CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Palliative cancer care - constipation - Evidence
Evidence on laxatives for constipation in palliative care
The evidence for the efficacy and safety of all laxatives is limited. However, there is good consensus between experts that the combination of a stimulant with a softening laxative is effective for treating constipation in palliative care.
- A Cochrane systematic review that addressed the use of laxatives for the management of constipation in palliative care found only four small trials (n = 280 in total) suitable for inclusion [Miles et al, 2006]:
- One study of 75 people in palliative care found no difference between lactulose and senna in terms of the mean number of defecation days, or the number of defecation-free 72-hour periods.
- A study of 36 people in a hospice setting found no significant difference between self-reported 'satisfactory' bowel movements with misrakasneham (an Indian herbal remedy) compared with senna.
- A crossover study of 51 people with cancer compared dantron plus poloxamer (co-danthramer) with lactulose plus senna. A significantly higher stool frequency was reported with lactulose plus senna compared with co-danthramer, regardless of the order the drugs were given in the crossover.
- An unpublished crossover study of 118 people in a hospice setting compared magnesium hydroxide plus liquid paraffin (Milipar®) with lactulose plus senna. There was no difference in stool frequency between treatments, regardless of the order the drugs were given in the crossover.
- There is good consensus between experts that the combination of a stimulant with a softening laxative is effective for treating constipation in palliative care [Regnard et al, 2004; Sykes, 2004; Pan-Glasgow Palliative Care Algorithm Group, 2005; Arthur Rank House, 2006; West Lancs Southport & Formby Specialist Palliative Care Services, 2006].
- Macrogols are used by some centres as the softening laxative [Wirz and Klaschik, 2005].
© NHS Institute for Innovation and Improvement