is a frequent issue for dialysis patients due to their dietary restrictions, comorbidities, and medications.

A study of US veterans with advanced chronic kidney disease found that laxative use, including PEG, did not significantly impact the decline of kidney function. This indicates that PEG is safe for patients with kidney disease transitioning to dialysis.

PEG is a suitable option for dialysis patients because it does not interfere with other medications and can be taken without additional fluid, which is often recommended for laxatives. It is essential to consult a nephrologist or physician to determine the most suitable treatment for constipation, as it can be influenced by individual medical history and other factors.

Senna (e.g. Senokot)

Senna (Senokot) is a laxative that is safe for dialysis patients. It is made from the senna plant, a natural vegetable laxative ingredient. It is available over the counter as a stimulant laxative and can be taken at bedtime to relieve constipation in 6-12 hours. It is important to note that senna should not be used for longer than a week without consulting a doctor.

Senna is also sold under different brand names, including Senokot. The dose of senna will depend on factors such as age, formulation, brand, and medical condition. It is recommended to follow the instructions on the product label or consult a healthcare provider for guidance. Senna should not be used by individuals with a known allergy to it or those with a blockage in the intestines or inflammatory bowel disease.

For adults and children aged 12 years and above, the recommended dose is 2 tablets once a day or 4 tablets twice a day. For children aged 6 to under 12 years, the dose is 2 tablets once a day. For children aged 2 to under 6 years, the dose is half a tablet once a day. It is important to keep Senna out of the reach of children, and in case of overdose, immediate medical help should be sought.

It is important to consult a doctor before using senna if you are pregnant or breastfeeding or have any existing medical conditions. Senna can interact with other medications, so it is advised to avoid taking it within 2 hours of taking other medicines. Additionally, it should not be used in combination with other laxatives unless directed by a healthcare professional.

Sorbitol

A nephrologist may allow the use of sorbitol as a laxative for patients on dialysis. However, it is important to consult your nephrologist, who can consider your complete medical history and ensure the laxative does not interfere with your other medications.

It is worth noting that in one study, seven patients with advanced chronic renal failure experienced severe side effects during peritoneal dialysis with sorbitol-containing dialysate. The side effects included upper abdominal pain, hypertension, vomiting, and, in some cases, coma. These signs did not recur when a glucose-containing dialysate of otherwise identical composition was used.

Lactulose

Common brand names for lactulose include:

• Acilac
• Cephulac
• Cholac
• Chronulac
• Constilac
• Constulose
• Duphalac
• Enulose
• Generlac
• GoLytely
• Lactugal
• Miralax
• Glycolax

Bisacodyl (e.g. Dulcolax)

Bisacodyl should only be used if other types of laxatives have been tried first, such as bulk-forming or osmotic laxatives. It is recommended that individuals try to increase fibre in their diet and drink more water before resorting to laxatives. Bisacodyl is not suitable for everyone. For example, it should not be taken by those with signs of dehydration, severe stomach pain, or a serious problem in the stomach. It is important to consult a doctor or pharmacist before taking bisacodyl to ensure it is safe for you.

The dosage of bisacodyl depends on age, medical condition, and response to treatment. It is typically taken once a day at bedtime and can be taken with or without food. However, it should not be taken with dairy products, indigestion remedies, or medicines that reduce stomach acid. Bisacodyl tablets usually take 6 to 12 hours to work, while suppositories take 10 to 45 minutes. It should not be taken for more than 5 consecutive days without consulting a doctor.

Side effects of bisacodyl may include nausea, stomach pain or cramps, diarrhoea, and weakness. More serious side effects include vomiting, severe dizziness, and trouble breathing. It is important to consult a doctor or pharmacist if any of these side effects occur.

Frequently asked questions