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. 1993 Sep 25;307(6907):769–771. doi: 10.1136/bmj.307.6907.769

Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination.

A P Passmore 1, K Wilson-Davies 1, C Stoker 1, M E Scott 1
PMCID: PMC1696423  PMID: 8219947

Abstract

OBJECTIVES--To compare the efficacy and cost effectiveness of a senna-fibre combination and lactulose in treating constipation in long stay elderly patients. DESIGN--Randomised, double blind, cross over study. SETTING--Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England. SUBJECTS--77 elderly patients with a history of chronic constipation in long term hospital or nursing home care. INTERVENTION--A senna-fibre combination (10 ml daily) or lactulose (15 ml twice daily) with matching placebo for two 14 day periods, with 3-5 days before and between treatments. MAIN OUTCOME MEASURES--Stool frequency, stool consistency, and ease of evacuation; deviation from recommended dose; daily dose and cost per stool; adverse effects. RESULTS--Mean daily bowel frequency was greater with the senna-fibre combination (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 to 0.7; t = 3.51 p < or = 0.001). Scores for stool consistency and ease of evacuation were significantly higher for the senna-fibre combination than for lactulose. The recommended dose was exceeded more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p or = 0.01). As an index of the standard daily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose and 10.3p for senna-fibre. Adverse effects were no different for the two treatments. CONCLUSIONS--Both treatments were effective and well tolerated for chronic constipation in long stay elderly patients. The senna-fibre combination was significantly more effective than lactulose at a lower cost.

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Selected References

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  1. Andersson M. Drugs prescribed for elderly patients in nursing homes or under medical home care. Compr Gerontol A. 1989;3 (Suppl):8–15. [PubMed] [Google Scholar]
  2. Connolly P., Hughes I. W., Ryan G. Comparison of "Duphalac" and "irritant" laxatives during and after treatment of chronic constipation: a preliminary study. Curr Med Res Opin. 1974;2(10):620–625. doi: 10.1185/03007997409111873. [DOI] [PubMed] [Google Scholar]
  3. Godding E. W. Laxatives and the special role of senna. Pharmacology. 1988;36 (Suppl 1):230–236. doi: 10.1159/000138445. [DOI] [PubMed] [Google Scholar]
  4. Hills M., Armitage P. The two-period cross-over clinical trial. Br J Clin Pharmacol. 1979 Jul;8(1):7–20. doi: 10.1111/j.1365-2125.1979.tb05903.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. MacLennan W. J., Pooler AFWM A comparison of sodium picosulphate ("Laxoberal") with standardised senna ("Senokot") in geriatric patients. Curr Med Res Opin. 1974;2(10):641–647. doi: 10.1185/03007997409111877. [DOI] [PubMed] [Google Scholar]
  6. Marlett J. A., Li B. U., Patrow C. J., Bass P. Comparative laxation of psyllium with and without senna in an ambulatory constipated population. Am J Gastroenterol. 1987 Apr;82(4):333–337. [PubMed] [Google Scholar]
  7. Primrose W. R., Capewell A. E., Simpson G. K., Smith R. G. Prescribing patterns observed in registered nursing homes and long-stay geriatric wards. Age Ageing. 1987 Jan;16(1):25–28. doi: 10.1093/ageing/16.1.25. [DOI] [PubMed] [Google Scholar]
  8. Rouse M., Chapman N., Mahapatra M., Grillage M., Atkinson S. N., Prescott P. An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults. Br J Clin Pract. 1991 Spring;45(1):28–30. [PubMed] [Google Scholar]
  9. Sanders J. F. Lactulose syrup assessed in a double-blind study of elderly constipated patients. J Am Geriatr Soc. 1978 May;26(5):236–239. doi: 10.1111/j.1532-5415.1978.tb01967.x. [DOI] [PubMed] [Google Scholar]
  10. Tedesco F. J., DiPiro J. T. Laxative use in constipation. American College of Gastroenterology's Committee on FDA-Related Matters. Am J Gastroenterol. 1985 Apr;80(4):303–309. [PubMed] [Google Scholar]
  11. Upton D. R., Taylor J. K., Holmes G. K., Poston J. W. Effects of withdrawal of co-danthramer on use of laxatives in a district general hospital. BMJ. 1988 Dec 3;297(6661):1446–1447. doi: 10.1136/bmj.297.6661.1446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. de Witte P., Lemli L. The metabolism of anthranoid laxatives. Hepatogastroenterology. 1990 Dec;37(6):601–605. [PubMed] [Google Scholar]

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