Usage
- Sorbitol is primarily used as a laxative for the treatment of occasional constipation. It works by increasing the water content in the colon, softening the stool and promoting bowel movements. It is also used as a sweetener in some medications and food products.
- Pharmacological Classification: Osmotic laxative, Sweetener.
- Mechanism of Action: Sorbitol exerts its laxative effect through its hyperosmotic properties. It is poorly absorbed in the small intestine, leading to an increased osmotic pressure within the intestinal lumen. This draws water into the bowel, increasing stool water content, softening the stool, and stimulating peristalsis.
Alternate Names
- D-Sorbitol, D-Glucitol.
- Brand names vary depending on the manufacturer and formulation.
How It Works
- Pharmacodynamics: Sorbitol’s primary effect is to soften stool and induce bowel movements. As a sugar alcohol, it is slowly absorbed from the gastrointestinal tract. The unabsorbed portion exerts an osmotic effect, increasing intraluminal pressure. This induces peristalsis and bowel evacuation.
- Pharmacokinetics:
- Absorption: Poorly absorbed in the gastrointestinal tract.
- Metabolism: Small amounts absorbed are metabolized in the liver to fructose.
- Elimination: Unabsorbed sorbitol is eliminated in the feces. Absorbed sorbitol is excreted in the urine.
Dosage
Standard Dosage
Adults:
- Oral: 30-150 mL of a 70% solution once daily.
- Rectal: 120 mL of a 25-30% solution as an enema once daily.
Children:
- 2-11 years: Oral: 2 mL/kg of a 70% solution once daily.
- 2-11 years: Rectal: 30-60 mL of a 25-30% solution as an enema once daily.
- 12 years and older: Refer to adult dosing.
Special Cases:
- Elderly Patients: Begin with the lower end of the dosing range and titrate upwards as needed. Monitor for dehydration and electrolyte imbalances.
- Patients with Renal Impairment: Use with caution. Monitor electrolyte levels.
- Patients with Hepatic Dysfunction: No specific dosage adjustments, but use with caution.
- Patients with Comorbid Conditions: Use cautiously in patients with diabetes mellitus. Excessive intake may cause hyperglycemia in susceptible individuals.
Clinical Use Cases:
- Sorbitol is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations, except as a laxative for managing constipation in these settings if necessary.
- Transurethral Surgical Procedures: A 3-3.3% solution is used for irrigation.
Dosage Adjustments:
- Adjust the dose based on individual patient response and tolerance. Start with lower doses and titrate upwards as necessary.
- Monitor electrolyte levels for potential imbalances in at-risk patients.
Side Effects
Common Side Effects
- Abdominal discomfort (cramping, bloating, flatulence)
- Diarrhea
- Nausea
- Dehydration
Rare but Serious Side Effects
- Severe dehydration and electrolyte imbalances
- Lactic acidosis (especially in patients with renal impairment or diabetes)
Long-Term Effects
- Chronic diarrhea and electrolyte disturbances can occur with prolonged or excessive use.
Adverse Drug Reactions (ADR)
- Intestinal necrosis has been reported with concomitant administration of sorbitol and sodium polystyrene sulfonate.
Contraindications
- Anuria
- Undiagnosed abdominal pain
- Intestinal obstruction or perforation
- Fructose intolerance
Drug Interactions
- Sodium polystyrene sulfonate: Concomitant use can cause intestinal necrosis.
- Lamivudine: Potential for interaction resulting in increased lamivudine concentrations.
- Other laxatives: Avoid concomitant use unless directed by a physician.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C (Consult a healthcare professional before use)
- Fetal risks are not well established. Use only if the potential benefits outweigh the risks.
- It is unknown if sorbitol is excreted in breast milk. Exercise caution if breastfeeding.
Drug Profile Summary
- Mechanism of Action: Osmotic laxative, draws water into the colon.
- Side Effects: Abdominal discomfort, diarrhea, nausea, dehydration.
- Contraindications: Anuria, undiagnosed abdominal pain, intestinal obstruction, fructose intolerance.
- Drug Interactions: Sodium polystyrene sulfonate, lamivudine.
- Pregnancy & Breastfeeding: Consult a healthcare professional.
- Dosage: Adults: 30-150 mL oral or 120 mL rectal; Children (2-11 years): 2 mL/kg oral or 30-60 mL rectal; Children (12 years and older): Refer to adult dosing.
- Monitoring Parameters: Monitor bowel movements, electrolyte levels, and hydration status, especially in at-risk patients.
Popular Combinations
- Sorbitol is not typically used in combination with other drugs, except when used as an adjunct to sodium polystyrene sulfonate for managing hyperkalemia. However, this combination carries a significant risk of intestinal necrosis and is generally avoided.
Precautions
- Use with caution in patients with renal or hepatic impairment, diabetes, or cardiovascular disease.
- Monitor electrolyte levels in patients at risk of imbalances.
- Discontinue use if rectal bleeding or no bowel movement occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Sorbitol Solution?
A: Adults: 30-150 mL of 70% solution orally or 120 mL of 25-30% solution rectally once daily. Children (2-11 years): 2 mL/kg of 70% solution orally or 30-60 mL of 25-30% solution rectally once daily. Children (12 years and older): Refer to adult dosing.
Q2: How does sorbitol work as a laxative?
A: It acts as an osmotic laxative, drawing water into the colon and softening the stool.
Q3: What are the common side effects of sorbitol?
A: The most common side effects are abdominal discomfort, diarrhea, nausea, and dehydration.
Q4: Is sorbitol safe for patients with diabetes?
A: Use with caution in diabetic patients. Sorbitol is a sugar alcohol and can cause hyperglycemia in susceptible individuals. Monitor blood glucose levels closely.
Q5: Can sorbitol be used during pregnancy?
A: Consult a healthcare professional before using sorbitol during pregnancy. The safety profile during pregnancy is not well established.
Q6: What are the contraindications to sorbitol use?
A: Contraindications include anuria, undiagnosed abdominal pain, intestinal obstruction or perforation, and fructose intolerance.
Q7: Are there any serious drug interactions with sorbitol?
A: The most serious interaction is with sodium polystyrene sulfonate. Concomitant use can lead to intestinal necrosis. Lamivudine is another drug with potential for interaction.
Q8: How long can sorbitol be used?
A: For occasional constipation, it should not be used for more than one week unless directed by a physician. For chronic constipation, consult a physician for appropriate management.
Q9: What should be done in case of an overdose?
A: Seek immediate medical attention or contact a poison control center. Overdose symptoms may include severe diarrhea, dehydration, and electrolyte imbalances.
