Usage
Sorbitol is primarily indicated for the treatment of occasional constipation. It acts as an osmotic laxative. It can also be used as a urologic irrigant during transurethral surgical procedures like prostatic resection. Sorbitol is classified as an osmotic laxative, and is also used as a humectant, sweetening agent, and diuretic.
Alternate Names
How It Works
Pharmacodynamics: Sorbitol exerts its laxative effect by increasing osmotic pressure within the intestinal lumen. This draws water into the bowel, softening the stool and promoting peristalsis. When used as an irrigant, it maintains a clear surgical field due to its non-electrolytic and hypotonic properties.
Pharmacokinetics:
- Absorption: Minimally absorbed after oral or rectal administration.
- Metabolism: Primarily metabolized in the liver to fructose. Patients with fructose intolerance should use sorbitol cautiously.
- Elimination: Unabsorbed sorbitol is excreted in feces. Metabolized sorbitol is eliminated via the kidneys.
Dosage
Standard Dosage
Adults:
- Constipation (Oral): 30-150 mL of a 70% solution once.
- Constipation (Rectal): 120 mL of a 25-30% solution as an enema once.
Children:
- Constipation (2-11 years, Oral): 2 mL/kg of a 70% solution once.
- Constipation (2-11 years, Rectal): 30-60 mL of a 25-30% solution as an enema.
- Constipation (12 years and older): Same as adult dose.
Special Cases:
- Elderly Patients: Use with caution; adequate hydration is essential.
- Patients with Renal Impairment: Use with caution.
- Patients with Hepatic Dysfunction: Use with caution.
- Patients with Comorbid Conditions (Diabetes): May cause hyperglycemia. Monitor blood glucose.
Clinical Use Cases
- Intubation: Not applicable for routine intubation.
- Surgical Procedures (Transurethral): 3-3.3% solution as an irrigant.
- Mechanical Ventilation: Not typically indicated.
- Intensive Care Unit (ICU) Use: Consider potential for fluid and electrolyte imbalances with larger volumes.
- Emergency Situations: Not indicated.
Dosage Adjustments
Dose adjustments may be needed based on patient response and tolerance. No specific renal or hepatic dose adjustments are provided.
Side Effects
Common Side Effects
- Abdominal discomfort (cramping, bloating, distension)
- Diarrhea
- Nausea
- Flatulence
Rare but Serious Side Effects
- Dehydration and electrolyte imbalance (especially with higher doses or prolonged use)
- Hyperglycemia (in patients with diabetes)
Long-Term Effects
Chronic use can lead to dependence.
Adverse Drug Reactions (ADR)
- Severe dehydration and electrolyte disturbances
- Lactic acidosis
Contraindications
- Anuria (for irrigation)
- Fructose intolerance
- Undiagnosed abdominal pain
- Intestinal obstruction
- Appendicitis symptoms
Drug Interactions
- Sodium Polystyrene Sulfonate (Calcium Polystyrene Sulfonate): Concurrent use may cause intestinal necrosis – avoid combination.
- Certain Medications (e.g., those affecting potassium levels): Monitor electrolyte levels.
Pregnancy and Breastfeeding
- Pregnancy: Consult a healthcare professional before use. Animal studies are lacking, and human data is limited.
- Breastfeeding: Consult a healthcare professional before use. Exercise caution as it is unknown if sorbitol is excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Osmotic laxative, draws water into intestines.
- Side Effects: Abdominal discomfort, diarrhea, nausea, flatulence. Rarely, dehydration, electrolyte imbalance, hyperglycemia.
- Contraindications: Anuria, fructose intolerance, appendicitis/intestinal obstruction symptoms.
- Drug Interactions: Sodium polystyrene sulfonate (avoid combination).
- Pregnancy & Breastfeeding: Consult a healthcare professional.
- Dosage: Adults: 30-150 mL (70% oral solution) once, 120 mL (25-30% rectal enema) once. Children (2-11 years): 2 mL/kg (70% oral solution) once, 30-60 mL (25-30% rectal enema).
- Monitoring Parameters: Fluid and electrolyte balance, especially in vulnerable populations.
Popular Combinations
No specific popular drug combinations for laxative purposes. When given as an adjunct with sodium polystyrene sulfonate, extreme caution is needed.
Precautions
- General Precautions: Avoid use in undiagnosed abdominal pain. Assess hydration status.
- Specific Populations: Use with caution in pregnant/breastfeeding women, children, and elderly.
- Lifestyle Considerations: Maintain adequate hydration.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Sorbitol?
A: Adults: 30-150 mL of 70% solution orally once, or 120 mL of 25-30% solution rectally once. Children (2-11 years): 2 mL/kg of 70% solution orally once, or 30-60 mL of 25-30% solution rectally.
Q2: How does Sorbitol work for constipation?
A: It acts as an osmotic laxative, drawing water into the intestines to soften stool and stimulate bowel movement.
Q3: What are the common side effects of Sorbitol?
A: Common side effects include abdominal discomfort, diarrhea, nausea, and flatulence.
Q4: Are there any serious side effects I should be aware of?
A: Dehydration and electrolyte imbalances can occur, especially with high doses or prolonged use. Monitor patients carefully.
Q5: Can Sorbitol be used in patients with diabetes?
A: Use with caution in diabetic patients as it can cause hyperglycemia. Monitor blood glucose levels closely.
Q6: Is Sorbitol safe to use during pregnancy or breastfeeding?
A: Consult a healthcare professional before use during pregnancy or breastfeeding. Safety data is limited.
Q7: How long does it take for Sorbitol to work?
A: Onset of action is typically within 30 minutes to 6 hours after oral ingestion, and within 15-60 minutes after rectal administration.
Q8: Can Sorbitol interact with other medications?
A: Avoid concurrent use with sodium polystyrene sulfonate due to the risk of intestinal necrosis. Use caution with other medications that might affect electrolyte balance.
Q9: When is Sorbitol contraindicated?
A: Sorbitol is contraindicated in patients with anuria (for irrigation), fructose intolerance, or symptoms suggestive of appendicitis or intestinal obstruction.
Q10: What precautions should I take when administering Sorbitol?
A: Carefully assess patients for dehydration and monitor fluid and electrolyte balance, especially in vulnerable populations. Monitor blood glucose in diabetics. Ensure adequate hydration in the elderly.
