Purgatives, choleraetics and

cholagogues
Dr.Jibachha Sah
M.V.Sc (Pharmacology)
College of veterinary science NPI,
Bhojard, Chitwan
Purgative Stronger action resulting in more fluid evacuation

Laxative Milder action, elimination of soft but formed stools.

PURGATIVES & LAXATIVES:
Definition: Chemical agents that promote defecation & used to treat
constipation.

M/A: They ↓ the viscosity of contents of large intestines.

Indications:
1. Constipation
2. Anal fissure
3. Haemorrhoids
4. IBS (Irritable Bowel Syndrome)
TYPES:
1.Bulk laxatives
2.Osmotic laxatives
3.Lubricants
4.Stimulant laxatives
5.Surface active agents
( Or Faecal softeners)
A.BULK LAXATIVES:
●Hydrophilic colloid (absorbs water from intestine) e.g.
1.Ispagula husk
2.Methyl cellulose

●Indigestible vegetable fibres e.g.

1. Bran
2.Agar

M/A: Retain water ↑ The volume of fibres (non-absorbable solid

residue). ↓ The viscosity of bowel. Promote stool within 1-3 hours.
No serious side effects.
B.OSMOTIC LAXATIVES/ SALINE PURGATIVES Agents:
1.Mg salts: Magnesium sulphate (MgSO 4 ), Magnesium
carbonate, (MgCO 3) , Magnesium hydroxide (Mg(OH) 2) .

2.Lactulose: Disaccharide

3. Na salts: Na citrate, Na phosphate.

M/A:

1.They absorb water by osmosis.

2.↑ Water content in the bowel by osmosis.

3.Little absorbed.

4.Distend large intestine & causes evacuation.

C. LUBRICANTS Agents:

● Liquid paraffin.
● Glycerin.

M/A: Make stool slippery.

Disadvantages of liquid paraffin when longer used:

1.Praffinoma (by collection)

2.May leak through anal sphincter.

3.Inhibits absorption of fat soluble vitamins (e.g. A,D,E,K).

STIMULANT LAXATIVES

Agents:
●Bisacodyl
●Castor oil
●Senna (trade name-senalax)

M/A:
1.Stimulation of wall of rectal mucosa.
2.↑ Its motility (peristalsis).
3.↑ Mucous secretion & causes defaecatiion.

Side effects: Abdominal cramp

Contraindications: Intestinal obstruction.

E. SURFACE ACTIVE AGENTS
(FAECAL SOFTENERS)
Agents: Docusate sulfate.

M/A:

●Wetting agents.

●Reduce surface tension of fluid in the bowel.

●Softening of stool.
RECATALLY ADMINISTERED
LAXATIVES:
Suppository
●Glycerine
● Bisacodyl
● Docusate Na.

Enema (liquid)
● Soap Ba-sulphate (Diagnostic)
● MgSO 4
● Docusate Na.
Indications:

●GIT surgery ,

● Radiological examination ,

● Endoscopy (Colonoscopy)

● Before delivery.
DRUGS CAUSING CONSTIPATION:

● Opoid analgesics

● Antimuscarinic agents (atropine, scopolamine)

● Iron preparation
● Aluminium containing antacid
● Benzodiazepines
● Calcium channel blocker
● Antiparkinsonian drugs
● Tricyclic antidepressants
 Choleraetics and cholagogues
Gastrointestinal agents that stimulate the flow of bile
into the duodenum (cholagogues) or stimulate the
production of bile by the liver (choleretic)
Cholagogues

Entero-Hepatic Circulation.
 The liver has a double function; it not only forms new bile, but re-
excretes the old bile which has been re-absorbed from the
intestine.

A certain quantity of bile is lost in the faeces, but a considerable

portion of it seems to be utilized again and again; being formed by
the liver, poured out into the intestine, reabsorbed and again
excreted.

This circulation of bile between the intestine and the liver has been
called the entero-hepatic circulation
Medicinal plants with the hepatobiliary mode of action remain essential therapeutic agents
for the treatment of cholestasis. They are denoted as cholagogues (promoting the flow of
bile from the liver and gall bladder into the intestines) and choleretics (increasing bile
production).

Cholagogic and choleretic properties of chamomile (Chamomilla recutita)

●elecampain (Inula helenium),

● dandelion (Taraxacum officinalis),
● St. John’s wort (Hypericum perforatum)
● Artemisia sp
● yarrow (Achillea millefolium)
● rosemary (Rosmarinus officinalis)
Ursodeoxycholic acid The drug decreases the absorption of
cholesterol and is used to dissolve
(cholesterol) gallstones in patients as
an alternative to a surgical procedure
to remove the gallstones.
Tauroursodeoxycholic acid Used in the treatment of cholesterol
gallstones.
Some hepatic stimulants increase also the peristaltic movements and
secretions from the intestine - for example, those substances which
have been already enumerated as cholagogue purgatives.
Aloes vera
Colchicum( autumn crocus,naked ladie) in large doses.
Colocynth.
Jalap.
Podophyllin.
Rhubarb.
Sulphate of potassium. Sulphate of sodium. Phosphate of
sodium. Mercury salts.
Cholagogues are useful by removing bile from the body,

Exercise therefore tends to expel bile from the liver, and prevent its accumulation in the
biliary capillaries, but a little brisk exercise as in riding, rowing, climbing, tennis, etc, will
have in a few minutes a more beneficial action than a lazy constitutional walk of a couple
of hours.

Adjuncts to Cholagogues. - The pressure under which bile is secreted is very low, so that a
very slight obstruction to its flow through the common bile-duct is sufficient to cause its
accumulation in the gall-bladder and gall-ducts, and thus to lead to its re-absorption. This is
readily observed in cases of catarrh, either of the duodenum or of the gall-ducts. In such cases
the use of ipecacuanha is indicated.
Function of liver
●1st, to form and store up glycogen, a material which will afterwards be used in
evolving heat and muscular energy;

● 2ndly, to secrete bile for use in digestion;

● 3rdly, to excrete bile;
● 4thly, to destroy peptones which are poisonous
● when they are directly
introduced into the general circulation, and to convert them into glycogen, etc.;

● 5thly, to destroy or store up and excrete other organic poisons which may have
been formed in the alimentary canal during the process of digestion, or may have
been introduced into it from without.