What is the focus of medical care in constipation and what is the FDA warning regarding OTC sodium phosphate products?

Updated: Mar 30, 2020
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Medical care should focus on dietary change and exercise rather than laxatives, enemas, and suppositories, none of which really address the underlying problem. The patient is at a high risk for becoming dependent on laxatives and developing a laxative colon. Potentially helpful measures include initiation of dietary fiber supplementation and stimulant and/or osmotic laxatices, as appropriate; if necessary, these can be followed by intestinal secretagogues and/or prokinetic agents. [3] Another option for opioid-induced constipation is peripherally acting mu-opiate antagonists (PAMORAs) (eg, methyltrexone [oral or parenteral], naldemedine [oral], naloxegol [oral]. [3, 23] If conservative measures fail and the patient is clearly compliant with the advice, a more detailed evaluation should be performed (see Workup).

In addition, in January 2014, the FDA issued a warning that exceeding one dose of OTC sodium phosphate products for constipation over a course of 24 hours may cause serious harm to the kidneys and heart and, in rare cases, may be fatal. [23, 24] Using more than the recommended dose of these products can cause severe dehydration and changes in serum electrolyte levels. Individuals who may be at higher risk for potential adverse events include young children; patients older than 55 years; patients who are dehydrated; patients with kidney disease, bowel obstruction, or inflammation of the bowel; and patients who are using medications that may affect kidney function. [23, 24]

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