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# Liquid Paraffin
## Overview
Liquid paraffin (mineral oil) is a non-absorbable lubricant laxative that works by coating the stool and intestinal mucosa, reducing water absorption from the colon and facilitating defecation.
## Primary Indications
* Treatment of occasional constipation.
* Fecal impaction (often used as an adjunct to stool softeners or stimulants).
## Adult Dosing
* **Oral:** 15 to 45 mL daily, taken as a single dose or in divided doses.
* **Maximum:** Usually limited by potential side effects (e.g., lipid pneumonia, malabsorption); consult local protocol.
## Pediatric Dosing
* **Children ≥ 6 years:** 5 to 20 mL daily in divided doses.
* **Safety Note:** Generally discouraged in children < 6 years due to high risk of aspiration and lipid pneumonia. Follow local institutional protocols for specific weight-based requirements.
## Dose Adjustments
* **Renal/Hepatic:** No specific adjustments required; however, use with extreme caution in debilitated and elderly patients due to aspiration risk.
## Contraindications
* Hypersensitivity to mineral oil.
* Patients with dysphagia, impaired swallowing, or gastroesophageal reflux (high risk of aspiration).
* Abdominal pain, nausea, vomiting, or other symptoms of appendicitis/undiagnosed abdominal pain.
* Bowel obstruction or fecal impaction without clinical supervision.
* Pregnancy (potential for reduced absorption of fat-soluble vitamins).
## Adverse Effects
* **Lipid Pneumonia:** Caused by accidental aspiration; can be severe and life-threatening.
* **Anal Leakage/Pruritus:** Resulting from the seepage of oil through the anal sphincter.
* **Malabsorption:** Prolonged use may interfere with the absorption of fat-soluble vitamins (A, D, E, and K).
* **Foreign Body Reactions:** Granulomatous reactions in intestinal mucosa or lymph nodes with chronic use.
## Key Drug Interactions
* **Oral Contraceptives:** Potential for decreased efficacy due to reduced absorption.
* **Fat-Soluble Vitamins:** Decreased absorption of vitamins A, D, E, K.
* **Docusate:** Combined use increases the risk of systemic absorption of mineral oil; **avoid concurrent administration**.
* **Warfarin:** Risk of altered levels due to interference with vitamin K absorption.
## Monitoring
* Monitor for signs of aspiration (cough, dyspnea).
* Assess stool consistency and frequency.
* Monitor long-term patients for metabolic signs of fat-soluble vitamin deficiency.
## Clinical Pearls
* **Administration:** Should not be taken immediately before bedtime due to the high risk of aspiration.
* **Texture:** Often emulsified to make it more palatable and reduce the risk of anal leakage.
* **Patient Education:** Advise patients that this is for short-term use only. If constipation persists beyond 7 days, medical consultation is required.
* **Special Populations:** Contraindicated in bedridden patients or those with restricted mobility due to the high aspiration risk.
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**Disclaimer:** This information is for educational purposes for healthcare professionals. Clinical practice guidelines and local protocols vary significantly. Always verify doses, contraindications, and drug interactions with the most current institutional resources (e.g., BNF, Lexicomp, or hospital formulary) before prescribing or administering.
