The Constipation Conversation Has Been Backed Up for Years.
From fears about laxative dependence to questions about pediatric safety, some laxative myths are still stuck in the system… despite growing evidence to the contrary.
In this episode, Don and Steve tackle some of the most common claims healthcare professionals hear about constipation treatment—and explore what the research really says.
- 💩 Why does docusate remain so popular if the evidence is questionable?
- ⚠️ Should patients worry about becoming dependent on stimulant laxatives?
- 🧩 What’s behind the PEG 3350 autism controversy?
- 🤰 Are magnesium-based laxatives really unsafe during pregnancy?
We’ll leave no stool unturned as we get to the bottom of these claims:
- Oral docusate isn’t an effective laxative.
- Chronic stimulant laxatives damage the gut.
- PEG 3350 causes autism and behavioral changes in kids.
- Magnesium-based laxatives aren’t safe to use in pregnancy.
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TRC Healthcare Editor Hosts:
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD, PMSP
Guest:
- Nina Pascua, MD, PharmD, MSCE, MBA
CE Information:
None of the speakers have anything to disclose.
TRC Healthcare offers CE credit for this podcast for subscribers at our platinum level or higher. Log in to your Pharmacist’s Letter, Pharmacy Technician’s Letter,or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- FAQ: Management of Constipation
- Website: Eating Disorders (National Institutes of Health)
- Toolbox: Resources for Discussing Medication Misinformation
- Chart: GI Med Use in Pregnancy and Lactation
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Transcript:
This transcript is automatically generated.
00:00:05 Narrator
Welcome to Rumor vs Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.
00:00:13 Narrator
Today, we’ll get to the bottom of claims around laxatives.
00:00:20 Steve Small
Well Don, of all the meds we’ve covered on this show, we keep getting questions about laxatives.
00:00:26 Steve Small
They will not stop.
00:00:28 Don Weinberger
It definitely seems this topic is clogging up our inbox.
00:00:33 Steve Small
Well, let’s not sit on it any longer then.
00:00:36 Steve Small
I’m Steve the pharmacist.
00:00:37 Don Weinberger
And I’m Don the pharmacist.
00:00:38 Don Weinberger
And I’m ready to plunge into some myths.
00:00:42 Steve Small
Quite right, Don.
00:00:43 Steve Small
And we’re going to flush out fiction about laxatives one claim at a time.
00:00:47 Don Weinberger
On to your hats, folks, the puns are going to be blowing this episode.
00:00:52 Steve Small
And before we make any big moves, remember that this podcast offers continuing education credit for pharmacists, pharmacy technicians, prescribers, and nurses.
00:01:01 Don Weinberger
Just log into your pharmacist’s letter, pharmacy technician’s letter, or prescriber insights account, and look for the title of this podcast in the list of available CE courses.
00:01:10 Steve Small
And for the purposes of disclosures today, none of the speakers have anything to disclose.
00:01:15 Don Weinberger
So laxatives are, you know, one of the most commonly used medication classes.
00:01:21 Steve Small
You know.
00:01:22 Don Weinberger
If you think about it, does make sense since everybody poops.
00:01:26 Steve Small
Yes, like the classic children’s book taught us.
00:01:29 Don Weinberger
Yeah, but forgot about the sequel, which is not everyone poops easily.
00:01:33 Don Weinberger
Unofficial.
00:01:35 Don Weinberger
If too much water is absorbed from feces, stools get hard and become difficult to pass.
00:01:41 Don Weinberger
That’s pretty much constipation in a nutshell.
00:01:43 Don Weinberger
And laxatives are the fix.
00:01:45 Don Weinberger
They’ll keep water in the stool
00:01:48 Don Weinberger
or help push it through the intestines to get patients back to being regular again.
00:01:53 Steve Small
And some treatments have been around forever, but that doesn’t mean they’ve necessarily had good evidence.
00:02:00 Don Weinberger
And that can lead to plenty of assumptions and hearsay.
00:02:04 Steve Small
Basically, we wanted to make this episode so we can bring evidence to a conversation that’s been backed up for a while.
00:02:11 Don Weinberger
Let’s have our producer put a pun counter up in the corner, maybe, to see where we’re, see if we can do a…
00:02:17 Don Weinberger
a new record.
00:02:18 Don Weinberger
But let’s go ahead and start with our first claim with a drug that somehow achieved legend status without the legend part being earned.
00:02:28 Don Weinberger
And that claim is oral Docusade isn’t an effective laxative.
00:02:33 Steve Small
Yes, the classic stool softener.
00:02:36 Steve Small
I still see it on so many patients’ med lists.
00:02:38 Steve Small
In fact, it’s even on the World Health Organization’s essential medicines list, meaning every health system should carry it.
00:02:44 Don Weinberger
Right.
00:02:45 Don Weinberger
And it’s been around for
00:02:47 Don Weinberger
decades, almost, millennia.
00:02:50 Don Weinberger
If you start, actually started out as a detergent in the 1930s, and it wasn’t used as a laxative until 20 years later.
00:02:58 Don Weinberger
So it’s supposed to act, almost act like a soap before your guts.
00:03:04 Don Weinberger
It lowers water tension so that water can better mix with the stool, leading to softening and making stools easier to pass.
00:03:12 Steve Small
That does sound nice in theory, Don.
00:03:14 Steve Small
Very gentle, very polite, perhaps.
00:03:16 Don Weinberger
And very ineffective.
00:03:18 Don Weinberger
Multiple randomized studies over the years failed to show that Docusate at any dose has meaningful benefit over placebo, or pretty much with no laxative at all.
00:03:30 Don Weinberger
And 1 1998 study showed that psyllium fiber improved stool water content and bowel movement frequency, while Docusate basically didn’t.
00:03:41 Steve Small
So docusate has a nice mechanism story, but the bowel doesn’t seem especially moved by it.
00:03:46 Steve Small
So then why does it keep sticking around?
00:03:51 Don Weinberger
So, you know, some patients and prescribers may think of it being gentle when therefore safer.
00:03:58 Don Weinberger
Gentle is only a virtue if it’s also effective.
00:04:02 Don Weinberger
But we may be delaying care by wasting time with this laxative.
00:04:06 Don Weinberger
We should be turning to more effective options instead.
00:04:09 Don Weinberger
And current guidelines for chronic constipation don’t even mention Docusate as an option anymore.
00:04:15 Don Weinberger
So going back to that claim, which is oral Docusate isn’t an effective laxative, the verdict is true.
00:04:30 Steve Small
Docusate, you had a long run.
00:04:32 Don Weinberger
And a very soft run, you might say.
00:04:36 Don Weinberger
You know, it does talk a smooth game, but the evidence doesn’t really slide in its favor.
00:04:44 Steve Small
But you mentioned more effective options, Don.
00:04:46 Steve Small
I’m sure the audience is wondering what should we turn to instead?
00:04:50 Don Weinberger
[For] patients [who] aren’t taking opioids.
00:04:54 Don Weinberger
We should typically turn to those osmotic laxities first, such as polyethylene glycol or PEG, for short, 3350 and lactulose.
00:05:05 Don Weinberger
What these do is they draw water into the gut to keep stool soft and they have stronger evidence than Docusate.
00:05:12 Steve Small
And if those don’t work.
00:05:13 Don Weinberger
In that case, we have our next best friend, which are stimulant laxatives, such as Senna or Bizocodal.
00:05:21 Don Weinberger
These work by stimulating the gut muscles to push that stool along.
00:05:25 Steve Small
I would say if a patient is taking opioids, that is a case where I would use a stimulant laxative first, since we know opioids inhibit gut muscle movement.
00:05:35 Steve Small
So that could be a case there.
00:05:37 Don Weinberger
Yep, exactly.
00:05:38 Don Weinberger
You can find a review of
00:05:40 Don Weinberger
over-the-counter and prescription laxatives using our management of constipation charts.
00:05:46 Steve Small
It even compares onset of action, warnings, and more.
00:05:49 Steve Small
And speaking of warnings here, I’ve seen this next claim drum up concern in prescribers and patients when folks need long-term constipation relief.
00:05:58 Steve Small
And it’s a claim that chronic stimulant laxatives damage the gut.
00:06:02 Don Weinberger
Well, where you start, damage the guts.
00:06:05 Don Weinberger
Pretty dramatic there.
00:06:07 Don Weinberger
What does damage actually mean?
00:06:09 Steve Small
Yeah, pretty vague, right?
00:06:11 Steve Small
There is a prevailing thought, though, that long-term stimulant laxatives like Senna can physically damage the colon lining and nerves, and that long-term use will lead to dependence, meaning that the patient won’t be able to have a bowel movement without taking a laxative.
00:06:26 Steve Small
I’ve sometimes heard this referred to as cathartic colon or even a lazy colon.
00:06:31 Don Weinberger
Yeah, speaking for the colons, I’m pretty sure they don’t like that low blow.
00:06:37 Steve Small
Right, if they’re listening.
00:06:38 Steve Small
And to see if this isn’t just a lazy rumor, I got in touch with one of our specialty consultants, Dr.
00:06:43 Steve Small
Nina Pasqua.
00:06:44 Steve Small
She’s not only a PharmD, she’s also an MD and gastroenterologist, so a triple threat.
00:06:50 Steve Small
Love it.
00:06:51 Steve Small
And it’s perfect for this claim.
00:06:53 Don Weinberger
I’m on the edge of my seat, Steve.
00:06:55 Don Weinberger
I can’t tell what my gut feeling will be.
00:06:58 Steve Small
Well, we’ll see.
00:06:59 Don Weinberger
Roll that tape.
00:07:03 Steve Small
Thank you for joining us today, Dr. Pasqua.
00:07:05 Steve Small
I’m so glad you can give us your expertise on this.
00:07:07 Steve Small
Before we jump into talking about using stimulant laxatives long-term, what are the risks with having chronic constipation?
00:07:14 Steve Small
Are certain patients perhaps more prone to it?
00:07:16 Nina Pascua
Yeah.
00:07:17 Nina Pascua
Well, first of all, thanks for having me, Steve.
00:07:20 Nina Pascua
And yeah, chronic constipation isn’t, it’s not just something that’s annoying, actually.
00:07:25 Nina Pascua
It’s a real medical issue.
00:07:28 Nina Pascua
And it actually hits women
00:07:30 Nina Pascua
a lot harder than men, twice as hard actually.
00:07:33 Nina Pascua
And there’s, several issues that could be related to that, hormonal, functional, anatomical.
00:07:39 Nina Pascua
So, yes, it does hit, some populations more than others.
00:07:46 Nina Pascua
And, chronic constipation is something that really is important.
00:07:50 Nina Pascua
Like I said, it’s an important condition to get managed.
00:07:53 Nina Pascua
And, you know, the reason for that is because there are, you know, serious complications that can occur.
00:08:00 Nina Pascua
stool impaction, where stool gets stuck in the colon and causes an obstruction, hemorrhoids, which are blood vessels at the lower end of the colon that can engorge and bleed, fissures or tears in the anal lining, and even where part of the rectal muscle actually protrudes out.
00:08:23 Nina Pascua
And so in these cases, you know, worst case scenario, you can get a serious ulceration and inflammation that can perforate the bowels.
00:08:32 Nina Pascua
And that’s a life-threatening condition.
00:08:34 Nina Pascua
So, hopefully for those individuals that are struggling with constipation, this is kind of a wake-up call to seek sort of treatment.
00:08:44 Steve Small
Right. And with those risks in mind, like how safe is it then to use stimulant laxatives in those scenarios chronically?
00:08:51 Steve Small
Do they damage the gut like some people claim?
00:08:54 Nina Pascua
So that’s a, that’s one of the kind of persistent myths in like GI medicine.
00:09:00 Nina Pascua
So I think it’s worth sort of, having this conversation and really sort of debunking that.
00:09:05 Nina Pascua
The short answer is that at the recommended doses, stimulant laxatives do not damage the colon.
00:09:13 Nina Pascua
And actually they’ve done reviews because this has been such a, pervasive sort of myth out there that, doctors, well-trained doctors aren’t even sort of talking about.
00:09:24 Nina Pascua
And so they did a comprehensive sort of study or research that specifically looked to see if these medications, if there’s evidence for harmful damage to the colon and, to the nerves, to the smooth muscle, and they found none.
00:09:42 Nina Pascua
And they also found that there’s really no evidence that they increase, colon cancer risk either.
00:09:49 Nina Pascua
There might be some association with other factors, that people have that increase their, risk for colon cancer.
00:09:57 Nina Pascua
and also, contribute to constipation, but it’s not the constipation that’s contributing to the colon cancer.
00:10:03 Nina Pascua
So that idea of having that what they call cathartic colon or fear that your bowels become dependent on laxatives and stops working, that’s outdated and it’s supported by, you know, modern research.
00:10:17 Nina Pascua
I do think that there’s something worth mentioning, though, because
00:10:21 Nina Pascua
you might hear about this or see this, is that when you do take some stimulant laxatives, you can get a pigmentation of the lining called melanosis coli that’s associated with these certain types of laxatives, one of which is called senna.
00:10:36 Nina Pascua
It’s completely benign, doesn’t cause cancer, and it actually resolves once you stop the medication.
00:10:42 Nina Pascua
It may look concerning if you see pictures of your colon, but actually it’s just a cosmetic sort of, it’s a cosmetic issue.
00:10:51 Nina Pascua
I think the bigger picture here is, that people really should walk away with is that treating constipation is much safer than leaving it left untreated, because of those complications that I mentioned sort of previously.
00:11:05 Steve Small
Yeah, I’d like that you point out those benefits there.
00:11:08 Steve Small
So we know that recommended doses are safe long-term, but what about those rare cases of patients are misusing these laxatives?
00:11:15 Steve Small
Let’s say they’re using them too frequently or maybe at really high doses.
00:11:19 Steve Small
Is that a concern?
00:11:21 Nina Pascua
So, and I’m glad you made that distinction.
00:11:24 Nina Pascua
misuse is an entirely different conversation.
00:11:27 Nina Pascua
And it is also worth taking, seriously.
00:11:31 Nina Pascua
So, historically, this came up with individuals that wanted to lose weight.
00:11:37 Nina Pascua
And they were taking far more than the recommended dosage in order to get all of that sort of food and stool out of their system.
00:11:49 Nina Pascua
And so the first major risk with taking too much is dehydration and nutrient and mineral imbalances.
00:11:56 Nina Pascua
So taking too much can cause excessive diarrhea.
00:11:59 Nina Pascua
And that means that your body isn’t just losing water, but it’s also losing important nutrients and minerals like, you know, potassium, sodium.
00:12:08 Nina Pascua
And this can lead to muscle weakness.
00:12:10 Nina Pascua
And in drastic cases, it can lead to heart rhythm problems and a bunch of other sort of metabolic issues.
00:12:21 Nina Pascua
And so that’s probably one of the more dangerous consequences of laxative use.
00:12:25 Nina Pascua
And then, you know, there’s also the toll it takes, the direct toll it takes on your GI system.
00:12:30 Nina Pascua
Overuse can cause painful cramping, nausea, diarrhea, and actually can reduce blood flow to the colon because of sort of the volume loss.
00:12:41 Nina Pascua
And that sometimes can lead to a medical emergency.
00:12:44 Nina Pascua
And then finally, sort of the third piece is just the cycle itself.
00:12:49 Nina Pascua
So
00:12:50 Nina Pascua
When someone stops taking a large amount of laxatives, the body often will temporarily hold on to water because again, they’re so used to removing, to getting dehydrated and removing all that water through all these laxatives that then when they’re holding on to excess water, they get really bloated and swollen.
00:13:10 Nina Pascua
And that can make people feel like, oh, I need to take more laxatives because I’m bloated and swollen.
00:13:16 Nina Pascua
But that’s not
00:13:17 Nina Pascua
swollen because there’s too much stool in your colon.
00:13:20 Nina Pascua
So that becomes a difficult cycle to break.
00:13:24 Steve Small
Yeah, vicious cycling deep.
00:13:25 Steve Small
But this has been incredibly interesting.
00:13:27 Steve Small
And thank you so much for explaining this gastroenterology topic for us.
00:13:30 Steve Small
I’ll bring it back to Don and see what he says.
00:13:32 Steve Small
But thank you so much for joining us today.
00:13:33 Steve Small
We really appreciate it.
00:13:35 Nina Pascua
Great. Appreciate the time.
00:13:40 Don Weinberger
So it seems we are generally okay to poo-poo this claim.
00:13:44 Don Weinberger
Long-term stimulant laxatives at usual doses shouldn’t be a problem.
00:13:48 Don Weinberger
It could be an effective option for patients with longstanding constipation due to chronic conditions such as spinal cord injuries or diabetes.
00:13:57 Steve Small
Yeah, and chronic constipation guidelines, the American Gastroenterological Association back in February 2026 even stated that concerns about chronic use of stimulant laxatives and managing refractory adult constipation are unfounded, end quote.
00:14:13 Steve Small
So when it comes to this claim that chronic stimulant laxatives damage the gut, the verdict is rumor with conditions.
00:14:25 Don Weinberger
And the condition here being that these laxatives are safe at recommended doses, Dr.
00:14:30 Don Weinberger
Pasqua said.
00:14:32 Steve Small
Very key point there.
00:14:34 Steve Small
Although there isn’t much published data,
00:14:36 Steve Small
Gut damage may be seen with laxative misuse, where patients inappropriately use high and frequent doses in situations like eating disorders, like we talked about.
00:14:46 Don Weinberger
So stay alert for patients frequently buying large amounts of laxatives.
00:14:51 Don Weinberger
It could be a sign of deeper medical problem.
00:14:55 Don Weinberger
You might be able to refer that patient to help.
00:14:59 Steve Small
And for more info, the National Institute of Mental Health has an eating disorders website with health facts, statistics, and support resources for patients.
00:15:07 Don Weinberger
So take a look at our show notes or description.
00:15:09 Don Weinberger
You’ll link directly that resource in pharmacist’s letter, pharmacy technician’s letter, and prescriber insights, as well as our management of constipation charts.
00:15:19 Steve Small
And if you aren’t already a subscriber, don’t miss out on these resources.
00:15:23 Steve Small
Sign up today to stay ahead with trusted insights and tools.
00:15:27 Don Weinberger
And while we’re talking about mental health, we’ve been hearing more internet chatter about this next claim regarding kids, constipation in psychiatry.
00:15:37 Don Weinberger
The claim is that polyethylene glycol or PEG-3350 causes autism and behavioral changes in kids.
00:15:46 Steve Small
Yes, as a pediatric pharmacist, this one has gotten a lot of attention and I have heard about him.
00:15:51 Steve Small
Understandably, it worries patients.
00:15:54 Steve Small
But where does this come from is the big question.
00:15:57 Don Weinberger
So that claim is based on the idea that PEG, which is polyethylene glycol, active ingredient in products, you know, you’ve seen labels like for MiraLax and Glycolax and others, could be absorbed and cause neuropsychiatric events from anxiety and mood swings to even autism.
00:16:16 Don Weinberger
Some parents have reported psychiatric changes in their kids after taking PEG.
00:16:21 Don Weinberger
In fact, FDA’s Adverse Event Reporting System, also called FERS,
00:16:26 Don Weinberger
or FAERS, had received reports of this in about 600 kids between 2007 and 2017.
00:16:34 Steve Small
And that does sound like a lot, but I think it’s important to note here that these reports can’t prove cause and effect and sometimes not even a correlation.
00:16:42 Steve Small
So keep that in mind.
00:16:43 Don Weinberger
Right.
00:16:44 Don Weinberger
And evidence we have shows that PEG 3350 essentially isn’t absorb into the blood.
00:16:50 Don Weinberger
You know, we’re talking less than 0.5%.
00:16:55 Don Weinberger
So systemic effects are unlikely.
00:16:57 Don Weinberger
Plus, there’s an assumption out there that PEG is the same as ethylene glycol, but it is not.
00:17:04 Steve Small
Ethylene glycol, as in automotive antifreeze, which we know is very toxic.
00:17:08 Don Weinberger
Very, yeah.
00:17:10 Don Weinberger
Yes, in 2008, FDA report did find trace amounts of ethylene glycol in several lots of PEG 3350, but this was likely as a byproduct from the manufacturing process.
00:17:23 Don Weinberger
PEG does not
00:17:25 Don Weinberger
spontaneously degrade into ethylene glycol under normal physiological or storage conditions.
00:17:31 Steve Small
So good that it doesn’t degrade, but this trace amount, I’m sure, could concern some folks.
00:17:36 Steve Small
That doesn’t sound good as a contaminant.
00:17:39 Don Weinberger
Don’t worry, Steve.
00:17:41 Don Weinberger
The FDA still considered those trace amounts to be safe.
00:17:45 Don Weinberger
And data after that report show that increases in blood ethylene glycol levels after taking PEG are very, very small.
00:17:51 Don Weinberger
Not enough to cause toxic effects.
00:17:55 Steve Small
Thank goodness.
00:17:56 Steve Small
But do we have clinical evidence that PEG does or doesn’t cause psychiatric changes in humans?
00:18:02 Don Weinberger
Yep, that is the question.
00:18:03 Don Weinberger
And the answer is no.
00:18:05 Don Weinberger
It’s human trials weren’t designed to detect if any, if it caused psychiatric or neurological issues.
00:18:12 Don Weinberger
But we do have that 2021 study in mice that showed PEG changed stool consistency but didn’t alter
00:18:19 Don Weinberger
anxiety-like behaviors and may lead to a future human trial to look more at this.
00:18:26 Steve Small
Right. It’s hard here to extrapolate mice to kids, but you got to start somewhere, right?
00:18:31 Steve Small
And I also wonder if timing might have an impact here now that I think about it.
00:18:36 Don Weinberger
How so with timing?
00:18:38 Steve Small
Well, constipation is pretty uncomfortable, as many of us know, and I’d argue even adults have personality changes and get irritable with it.
00:18:46 Steve Small
And could constipation itself, or maybe even the gas and bloating from PEG when you take it, could that be indirectly causing the behavioral changes that parents are seeing here?
00:18:56 Steve Small
Plus, you know, evidence shows that children with autism are more likely to have GI issues and take more laxatives.
00:19:04 Steve Small
So maybe these factors are lining up, but don’t actually connect and could be sort of a chicken versus egg scenario.
00:19:11 Don Weinberger
Yep, that’s all true points that could be.
00:19:15 Don Weinberger
will be the case here.
00:19:16 Don Weinberger
So let’s go ahead and circle back up to that claim, which is PEG 3350 causes autism and behavioral changes in kids.
00:19:25 Don Weinberger
And the verdict is, rumor.
00:19:33 Don Weinberger
We don’t have reliable evidence to say that PEG causes behavioral changes in kids.
00:19:38 Don Weinberger
And current animal evidence so far supports that there isn’t a connection.
00:19:43 Steve Small
And PEG 3350 is still recommended as a first-line laxative for kids due to its long safety record and ease of use for parents and kids.
00:19:52 Don Weinberger
So parents will ask, what about an alternative?
00:19:54 Don Weinberger
So if they want to try it, watch for age restrictions on products, and some may not be appropriate for younger patients.
00:20:01 Don Weinberger
You know, for example, avoid oral bisocodal for kids under 6 years old.
00:20:08 Steve Small
And check out our chart, resources for discussing medical misinformation.
00:20:13 Steve Small
to help parents navigate peg claims that they may be hearing from social media or family and friends.
00:20:19 Don Weinberger
And now everyone’s favorite segments, objectively, right?
00:20:24 Don Weinberger
Fast facts.
00:20:31 Steve Small
This is where we jump into some nugget-sized claims about laxatives to decide which ones get the stamp of approval and which ones need to be wiped from the record quickly.
00:20:42 Don Weinberger
All right, so the first claim is nicotine is safe and effective for constipation.
00:20:47 Don Weinberger
The verdict is rumor.
00:20:49 Don Weinberger
We found forum discussions online talking about using diarrhea side effects from nicotine gum and pouches to help with constipation.
00:20:59 Steve Small
Creative idea, but nicotine is addictive and can cause toxicity in high doses.
00:21:04 Steve Small
So avoid it for constipation, please, and stick to laxatives with evidence.
00:21:09 Steve Small
Now our next claim is linaclotide and plecanatide can cause fatal diarrhea, and the verdict here is true with conditions.
00:21:17 Don Weinberger
So these prescription one-light cyclase C agonists, say that three times fast, draw fluids into the gut to help patients with irritable bowel syndrome with constipation or, as we know, IBS-C.
00:21:28 Steve Small
Right, but both meds have boxed warnings.
00:21:31 Steve Small
Linaclutide is contraindicated in kids under two years old and under six years old for pecanotide due to severe diarrhea and dehydration.
00:21:40 Steve Small
Although no human deaths have been reported, juvenile mice died from dehydration in studies
00:21:46 Steve Small
for both NEDs.
00:21:47 Steve Small
And we know severe dehydration can be deadly in kids, hence the true with conditions.
00:21:54 Don Weinberger
Next one is claim laxative doses should be titrated to one stool per day.
00:22:00 Don Weinberger
The verdict is true with conditions.
00:22:03 Steve Small
Yeah, one time per day has always felt like a gold standard when it comes to laxatives.
00:22:08 Don Weinberger
Or more like the Brown standard.
00:22:10 Don Weinberger
Stats show that 95% of US adults normally have between 3 bowel movements per day and three per week.
00:22:22 Don Weinberger
Adjust regimens to keep patients comfortable rather than targeting an arbitrary number.
00:22:32 Steve Small
Well, that was indeed fast on.
00:22:35 Don Weinberger
Just like many folks expect out of their laxatives, Steve.
00:22:38 Steve Small
Indeed.
00:22:39 Steve Small
But we also need to think about safety when it comes to meds, including in pregnant patients.
00:22:44 Steve Small
So our next claim is that magnesium-based laxatives aren’t safe to use in pregnancy.
00:22:49 Don Weinberger
You know, when I saw this claim, I did look at magnesium citrates and magnesium hydroxide in the Briggs drugs in pregnancy and lactation reference, and I didn’t even find an entry for them.
00:23:01 Don Weinberger
It was just magnesium sulfate.
00:23:04 Steve Small
Right.
00:23:05 Steve Small
And we commonly use injectable magnesium sulfate in pregnancy to treat complications such as preeclampsia in the hospital.
00:23:12 Steve Small
It can also slow down uterine contractions during labor, which may make some prescribers and patients wary of using any magnesium products during pregnancy.
00:23:22 Don Weinberger
Okay, so interesting.
00:23:24 Don Weinberger
Where does, you know, oral magnesium fit, even if it fits at all, when treating pregnant patients with constipation?
00:23:32 Steve Small
Yeah, good point.
00:23:33 Steve Small
the 2024 American Gastroenterological Association guidelines on GI disorders in pregnancy say that dietary fiber, lactulose, and PEG should be used first line based on their safety evidence.
00:23:47 Steve Small
But if you look at mother to baby, another trusted medication safety reference, it notes that magnesium-based laxatives have low absorption and are unlikely to cause fetal issues in normal doses.
00:24:00 Don Weinberger
Based on that, makes that claim, which is magnesium isn’t safe, it’s just too absolute.
00:24:05 Don Weinberger
So let’s not throw the bowel regimen out with the bathwater.
00:24:09 Steve Small
Exactly.
00:24:10 Steve Small
It’s more nuanced.
00:24:11 Steve Small
And magnesium-based products are not flatly forbidden, but they also aren’t the main option that guidelines highlight first.
00:24:18 Don Weinberger
And as with any med, I would recommend that they be used at the lowest dose,
00:24:24 Don Weinberger
shortest duration needed for the optimal effects.
00:24:26 Don Weinberger
And the patient should ideally check with their obstetrician first.
00:24:30 Steve Small
Absolutely agree.
00:24:31 Steve Small
So when it comes to this claim that magnesium-based laxatives aren’t safe to use in pregnancy, the verdict is rumor with conditions.
00:24:43 Steve Small
So as long as we’re talking about recommended doses at limited durations, like you said, Don, with adequate supervision,
00:24:49 Steve Small
Magnesium-based laxatives may be a safe option if first-line ones like PEG have failed.
00:24:54 Don Weinberger
Yeah, and any laxative, I would want to watch for excessive diarrhea and dehydration.
00:25:00 Don Weinberger
Those could be dangerous for mom and fetus in this case.
00:25:04 Steve Small
And to find out more, use our GI med use in pregnancy and lactation chart for details and med options for various issues, including constipation.
00:25:13 Steve Small
And for our bottom line truth today, don’t default to tradition and assumptions.
00:25:18 Steve Small
Follow the evidence for constipation care when it comes to laxatives.
00:25:21 Don Weinberger
And when you lift the lid on some claims, you might be surprised at what you find.
00:25:28 Steve Small
Yeah, the data might just stink.
00:25:31 Don Weinberger
So steer patients to effective evidence-based options and put side effect claims in perspective.
00:25:37 Don Weinberger
Now, if this episode has given you a dose of a relief around laxatives, claim received credit and access evidence-based resources from pharmacist’s letter, pharmacy technician’s letter, and prescriber insights.
00:25:48 Steve Small
And if you’re not yet a subscriber or you just want to upgrade, you can save 10% with our exclusive listener code, RVT1026 at checkout.
00:25:57 Steve Small
And there’s an easy link in the show notes.
00:25:58 Don Weinberger
If you’re already a subscriber, tap the claim credit link in the show notes or search or see your organizer for this episode.
00:26:06 Don Weinberger
And now, mailbag time.
00:26:08 Don Weinberger
We’ve got an audience question from last episode about ivermectin that came in through our Send Us Fan Mail link in the podcast show notes.
00:26:16 Don Weinberger
They wrote,
00:26:17 Don Weinberger
I saw the kids list was updated.
00:26:20 Don Weinberger
So can ivermectin be used in all kids?
00:26:24 Steve Small
Good question about the key potentially inappropriate drugs in pediatrics list or kids list.
00:26:29 Steve Small
And we’ll try not to kid around too much in our answer.
00:26:32 Steve Small
It does deserve the grown-up treatment.
00:26:34 Don Weinberger
If you’re curious, just scroll your feed for the bonus mailbag and you’ll find our full answer there.
00:26:40 Steve Small
And if you’re straining to have your laxative questions about this episode answered for our next bonus mailbag, let them loose by sending us a message.
00:26:49 Don Weinberger
E-mail us at reversus truth at TRC healthcare.com or send us fan mail right from the podcast show notes.
00:26:56 Don Weinberger
We also use our suggestions and feedback to plan our episodes.
00:27:00 Steve Small
And join us next time where we’ll take the pain out of claims around opioids.
00:27:03 Don Weinberger
Yeah, that’ll be a good one.
00:27:05 Don Weinberger
Although all of them are good, right?
00:27:07 Don Weinberger
I promise not to overprescribe the punchlines.
00:27:10 Don Weinberger
Thank you for joining us on Rum Versus Truth, your trusted source for facts where we dissect the evidence behind risky rumors and reveal clinical truths.
00:27:18 Steve Small
We’ll see you next time.
Rumor vs Truth
