Constipation is often a chronic problem in the elderly and there are many diseases and obviously many medications that can cause constipation. There are ways to try to minimize pill burden in this patient population when reducing the actual number may not be possible. Consolidating medications to reduce polypharmacy is one of those strategies.
I will often see patients on chronic opioids also on numerous constipation medications. Here’s a list of constipation medications I recently came across.
- Dulcolax 5 mg daily
- Senna one tablet twice daily
- Colace 100 mg daily
- Miralax 17 grams daily
It is always important to try to get the history as to why a patient would be taking duplicate stimulant laxatives like Senna and Dulcolax, but here’s a case where we should be able to discontinue the Dulcolax (bisacodyl) and increase the Senna or vice versa.
Another option to try to reduce pill burden would be to use the Senna-S product which contains the stool softener docusate (Colace) as well as the stimulant Senna. So instead of the current regimen, we could look to discontinue Dulcolax and Colace and go to Senna-S one tablet twice daily and will likely need to titrate upward another tab or two with the DC of Dulcolax.
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