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# Liquid Paraffin (Mineral Oil)
## Overview
Liquid paraffin is a highly refined mineral oil used as a lubricant laxative. It acts by coating the stool and intestinal mucosa, preventing water absorption and facilitating easier passage of feces.
## Primary Indications
* Short-term relief of occasional constipation.
* Management of fecal impaction (often used as an adjunct to stool softeners).
## Adult Dosing
* **Oral:** 15–45 mL once daily, preferably at bedtime.
* **Maximum:** Should not exceed 45 mL per 24 hours. Limit use to less than one week.
## Pediatric Dosing
* **Children 6–12 years:** 5–20 mL once daily, preferably at bedtime.
* **Children <6 years:** Not recommended without direct specialist supervision due to high risk of aspiration pneumonia.
* **Note:** Dosing varies by local protocol and clinical setting; always adjust based on patient response and weight.
## Dose Adjustments
* **Hepatic/Renal:** No specific adjustments required; however, use with caution in the frail elderly or those with swallowing difficulties.
## Contraindications
* Patients with dysphagia, neurologic impairment, or risk of esophageal reflux (high risk of lipoid pneumonia).
* Abdominal pain, nausea, vomiting, or other symptoms of appendicitis/obstruction.
* Pregnancy (systemic absorption may occur, and it may interfere with maternal fat-soluble vitamin absorption).
* Concurrent use with stool softeners (e.g., docusate) as they may increase mineral oil absorption.
## Adverse Effects
* **Aspiration Pneumonia:** Severe, potentially fatal risk if aspirated.
* **Anal Leakage:** Seepage of oil causing perianal irritation/pruritus.
* **Malabsorption:** Chronic use may interfere with the absorption of fat-soluble vitamins (A, D, E, K).
* **Foreign Body Granulomas:** Rare, caused by systemic absorption into intestinal submucosa or lymph nodes.
## Key Drug Interactions
* **Fat-soluble vitamins:** Chronic use may lead to deficiency of vitamins A, D, E, and K.
* **Oral contraceptives/Warfarin:** Potential for decreased absorption or altered efficacy.
* **Docusate:** Combined use increases systemic absorption of paraffin; avoid this combination.
## Monitoring
* Monitor for signs of aspiration (cough, dyspnea).
* Monitor bowel movement frequency and consistency.
* Monitor for potential nutritional deficiencies during prolonged use (not recommended).
## Clinical Pearls
* **Aspiration Risk:** Never administer to patients in the supine position; keep the patient upright for at least 30 minutes after dosing.
* **Formulation:** Patients may struggle with the texture; chilling the dose can improve palatability.
* **Last Resort:** Due to the risk of lipoid pneumonia, it is generally considered a second or third-line agent behind osmotic (PEG 3350) or stimulant laxatives.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical guidelines and local formulary protocols change frequently. Always consult current institutional prescribing guidelines or a clinical pharmacist before initiating therapy.
