Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2016; 7(2): 334-342
Published online May 6, 2016. doi: 10.4292/wjgpt.v7.i2.334
Review of efficacy and safety of laxatives use in geriatrics
Manhal Izzy, Anju Malieckal, Erin Little, Sury Anand
Manhal Izzy, Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
Manhal Izzy, Anju Malieckal, Erin Little, Sury Anand, Division of Gastroenterology, the Brooklyn Hospital Center, Brooklyn, NY 11205, United States
Anju Malieckal, Division of Gastroenterology, NYU-Lutheran Medical Center, Brooklyn, NY 11220, United States
Author contributions: Izzy M and Malieckal A contributed equally to this work; Izzy M and Malieckal A designed the research; Izzy M and Little E did the data collection and analyzed the data; Izzy M, Malieckal A and Little E wrote the paper; Anand S reviewed the results, revised the paper, and granted the final approval.
Conflict-of-interest statement: The above-mentioned authors of this manuscript hereby declare that they do not have any conflict-of-interest (including but not limited to commercial, personal, political, intellectual, or religious interests) related to the work submitted herein.
Data sharing statement: Non applicable for this type of studies (minireview without statistical analysis).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manhal Izzy, MD, Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, United States. mizzy@montefiore.org
Telephone: +1-718-9204154 Fax: +1-917-6720198
Received: June 29, 2015
Peer-review started: July 2, 2015
First decision: September 17, 2015
Revised: November 29, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: May 6, 2016
Processing time: 296 Days and 15.3 Hours
Abstract

AIM: To study the efficacy and safety of pharmacological treatment of constipation in geriatrics.

METHODS: PubMed, MEDLINE, google scholar, and Ovid were searched to identify human studies performed on the use of laxatives in elderly with constipation, which were conducted between January 1990 and January 2013 using the specified keywords. Controlled studies that enrolled geriatric patients with a diagnosis of constipation and addressed the efficacy and/or the safety of pharmacological treatments were included. Studies were excluded from this review if they were non-controlled trials, case series, or case reports.

RESULTS: Out of twenty three studies we initially retrieved in our search, only nine studies met the eligibility criteria of being controlled trials within geriatrics. The laxatives examined in the nine studies were senna, lactulose, sorbital, polyethylene glycol (PEG), lubiprostone, linaclotide, and prucalopride. In those studies, senna combinations had a higher efficacy than sorbitol or lactulose as well as, a very good adverse effect profile. PEG was also shown to be safe and effective in geriatric population. Furthermore, it has been shown that PEG is as safe in geriatrics as in general population. New agents like lubiprostone and prucalopride show promising results but the data about these agents in geriatrics are still limited which warrants further investigation.

CONCLUSION: Senna combinations and PEG appear to have a more favorable profile over the other traditionally used laxatives in elderly patients with constipation.

Keywords: Chronic constipation; Laxatives; Elderly; Lubiprostone; Linaclotide; Prucalopride

Core tip: Laxatives are among the most commonly prescribed medications for elderly patients, however, data about safety and efficacy of laxatives in this patient population are limited. We show in this paper, based on reviewing geriatric studies, that senna combinations and polyethylene glycol appear to have better outcomes in this population than other classic laxatives. We also discuss here the promising results of the new agents, lubiprostone, linaclotide, and prucalopride, which can be helpful in treating geriatric populations in the near future.