Hepatic encephalopathy

Question 1

Laxatives, bulk-forming

Ispaghula husk

Common indications

Answer 1

1. Constipation and faecal impaction, particularly in patients who can not increase their dietary fibre intake
2. Mild chronic diarrhoea associated with diverticular disease or IBS

Question 2

Bulk-forming laxatives

MOA

Answer 2

• Bulk-forming laxatives contain a hyperphillic substances, such as a polysaccharide or cellulose, which is not absorbed or broken down in the gut
• Dietary fibre, this attracts water into the stool and increases its mass
• Adequate fluid intake is therefore important to the action of bulk-forming laxatives
• Increased stool bulk stimulates peristalsis and helps relieve constipation
• It can also help in chronic diarrhoea
• This can be useful for some patients with diverticular disease, IBS or when managing stoma output

Question 3

Bulk-forming laxatives

Adverse effects

Answer 3

• These drugs are generally well tolerated, with mild abdominal distension and flatulence being the most common side effect
• Rarely, but more seriously they may cause faecal impaction and GI obstruction

Question 4

Bulk-forming laxatives

Warnings

Answer 4

• They should be used in patients with subacute or established intestinal obstruction or faecal impaction, and in general should not be used in patients with ileus

Question 5

Bulk-forming laxatives

Interactions

Answer 5

• There are no clinically significant adverse drug interactions with bulk-forming laxatives

Question 6

Bulk-forming laxatives

Communications

Answer 6

• Explain that you are offering a laxative that works as a fibre supplement
• This will hopefully make their stool easier to pass
• Outline the common side effects, tell them that the dose can be adjusted according to their symptoms, provided they do not exceed the max dose
• Advise them to take the laxative with a meal and plenty of fluid. As bulk-forming laxatives absorb water, they should be stored in a dry place