Liquid Paraffin

# Liquid paraffin ## Overview - **Classification**: Bulk-forming laxative, lubricant laxative - **Mechanism**: Acts as a lubricant, softening faeces and making them easier to pass. It also prevents water reabsorption from the stool. ## Primary Indications 1. **Constipation** - Relief of chronic or occasional constipation. 2. **Faecal impaction** - Facilitates passage of hardened stool. 3. **Prior to colonoscopy/surgery** - Bowel preparation to clear the colon. ## Adult Dosing ### Standard Dosing **Constipation / Faecal Impaction** - **Dose**: **10-30 mL** - **Frequency**: Once daily, usually at night - **Route**: Oral - **Duration**: Short-term use only (typically **<1 week**), unless under medical supervision. ### Dose Adjustments - **Renal Impairment**: No specific dose adjustments needed as systemic absorption is minimal. - **Hepatic Impairment**: No specific dose adjustments needed. - **Elderly Patients**: Use with extreme caution due to increased risk of aspiration pneumonia, especially if bedridden or with swallowing difficulties. Start with lower doses. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **Not recommended** - **Special Notes**: High risk of aspiration leading to severe pneumonitis. Consider alternative treatments. ### Infants (1-12 months) - **Dose**: **Not recommended** - **Special Notes**: High risk of aspiration and malabsorption of fat-soluble vitamins. Strongly advise against use. ### Children (1-12 years) - **Dose**: **5-15 mL** - **Frequency**: Once daily, usually at night - **Maximum**: **15 mL/day** - **Special Notes**: Use with **extreme caution** and only if other laxatives are ineffective. Significant risk of aspiration pneumonia, especially in children with swallowing difficulties or neurological impairment. Monitor for malabsorption. ### Adolescents (13-18 years) - **Dose**: **10-20 mL** - **Frequency**: Once daily, usually at night - **Maximum**: **20 mL/day** - **Special Notes**: Start with lower dose. Educate on aspiration risk and proper administration (do not take immediately before lying down). Limit duration of use. ## Safety Information ### Contraindications - **Absolute**: Acute abdominal pain (e.g., appendicitis, undiagnosed abdominal pain), intestinal obstruction, paralytic ileus. - **Absolute**: Dysphagia, hiatal hernia, oesophageal obstruction, or risk of aspiration (e.g., bedridden, very young/old, neurological impairment). - **Absolute**: Concomitant use with docusate sodium (increases liquid paraffin absorption). - **Relative**: Pregnancy (risk of malabsorption of fat-soluble vitamins, uterine stimulation), breast-feeding (insufficient data). ### Common Adverse Effects - **Very Common (>10%)**: Anal leakage (oily seepage), pruritus ani. - **Common (1-10%)**: Nausea, vomiting, abdominal cramps, diarrhoea. - **Serious but Rare**: Lipoid pneumonia (due to aspiration into lungs), malabsorption of fat-soluble vitamins (A, D, E, K) with prolonged use. ### Key Drug Interactions - **Fat-soluble Vitamins (A, D, E, K)**: Decreases absorption of these vitamins, leading to potential deficiency with prolonged use. - **Oral Contraceptives**: May theoretically reduce absorption, though clinical significance is low. - **Docusate Sodium**: Enhances absorption of liquid paraffin, increasing risk of granuloma formation. **Concomitant use is contraindicated.** ## Monitoring & Follow-up - **Before Treatment**: Assess swallowing ability and risk of aspiration. Exclude acute abdominal conditions. - **During Treatment**: Monitor for aspiration symptoms (cough, wheezing), abdominal pain, changes in bowel habits. - **Clinical Signs**: Watch for signs of fat-soluble vitamin deficiency with prolonged use (e.g., bruising for Vit K, night blindness for Vit A). ## Clinical Pearls - 💡 **Timing is Key**: Advise patients to take liquid paraffin at bedtime but **NOT immediately before lying down** to reduce aspiration risk. Allow several hours between dose and lying flat. - 💡 **Administration**: Take on an empty stomach and avoid with meals, as it can interfere with nutrient absorption. - 💡 **Not First-Line**: Generally not a first-line laxative due to aspiration risk and malabsorption potential. Consider osmotic or bulk-forming laxatives first. - 💡 **Stool Lubrication**: Warn patients about possible anal leakage and staining of undergarments. - 💡 **Children/Elderly**: Avoid use in very young children and frail elderly due to high aspiration risk. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.