Issues for surgery
Risk of constipation if omitted, particularly in patients with chronic laxative use, which may further be exacerbated by medication administered perioperatively, e.g. opioids.
Risk of fluid imbalance and hypokalaemia with chronic or excessive use, which may further be exacerbated if continued during prolonged periods of fasting.
Advice in the perioperative period
Elective surgery
Continue, if required.
EXCEPT:
- for patients having bowel cleansing preparations prior to surgery – stop when bowel preparation starts.
Check electrolytes pre-operatively in patients with chronic or suspected excessive stimulant laxative use.
Emergency surgery
Continue, if required.
EXCEPT:
- for patients with suspected bowel obstruction or perforation.
Check electrolytes in patients with chronic or suspected excessive stimulant laxative use.
Post-operative advice
Resume post-operatively, if needed, once enteral intake resumed.
If concomitant use of opioids or other medication that may cause constipation, or antibiotics that may cause diarrhoea, monitor response to treatment and adjust dose accordingly.
Review if patient develops reduced gastrointestinal motility (e.g. ileus) post-operatively.
Patients undergoing colorectal surgery
Review the need for stimulant laxatives post-operatively.
Interactions with common anaesthetic agents
Hypokalaemia
Co-danthrusate may cause hypokalaemia (mainly in cases of misuse or overdose). Concomitant use with medications that prolong the QT-interval, e.g. desflurane, isoflurane, sevoflurane and possibly thiopental, increases the risk of torsades de pointes. Monitor serum potassium and QT-interval with concomitant treatment.
Interactions with other common medicines used in the perioperative period
Hypokalaemia
Stimulant laxatives can cause hypokalaemia (mainly in cases of misuse or overdose). Hypokalaemia increases the risk of torsades de pointes with medicines which prolong the QT-interval, e.g. antiemetics (haloperidol, ondansetron), antimicrobials (ciprofloxacin, clarithromycin, erythromycin), corticosteroids and loperamide. Monitor serum potassium and with concomitant treatment.
Further information
Co-danthrusate is only licensed for constipation in terminally ill patients since dantron is a potential human carcinogen.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed 26 March 2024]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed 26 March 2024]