Dulcolax (bisacodyl); Ex‑Lax, Senokot (senna)

Probiotics, Digestive Enzymes, Adsorbents

Lactase products; Polycarbophil

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GI Disorders

C/D, IBS-C/D Therapies

Generic Name	Brand name	Eligible Population	Mechanism of Action	Dose if applicable	Contraindications	Warnings	ADRs	Other Information
Psyllium, Polycarbophil, Methylcellulose	Metamucil	elderly & PREGNANT pts	similar to dietary fiber. ↑ stool H2O → ↑ stool wt/ bulk. ↑ rate of stool transit		Can result in bowel obstruction → take w/fluids	Separate other meds by 1–2 hrs	Flatulence, bloating, abdominal distension	relief ~ 3 DAYS
Docusate	Colace®		mixes H2O + lipids in GI tract ↑ H2O, secretion & secret electrolyte in bowels → ↑ stool moisture → softer	100 mg PO BID	Avoid in <2 y/o: fatal benzyl alcohol toxicity		Well tolerated and no significant medication interactions	relief ~ 3 DAYS
Mineral Oil		Avoid: long‑term use; HS admin; use in bedridden pts	Lubricates stool	Adults: 14–45 mL PO daily		Avoid long‑term use, HS admin, & bedridden pts	Nutritional deficiencies ↓ abs of vit A, D, E, K. aspiration risk → lipid pneumonia	relief ~6–8 hours
PEG	Miralax, GoLytely	bowel prep procedures	water retention in the stool, ↑ stool frequency	Adults: 17 g PO daily	mechanical GI obstruction	Separate other meds by 2 hrs	Nausea, vomiting, flatulence, abdominal cramping	BMs ~ 1–3 days; don’t use for >1–2 weeks
Lactitol	Pizensy®	Adults only	Monosaccharide that causes water influx into the small intestine		mechanical GI obstruction and galactosemia	Separate other meds by 2 hrs	Flatulence, diarrhea	BM _ 1 - 2 days
Saline Laxatives	Milk of magnesia; Fleet enema		Keep electrolytes in colon → stool H2O retention; ↑ peristalsis		<2 yrs old, pregnant, renal dysfunction, CHF	hydration; monitor electrolytes	↓fluid & electrolyte; ↑ Mg/Na in renal dysfunction	BM in 1–3 hours
Stimulant Laxatives	Dulcolax (bisacodyl); Ex‑Lax, Senokot (senna)	pediatrics → not preferred	Stimulate enteric nervous system; fluid/electrolyte colonic secretion	Senna: 17.2 mg PO once daily.	antacids = early bisacodyl release = ↓ efficacy	antacids = early bisacodyl release = ↓ efficacy	Cramping, NV, abn electrolytes/ malabsorption if long‑term use	Relief ~ 8–12 hours
Naloxegol	Movantik®	OIC	Peripherally Acting μ Opioid Receptor Antagonist	empty stomach; half dose if abdominal pain or CrCl <60	severe liver impairment, obstruction suspecte, or strong 3A4 inhibs	↓ effective if opioid use <4 wks	Abdominal pain (dose‑reduce if needed)
Naldemedine	Symproic®	OIC	Peripherally Acting μ Opioid Receptor Antagonist	0.2 mg PO daily	obstruction or severe liver impairment	↓ effective if opioid use <4 wks		with or without food
Methylnaltrexone	Relistor®	palliative care and OIC	Antagonist of peripheral μ opioid receptors	wt‑based SQ QOD or SQ/PO daily	C/I OBSTRUCTION suspected	Renal/hepatic dosing adjustments	abdominal pain and flatulence	Take on an empty stomach w/water >30 mins b4 1st meal
Loperamide	Imodium®	<12 have specific max daily dosing	Stimulates μ opioid receptors in GI	Adults: 4 mg initially → 2 mg after each stool (MAX 16 mg/day x 48 hrs). kids <12: 2mg --> 1 mg --> 6 max (9-11) or 4 max (6-8)	Do NOT use if infectious diarrhea		Constipation, dry mouth, dizziness, abdominal pain	Well tolerated, ↓ ARs in class
Diphenoxylate-Atropine	Lomotive (CS-V)	Children 2–12: liquid only	Diphenoxylate stimulates the μ opioid receptors in intestine; atropine added to discourage drug abuse via antimuscarin effects	Adults: QID til better then ↓dose. MAX 20 mg – 0.2 mg/day x10 days (max: 10mg - 0.1mg/day)	glaucoma, obstructive uropathy, CV (due to atropine); Do NOT use if infectious diarrhea	Avoid w/azelastine, ipratropium, MAOI, K+, CNS depressants	dry mouth, nausea constipation, dizzy, drowsy, blurr vision	liquid only for pediatrics
Bismuth Subsalicylate	Pepto-Bismal	Avoid: preg & kids w/ chickenpox/ flu	Antisecretory, direct antimicrob vs. bacterial/viral pathogens; ↓ intestinal prostaglanin ad chloride secretion	Adults: 524 mg every 30–60 minutes for 48 hours (MAX 4800 mg/day).	Avoid in: pregnancy; children w/flu or chickenpox, h/o GI bleed, anticoagS		tinnitus, neurotox in ↑ doses; Reye’s syndrome	Black tongue ±stools
Probiotics, Digestive Enzymes, Adsorbents	Lactase products; Polycarbophil	Probiotics: clinical trial	Probiotics replace microflora; ↓patho flora. Dig enzy for lactose intol, take w/dairy meals. Ads: Adsorb nutrients, toxins, meds, dig. juices	Lactase: taken with dairy at mealtimes.		Lack of evidence of efficacy → rarely used	Probiotics: flatus
Octreotide	cirrhotic patients	diarrhea 2/2 carcin tumors ± chemo	Somatostatin analog, blocks 5‑HT release; inhibits GI secretion, stimulate intestinal absorp			ab pain, bradycardia, ± hyperglycemia	Abdominal pain, bradycardia, hyperglycemia	Injectable
Cholestyramine	Prevalite	DLP, pruritis	Decrease fecal bile acids by forming a non‑absorbable complex			DDI due to binding abilities w/diuretics, contraceptives, vitamins, NSAIS, amiodarone
Fiber	Metamucil	IBS-C; preferred constipation treatment in elderly and PRENANT patients		1 tbsp with 1 meal/day; gradually increase	OIC		abdominal distension, flatulence	Take with fluids to prevent bowel obstruction
PEG	Miralax; GoLytely	OIC (1st line); Constipation; IBS-C (off-label)		Adults: 17 g PO DAILY			nausea, vomiting, flatulence, abdominal cramping
Linaclotide	Linzess	IBS-C (adults)	guanylate cyclase-C agonist on intestinal epithelium to increase intestinal fluid secretion and decrease GI transit time (increase RATE)	290 mcg PO daily 30 mins before first meal on empty stomach	OIC; pediatrics: severe dehydration and GI obstruction	D/C if severe diarrhea
Plecanatide	Trulance	IBS-C (adults)	guanylate cyclase-C agonist on intestinal epithelium to increase intestinal fluid secretion and decrease GI transit time (increase RATE)	3 mg PO daily	pediatrics: severe dehydration and GI obstruction			use alternative if no improvement after 4 weeks
Tenapanor	Ibsrela	IBS-C (adults)	Inhibitor of the sodium/hydrogen exchanger isoform 3: ↓ GI absorption of dietary Na+; ↑ gut [Na+] and water to loosen stool (accelerate transit time)	50 mg PO BID immediately prior to breakfast and dinner	pediatrics: severe dehydration; GI obstruction	D/C if severe diarrhea
Lubiprostone	Amitiza	IBS-C (adult females); if patient fails other agents due to high cost and less evidence	ClC-2 channel stimulator	8 mcg PO BID with food and water	OIC; GI obstruction, severe diarrhea
Loperamide	Imodium®	Used for management of urgent diarrhea	Opioid receptor agonist: inhibits peristalsis & anti‑se cretory activity; ↑ intestinal time			Weak recommendation; avoid for acute symptom onset.
Cholestyramine			Decrease fecal bile acids by forming a non‑absorbable complex			MONITOR FOR MEDICATION INTERACTIONS due to binding abilities		dyslipidemia, pruritis
Eluxadoline (CS-IV)	Viberzi®	IBS-D, adults and children	Mixed μ‑ & κ‑opioid receptor agonist & δ‑receptor antagonist → ↓ abdominal pain & diarrhea.	100 mg PO BID with food; lower dose if renal/hepatic impairment or lack of tolerability.	severe hepatic impairment, no gallbladder, >3 alcoholic drinks/day	D/C if severe constipation, pancreatitis, sphincter of Oddi spasm, biliary duct obstruction, or CNS depression	Severe constipation, pancreatitis, biliary obstruction, CNS depression.	Dose adjust for renal/hepatic impairment. Food required.
Rifaximin	Xifaxan®	May repeat up to 2 times if recurrence; traveler’s diarrhea and cirrhosis.	Nonabsorbable rifamycin antibacterial, improved abdominal pain, urgency, QoL	550 mg PO TID × 2 weeks; may repeat up to 2 times if recurrence.			Less impact on stool consistency and bloating.	May repeat treatment; use in traveler’s diarrhea and cirrhosis.
Alosetron	Lotronex®	Women w/ severe symptoms not relieved by conventional Tx	Selective 5‑HT3 receptor antagonist… improves urgency, stool consistency, QoL	0.5 mg BID; discontinue immediately if constipation, rectal bleeding, or worsening abdominal pain.	Contraindicated in severe hepatic impairment.	REMS program; requires physician education.	Severe constipation & ischemic colitis	FDA‑restricted use; D/C ASAP if constipation or GI bleeding.
Dicyclomine Hyoscyamine	Bentyl® / Levsin®	PRN for abdominal pain reduction; IBS‑C & IBS‑D	Relief of abdominal pain by ↓ smooth muscle contraction and possibly visceral hypersensitivity.	Dicyclomine: 20 mg PO QID × 7 days → 40 mg QID; stop if no efficacy in 2 wks. Hyoscyamine: 0.125–0.25 mg PO q4h PRN (max 1.5 mg/day)	obstructive GI diseases and severe ulcerative colitis.	Caution use in CVD, hepatic impairment, renal impairment, hyperthyroidism.	Drowsiness, dizziness, blurred vision.	Monitor for drowsiness, dizziness, blurred vision

Created by: CaristW

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