Bulking agents | | | |
Methylcellulose powder | 2 g per day | $16 for one 479-g bottle | Insoluble fiber; start with low dose and increase gradually |
Polycarbophil (Fibercon) | 1.25 g one to four times per day, maximum: 5 g per day | $7 for one 140-capsule bottle | Soluble fiber; start with low dose and increase gradually |
Psyllium (Metamucil) | 2.5 g to 30 g per day in divided doses | $11 for one 300-capsule bottle | Soluble and insoluble fiber; start with low dose and increase gradually |
Osmotic laxatives | | | |
Polyethylene glycol 3350 formula (Miralax) | 17 g per day | $13 for one 510-g bottle | Titratable; response may take up to 72 hours; use shortest effective treatment duration; concern for dependence with long-term use |
Lactulose | 15 mL to 30 mL per day | $15 for one 473-mL bottle | Response may take up to 48 hours; cramps and abdominal distention common |
Magnesium hydroxide | 30 mL to 60 mL | $5 for one 769-mL bottle | Not for daily use; takes effect within six hours; may cause electrolyte disturbances |
Magnesium citrate | 195 mL to 300 mL | $3 for one 296-mL bottle (one dose) |
Magnesium sulfate (Epsom salt) | 10 g to 20 g | $6 for one 3.6-kg container | |
Stimulant laxatives | | | |
Bisacodyl (Dulcolax) | 5 mg to 15 mg once per day | $28 for a one-month supply | Short-term use; avoid use within one hour of consuming antacids or milk |
Senna | One to two 8.6-mg tablets twice per day, maximum: four 8.6-mg tablets twice per day | $5 for a 60-tablet bottle | May cause urine discoloration and melanosis coli |
Stool softener | | | |
Docusate calcium | 240 mg once per day | $12 for a 100-tablet bottle | Generally well tolerated |
Secretagogues | | | |
Linaclotide (Linzess) | 145 mcg once per day | $509 for a one-month supply | Dosing differs for chronic constipation vs. irritable bowel syndrome with constipation |
Lubiprostone (Amitiza) | 24 mcg twice per day | $158 for a one-month supply | Rarely can cause hypotension or syncope |
Plecanatide (Trulance) | 3 mg to 6 mg per day | $540 for a 30-tablet bottle | Can cause hypersensitivity reaction |
Serotonin agonist | | | |
Prucalopride (Motegrity) | 1 mg to 2 mg per day | $508 for a 30-tablet bottle | Serious adverse effects include suicidal thoughts and depression |