Table 4, Laxatives: recommended doses - Constipation in children and young people: diagnosis and management

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Table 4Laxatives: recommended doses

Laxatives	Recommended doses
Macrogols
Polyethylene glycol 3350 + electrolytes	Paediatric formula: Oral powder: macrogol 3350 (polyethylene glycol 3350)^a 6.563 g; sodium bicarbonate 89.3 mg; sodium chloride 175.4 mg; potassium chloride 25.1 mg/sachet (unflavoured) Disimpaction Child under 1 year: ½-1 sachet daily (non-BNFC recommended dose) Child 1-5 years: 2 sachets on 1st day, then 4 sachets daily for 2 days, then 6 sachets daily for 2 days, then 8 sachets daily (non-BNFC recommended dose) Child 5-12 years: 4 sachets on 1st day, then increased in steps of 2 sachets daily to maximum of 12 sachets daily (non-BNFC recommended dose) Ongoing maintenance (chronic constipation, prevention of faecal impaction) Child under 1 year: ½-1 sachet daily (non-BNFC recommended dose) Child 1-6 years: 1 sachet daily; adjust dose to produce regular soft stools (maximum 4 sachets daily) (for children under 2, non-BNFC recommended dose) Child 6-12 years: 2 sachets daily; adjust dose to produce regular soft stools (maximum 4 sachets daily) Adult formula: Oral powder: macrogol 3350 (polyethylene glycol 3350) 13.125 g; sodium bicarbonate 178.5 mg; sodium chloride 350.7 mg; potassium chloride 46.6mg/sachet (unflavoured) Disimpaction Child/young person 12-18 years: 4 sachets on 1st day, then increased in steps of 2 sachets daily to maximum of 8 sachets daily (non-BNFC recommended dose) Ongoing maintenance (chronic constipation, prevention of faecal impaction) Child/young person 12-18 years: 1-3 sachets daily in divided doses adjusted according to response; maintenance, 1-2 sachets daily
Osmotic laxatives
Lactulose	Child 1 month to 1 year: 2.5 ml twice daily, adjusted according to response Child 1-5 years: 2.5-10 ml twice daily, adjusted according to response (non-BNFC recommended dose) Child/young person 5-18 years: 5-20 ml twice daily, adjusted according to response (non-BNFC recommended dose)
Stimulant laxatives
Sodium picosulfate^b	Non-BNFC recommended doses Elixir (5 mg/5 ml) Child 1 month to 4 years: 2.5-10 mg once a day Child/young person 4-18 years: 2.5-20 mg once a day
Sodium picosulfate^b	Non-BNFC recommended dose Perles^c (1 tablet = 2.5mg) Child/young person 4-18 years: 2.5-20mg once a day
Bisacodyl	Non-BNFC recommended doses By mouth Child/young person 4-18 years: 5-20 mg once daily By rectum (suppository) Child/young person 2-18 years: 5-10 mg once daily
Senna^d	Senna syrup (7.5 mg/5 ml) Child 1 month to 4 years: 2.5-10 ml once daily Child/young person 4-18 years: 2.5-20 ml once daily Senna (non-proprietary) (1 tablet = 7.5 mg) Child 2-4 years: ½-2 tablets once daily Child 4-6 years: ½-4 tablets once daily Child/young person 6-18 years: 1-4 tablets once daily
Docusate sodium^e	Child 6 months-2 years: 12.5 mg three times daily (use paediatric oral solution) Child 2-12 years: 12.5-25 mg three times daily (use paediatric oral solution) Child/young person 12-18 years: up to 500 mg daily in divided doses

: All drugs listed above are given by mouth unless stated otherwise.
: Unless stated otherwise, doses are those recommended by the British National Formulary for Children (BNFC) 2009. Informed consent should be obtained and documented whenever medications/doses are prescribed that are different from those recommended by the BNFC.
a: A range of paediatric plains are available, but not all are licensed for childen under 12.
b: Elixir, licensed for use in children (age range not specified by manufacturer). Perles not licensed for use in children under 4 years. Informed consent should be obtained and documented.
c: Perles produced by Sanofi should not be confused with Dulcolax tablets which contain bisacodyl as the active ingredient
d: Syrup not licensed for use in children under 2 years. Informed consent should be obtained and documented.
e: Adult oral solution and capsules not licensed for use in children under 12 years. Informed consent should be obtained and documented.

From: Constipation in children and young people: diagnosis and management

Constipation in children and young people: diagnosis and management.

NICE Clinical Guidelines, No. 99.

London: National Institute for Health and Care Excellence (NICE); 2017 Jul.

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