Gattuso J M, Kamm M A
Sir Alan Parks Physiology Unit, St Mark's Hospital, London, England.
Drug Saf. 1994 Jan;10(1):47-65. doi: 10.2165/00002018-199410010-00004.
Most laxatives, if used intermittently in the absence of contraindications, are relatively safe. Bulking agents may diminish absorption of some minerals and drugs, but this is not usually clinically significant. Ispaghula can cause serious allergic reactions. The chronic ingestion of stimulant laxatives has been blamed for the development of the 'cathartic colon', but there are no definitive studies which have demonstrated this. Dantron (danthron) preparations should only be used in older patients and the terminally ill because of the risk of hepatotoxicity with this drug. Oral oxyphenisatine should no longer be used. Senna would appear to be the stimulant laxative of choice during pregnancy and lactation. Bisacodyl is the polyphenolic derivative of choice. Lactulose, sorbitol and lactilol rarely cause significant adverse effects. Magnesium salt laxatives and phosphate enemas can cause serious metabolic disturbances in babies and young children. Liquid paraffin is contraindicated if there is any risk of aspiration. Interference with the absorption of fat soluble vitamins would not appear to be clinically significant. Docusate sodium may potentiate the hepatotoxicity of other drugs, but reports of this are rare. The role of cisapride in constipation has not been established. Antidiarrhoeal drugs are second line drugs whose use is aimed at minimising inconvenience and discomfort. No antidiarrhoeals can be recommended for children under 4 years of age. Loperamide is the drug of choice in older children and adults. The atropine component of diphenoxylate/atropine combinations can cause significant adverse effects. Bismuth salicylate is an inconvenient treatment for travellers' diarrhoea as large frequent doses of the liquid formulation are needed. Some bismuth can be absorbed and there is the potential to cause encephalopathy. Octreotide, methysergide and cholestyramine have a role for specific causes of diarrhoea only. Octreotide is effective in high output states from the small or large bowel, with few adverse effects. Clonidine and lidamidine may have a role in the treatment of chronic diabetic diarrhoea. The role of lidamidine in nondiabetic chronic diarrhoea has not been established.
大多数泻药在无禁忌证的情况下间断使用相对安全。容积性泻药可能会减少某些矿物质和药物的吸收，但这在临床上通常不具有显著意义。卵叶车前可能会引起严重的过敏反应。长期服用刺激性泻药被认为是“泻剂性结肠”形成的原因，但尚无确凿研究证实这一点。由于丹蒽醌（蒽醌）制剂存在肝毒性风险，仅应用于老年患者和晚期患者。口服奥昔芬净不应再使用。番泻叶似乎是孕期和哺乳期刺激性泻药的首选。比沙可啶是首选的多酚衍生物。乳果糖、山梨醇和拉克替醇很少引起显著不良反应。镁盐泻药和磷酸盐灌肠剂可在婴幼儿中引起严重的代谢紊乱。如有误吸风险，则禁用液状石蜡。对脂溶性维生素吸收的干扰在临床上似乎不具有显著意义。多库酯钠可能会增强其他药物的肝毒性，但此类报道很少。西沙必利在便秘治疗中的作用尚未确定。止泻药是二线药物，其使用目的是尽量减少不便和不适。4岁以下儿童不推荐使用任何止泻药。洛哌丁胺是大龄儿童和成人的首选药物。地芬诺酯/阿托品组合中的阿托品成分可引起显著不良反应。水杨酸铋用于治疗旅行者腹泻不太方便，因为需要频繁大剂量服用液体制剂。部分铋可被吸收，有可能导致脑病。奥曲肽、麦角新碱和考来烯胺仅在特定腹泻病因中有作用。奥曲肽对小肠或大肠高流量状态有效，且不良反应较少。可乐定和利达脒可能在慢性糖尿病性腹泻的治疗中有作用。利达脒在非糖尿病性慢性腹泻中的作用尚未确定。
