Liquid Paraffin + Milk of Magnesia

Usage

• This combination medication is primarily prescribed for the relief of occasional constipation. Constipation is characterized by infrequent bowel movements, often with dry, hard, and difficult-to-pass stools. It can also provide relief from heartburn, upset stomach, and acid indigestion.
• Pharmacological classification: Laxative (combination of a lubricant laxative and an osmotic laxative). It also has antacid properties.
• Mechanism of Action: Liquid paraffin lubricates the intestinal walls and softens the stool, while milk of magnesia (magnesium hydroxide) draws water into the intestine, increasing stool volume and making it easier to pass. The combination facilitates smoother bowel movements.

Alternate Names

• Liquid Paraffin/Milk of Magnesia/Sodium Picosulfate Suspension.
• Various brand names exist depending on the manufacturer (e.g., Bioffin, Cremadex, PODEASY, Mil-Par, EzyGo).

How It Works

• Pharmacodynamics: Liquid paraffin coats the stool and intestinal lining, creating a slippery surface that reduces friction during bowel movements. Milk of magnesia increases the osmotic pressure within the intestinal lumen, drawing water into the bowel and increasing stool bulk. This softens the stool and stimulates peristalsis. As an antacid, magnesium hydroxide neutralizes stomach acid providing relief from heartburn and indigestion.

• Pharmacokinetics: Liquid paraffin is not absorbed from the gastrointestinal tract and is eliminated unchanged in the feces. Milk of magnesia is poorly absorbed, with the unabsorbed portion exerting its laxative effect in the colon. A small amount of magnesium may be absorbed, which is then primarily excreted by the kidneys.

• Mode of Action: No receptor binding, enzyme inhibition, or neurotransmitter modulation is involved.

• Elimination Pathways: Liquid paraffin is eliminated unchanged in the feces. Absorbed magnesium is excreted renally.

Dosage

Standard Dosage

Adults:

• 15-30 ml of suspension or 7.5ml - 15ml orally, usually once daily at bedtime, or as directed by a physician.
• For concentrated milk of magnesia preparations, the dosage is lower.
• Do not exceed 60ml within a 24-hour period.

Children:

• 2-6 years: 5-15 ml of regular strength liquid orally, at bedtime or in divided doses.
• 6-11 years: 15-30 ml of regular strength liquid or 7.5-15 ml of concentrated liquid orally, at bedtime or in divided doses.
• 12 years and older: Same as adult dose.
• Not recommended for children under 2 years of age (unless specifically directed by a physician).

Special Cases:

• Elderly Patients: Start with the lower end of the adult dose range and adjust as needed based on response and tolerance. Monitor for dehydration.
• Patients with Renal Impairment: Use with caution due to the potential for magnesium accumulation. Monitor serum magnesium levels.
• Patients with Hepatic Dysfunction: No specific dose adjustments are typically required, but monitor closely.
• Patients with Comorbid Conditions: Consult a healthcare professional for individual dose recommendations based on specific circumstances.

Clinical Use Cases

• Use before diagnostic or surgical procedures to evacuate bowels is at the discretion of the physician.
• Not generally indicated for other specific clinical cases outlined in the prompt, such as those requiring intensive care. It is primarily for short-term relief of occasional constipation.

Dosage Adjustments

• Adjust dose based on patient response and tolerance.
• Reduce dose in patients with renal impairment.

Side Effects

Common Side Effects

• Diarrhea
• Abdominal discomfort, cramps, or pain
• Nausea
• Vomiting
• Dehydration

Rare but Serious Side Effects

• Rectal bleeding
• Severe abdominal pain
• Allergic reactions
• Electrolyte imbalance (especially in patients with renal impairment)

Long-Term Effects

• Long-term use can lead to laxative dependence (where bowels won’t move without taking the medication) and electrolyte imbalances.

Adverse Drug Reactions (ADR)

• Magnesium toxicity (muscle weakness, slow/irregular heartbeat, slow/shallow breathing, mental confusion) can occur in individuals with kidney disease.
• Severe dehydration (decreased urination, dizziness, extreme thirst, very dry mouth).

Contraindications

• Hypersensitivity to any of the components.
• Appendicitis (or symptoms suggestive of it).
• Bowel obstruction or fecal impaction.
• Undiagnosed abdominal pain.
• Kidney disease (especially severe).
• Magnesium-restricted diet.
• Acute abdominal conditions.

Drug Interactions

• May interfere with the absorption of certain medications (e.g., tetracycline antibiotics, some antifungals, digoxin, quinolone antibiotics). Separate administration times.
• May interact with other medications that affect magnesium levels (e.g., raltegravir, sodium polystyrene sulfonate).
• Consult drug interaction resources for detailed information.

Pregnancy and Breastfeeding

• Consult a physician before use during pregnancy or breastfeeding.
• Safety has not been established.

Drug Profile Summary

• Mechanism of Action: Lubricant and osmotic laxative, antacid.
• Side Effects: Diarrhea, abdominal discomfort, nausea, vomiting, dehydration.
• Contraindications: Hypersensitivity, appendicitis, bowel obstruction, kidney disease.
• Drug Interactions: Tetracyclines, antifungals, digoxin, quinolones.
• Pregnancy & Breastfeeding: Consult a physician.
• Dosage: Adults: 15-30ml, children: consult physician based on age. Adjust for renal impairment.
• Monitoring Parameters: Bowel movements, electrolyte levels, hydration status.

Popular Combinations

• Sodium picosulfate is sometimes added for its stimulant laxative effect.

Precautions

• Do not use for longer than one week unless under the supervision of a healthcare professional.
• Drink plenty of fluids to avoid dehydration.
• Use with caution in elderly patients and those with renal impairment.
• Monitor electrolytes with long-term use.
• Avoid in children under 2 (or as advised by a doctor).
• Driving is not likely affected.
• Effects on liver and heart are unknown.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Liquid Paraffin + Milk of Magnesia?

A: Adults: Typically 15-30 ml once daily at bedtime. Children: Consult a physician for age-appropriate dosing.

Q2: How long does it take for this medication to work?

A: Usually within 6-8 hours.

Q3: Can I take this medication daily?

A: No, it is intended for short-term use. Long-term daily use can lead to dependence.

Q4: Is it safe for pregnant or breastfeeding women?

A: Consult a physician before use during pregnancy or breastfeeding.

Q5: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember, unless it’s close to the time for the next dose. Do not double the dose.

Q6: Can I mix this medication with other medications or drinks?

A: It’s best taken with water. Consult your doctor about mixing it with other medications or drinks as interactions may occur.

Q7: Does it cause dehydration?

A: It can contribute to dehydration. Drink plenty of water while using it.

Q8: Can I use this if I have kidney disease?

A: It’s generally contraindicated in moderate to severe kidney disease due to potential magnesium build-up. Consult with a nephrologist.

Q9: What are the signs of an allergic reaction to this medication?

A: Skin rash, itching, hives, difficulty breathing, swelling of the face, lips, tongue, or throat. Seek immediate medical attention if any of these occur.