Xing J H, Soffer E E
Department of Gastroenterology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Dis Colon Rectum. 2001 Aug;44(8):1201-9. doi: 10.1007/BF02234645.
Laxatives are among the most commonly used drugs or additives. Most are quite safe when used judiciously, intermittently when possible, and in the absence of contraindications. Bulking agents and nonabsorbable compounds such as lactulose can cause bloating but have very few serious adverse effects except for the allergic reaction to psyllium preparations. Osmotic laxatives containing poorly absorbable ions such as magnesium or phosphate can cause metabolic disturbances, particularly in the presence of renal impairment. However, if taken intermittently, in the absence of conditions such as ileus or bowel obstruction, they have few adverse effects. Polyethylene glycol solutions are emerging as an effective and safe mode of treatment for chronic constipation. Of stimulant laxatives, senna compounds and bisacodyl are the most commonly used. Although there are data to support the neoplastic potential of this class of drugs in in vitro studies, epidemiologic data in humans so far has not established a clear link between these laxatives and colonic neoplasia. The link between stimulant laxatives and structural changes, such as the "cathartic colon" or enteric nerve damage, is not well established either. Danthron compounds should be avoided because of hepatotoxicity.
泻药是最常用的药物或添加剂之一。大多数泻药在谨慎使用、尽可能间歇性使用且无禁忌证的情况下是相当安全的。容积性泻药和不可吸收的化合物（如乳果糖）可能会导致腹胀，但除了对车前草制剂的过敏反应外，很少有严重的不良反应。含有难以吸收的离子（如镁或磷酸盐）的渗透性泻药可引起代谢紊乱，尤其是在肾功能损害的情况下。然而，如果间歇性服用，在不存在肠梗阻或肠道梗阻等情况时，它们几乎没有不良反应。聚乙二醇溶液正成为治疗慢性便秘的一种有效且安全的方法。在刺激性泻药中，番泻叶化合物和比沙可啶是最常用的。虽然有数据支持这类药物在体外研究中的致癌潜力，但迄今为止人类的流行病学数据尚未证实这些泻药与结肠肿瘤之间存在明确联系。刺激性泻药与结构变化（如“泻药性结肠”或肠神经损伤）之间的联系也尚未明确确立。由于具有肝毒性，应避免使用丹蒽醌化合物。
