Sorbitol 70% Solution
It is used to treat constipation.
Drug Class
Osmotic Laxative; Urologic Irrigating Solution
Pharmacologic Class
Polyol; Osmotic Agent
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Sorbitol is a type of sugar alcohol that works by drawing water into your intestines, which helps to soften your stool and make it easier to pass. It's used to treat occasional constipation or as a solution during certain surgical procedures.
How to Use This Medicine
Taking Your Medication Correctly
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely.
Oral and Rectal Solution Administration
When taking the liquid form of this medication, measure your dose accurately using the measuring device provided with the medication. If no device is included, ask your pharmacist for a suitable measuring device.
To stay hydrated, drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Oral Solution Instructions
You can take the oral solution with or without food. Take it with a full glass of water to help with swallowing. If you find the taste unpleasant, you can mix it with juice, milk, water, or sweet foods to make it more palatable.
Rectal Use (Enema)
If your doctor has prescribed this medication as an enema, use it rectally as directed.
Storing and Disposing of Your Medication
Store your medication at room temperature, away from freezing temperatures. Keep it in a dry place, avoiding storage in a bathroom. Ensure all medications are kept out of the reach of children and pets.
When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. Instead, check with your pharmacist for guidance on the best disposal method or inquire about drug take-back programs in your area.
Missing a Dose
If you take this medication on a regular schedule and miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Avoid taking two doses at the same time or taking extra doses.
If you take this medication as needed, do not take it more frequently than directed by your doctor.
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your medication and follow the instructions closely.
Oral and Rectal Solution Administration
When taking the liquid form of this medication, measure your dose accurately using the measuring device provided with the medication. If no device is included, ask your pharmacist for a suitable measuring device.
To stay hydrated, drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Oral Solution Instructions
You can take the oral solution with or without food. Take it with a full glass of water to help with swallowing. If you find the taste unpleasant, you can mix it with juice, milk, water, or sweet foods to make it more palatable.
Rectal Use (Enema)
If your doctor has prescribed this medication as an enema, use it rectally as directed.
Storing and Disposing of Your Medication
Store your medication at room temperature, away from freezing temperatures. Keep it in a dry place, avoiding storage in a bathroom. Ensure all medications are kept out of the reach of children and pets.
When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. Instead, check with your pharmacist for guidance on the best disposal method or inquire about drug take-back programs in your area.
Missing a Dose
If you take this medication on a regular schedule and miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Avoid taking two doses at the same time or taking extra doses.
If you take this medication as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Drink plenty of fluids (water, clear broths) while using sorbitol to prevent dehydration, especially when used as a laxative.
- Maintain a balanced diet rich in fiber (fruits, vegetables, whole grains) to help prevent future constipation.
- Engage in regular physical activity to promote healthy bowel function.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
Oral/Rectal Laxative: 30-150 mL of 70% solution as a single dose. Urologic Irrigant: Used continuously as a 3% to 3.3% solution during transurethral procedures.
Dose Range:
30 - 150 mg
Condition-Specific Dosing:
constipation:
Oral/Rectal: 30-155 mL of 70% solution as a single dose.
urologic_irrigation:
Continuous irrigation with 3% to 3.3% solution during transurethral procedures (e.g., TURP, TURBT).
Pediatric Dosing
Neonatal:
Not established for routine use; consult specialist for specific indications.
Infant:
Oral/Rectal Laxative: 2 mL/kg of 70% solution (max 30 mL) as a single dose. Use with caution.
Child:
Oral/Rectal Laxative: 2 mL/kg of 70% solution (max 100 mL) as a single dose. Use with caution.
Adolescent:
Oral/Rectal Laxative: 30-150 mL of 70% solution as a single dose. Use with caution.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment typically required for laxative use due to minimal systemic absorption. For irrigant use, monitor fluid and electrolyte balance.
Moderate:
No specific adjustment typically required for laxative use. For irrigant use, monitor fluid and electrolyte balance closely due to potential for systemic absorption and fluid overload.
Severe:
No specific adjustment typically required for laxative use. For irrigant use, use with extreme caution or avoid due to risk of fluid overload, electrolyte disturbances, and hyperosmolality if significant absorption occurs.
Dialysis:
Not typically used as a primary laxative in dialysis patients without careful consideration of fluid and electrolyte status. For irrigant use, use with extreme caution.
Hepatic Impairment:
Mild:
No specific adjustment typically required.
Moderate:
No specific adjustment typically required.
Severe:
No specific adjustment typically required.
Pharmacology
Mechanism of Action
Sorbitol is a hexahydric alcohol that acts as an osmotic laxative. When administered orally or rectally, it is poorly absorbed from the gastrointestinal tract. Its osmotic action draws water into the intestinal lumen, leading to increased intraluminal pressure, stimulation of peristalsis, and softening of the stool. As a urologic irrigating solution, it provides a non-hemolytic, electrically non-conductive medium for surgical procedures, and its osmotic properties help maintain tissue turgor.
Pharmacokinetics
Absorption:
Bioavailability:
Poor (less than 50% orally/rectally); significant systemic absorption can occur during urologic irrigation.
Tmax:
Not applicable for laxative effect; systemic absorption during irrigation is rapid.
FoodEffect:
Not applicable for laxative effect; generally taken on an empty stomach for faster action.
Distribution:
Vd:
Not widely distributed systemically when used as a laxative. If absorbed systemically (e.g., during irrigation), it distributes throughout the extracellular fluid.
ProteinBinding:
Negligible
CnssPenetration:
Limited
Elimination:
HalfLife:
Not well-defined for laxative use; systemically absorbed sorbitol is rapidly metabolized.
Clearance:
Rapid metabolic clearance if absorbed.
ExcretionRoute:
Primarily excreted unchanged in feces if not absorbed (laxative use). Absorbed portion is metabolized and eliminated via respiration (CO2) and urine (water).
Unchanged:
High percentage (laxative use); negligible if systemically absorbed.
Pharmacodynamics
OnsetOfAction:
Oral: 24-48 hours (for laxative effect). Rectal: 15-60 minutes (for laxative effect).
PeakEffect:
Not well-defined for laxative effect; continuous during irrigation.
DurationOfAction:
Variable, depending on dose and individual response for laxative effect; continuous during irrigation.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
- Signs of an allergic reaction, such as:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin (with or without fever)
- Wheezing
- Tightness in the chest or throat
- Difficulty breathing, swallowing, or talking
- Unusual hoarseness
- Swelling of the mouth, face, lips, tongue, or throat
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
- Stomach pain or heartburn
- Stomach cramps
- Gas
- Diarrhea
- Upset stomach
- Vomiting
- Rectal irritation
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, contact your doctor for medical advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
- Signs of an allergic reaction, such as:
- Rash
- Hives
- Itching
- Red, swollen, blistered, or peeling skin (with or without fever)
- Wheezing
- Tightness in the chest or throat
- Difficulty breathing, swallowing, or talking
- Unusual hoarseness
- Swelling of the mouth, face, lips, tongue, or throat
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
- Stomach pain or heartburn
- Stomach cramps
- Gas
- Diarrhea
- Upset stomach
- Vomiting
- Rectal irritation
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, contact your doctor for medical advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe or persistent abdominal pain
- Excessive or watery diarrhea
- Signs of dehydration (e.g., extreme thirst, dizziness, decreased urination)
- Muscle weakness or cramps
- Rectal bleeding
- No bowel movement after several doses (for laxative use)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
Certain health conditions, including:
+ Bowel blockage
+ Abdominal pain
+ Upset stomach
+ Rectal bleeding
+ Vomiting
+ Changes in bowel habits that last longer than 2 weeks
* If you are currently taking mineral oil
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
Certain health conditions, including:
+ Bowel blockage
+ Abdominal pain
+ Upset stomach
+ Rectal bleeding
+ Vomiting
+ Changes in bowel habits that last longer than 2 weeks
* If you are currently taking mineral oil
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Do not use this medication for more than 7 days without explicit instructions from your doctor to do so. Additionally, refrain from using other laxatives or stool softeners unless your doctor has advised you to do so.
If you experience rectal bleeding or fail to have a bowel movement after using this medication, it is crucial that you consult with your doctor.
If you are pregnant, planning to become pregnant, or are breastfeeding, you must discuss this with your doctor. This conversation will help you understand the benefits and risks associated with using this medication during these conditions, allowing you to make an informed decision regarding you and your baby's health.
Do not use this medication for more than 7 days without explicit instructions from your doctor to do so. Additionally, refrain from using other laxatives or stool softeners unless your doctor has advised you to do so.
If you experience rectal bleeding or fail to have a bowel movement after using this medication, it is crucial that you consult with your doctor.
If you are pregnant, planning to become pregnant, or are breastfeeding, you must discuss this with your doctor. This conversation will help you understand the benefits and risks associated with using this medication during these conditions, allowing you to make an informed decision regarding you and your baby's health.
Overdose Information
Overdose Symptoms:
- Severe diarrhea
- Dehydration
- Electrolyte imbalances (e.g., low potassium, low sodium)
- Abdominal cramping
- Nausea
- Vomiting
- Hyperosmolality (especially with systemic absorption during irrigation)
What to Do:
Discontinue use immediately. Seek emergency medical attention. Treatment involves supportive care, correction of fluid and electrolyte imbalances, and management of symptoms. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Contraindicated Interactions
- Anuria (for urologic irrigation if significant absorption is anticipated)
- Acute abdominal pain of unknown origin
- Appendicitis
- Intestinal obstruction
- Fecal impaction (unless used for disimpaction under medical supervision)
- Undiagnosed rectal bleeding
Major Interactions
- Sodium polystyrene sulfonate (Kayexalate, Kionex): Concurrent use can cause intestinal necrosis, especially in patients with reduced bowel motility. This interaction is primarily with oral/rectal sorbitol.
Moderate Interactions
- Other laxatives: Concurrent use may increase risk of excessive fluid loss and electrolyte imbalance.
- Diuretics: May exacerbate fluid and electrolyte imbalances, particularly hypokalemia.
Monitoring
Baseline Monitoring
Electrolyte levels (Na, K, Cl, Mg, Ca)
Rationale: To establish baseline before initiating therapy, especially if prolonged use or significant systemic absorption (e.g., during irrigation) is anticipated, or in patients at risk for electrolyte disturbances.
Timing: Prior to initiation of therapy.
Hydration status
Rationale: To assess baseline fluid balance and identify patients at risk for dehydration.
Timing: Prior to initiation of therapy.
Routine Monitoring
Bowel movements (frequency, consistency)
Frequency: Daily during treatment
Target: Regular, soft, formed stools
Action Threshold: Lack of bowel movement after appropriate time, or excessive diarrhea.
Hydration status (skin turgor, mucous membranes, urine output)
Frequency: Daily during treatment, especially with prolonged or high-dose use.
Target: Adequate hydration
Action Threshold: Signs of dehydration (e.g., dry mucous membranes, decreased urine output, thirst).
Electrolyte levels (Na, K, Cl, Mg)
Frequency: As clinically indicated, especially with prolonged use, high doses, or in patients with renal/cardiac impairment or during urologic irrigation.
Target: Within normal limits
Action Threshold: Significant deviations from normal range (e.g., hypokalemia, hypernatremia).
Abdominal assessment (distension, pain, bowel sounds)
Frequency: Daily during treatment.
Target: Soft, non-tender abdomen with active bowel sounds.
Action Threshold: Increasing abdominal pain, distension, or absent bowel sounds.
Symptom Monitoring
- Abdominal cramping
- Bloating
- Diarrhea (excessive or persistent)
- Nausea
- Vomiting
- Signs of dehydration (e.g., thirst, dry mouth, decreased urination, dizziness)
- Muscle weakness or cramps (suggestive of electrolyte imbalance)
- Confusion or altered mental status (severe electrolyte imbalance)
Special Patient Groups
Pregnancy
Sorbitol is generally considered safe for occasional use during pregnancy for constipation. However, excessive or prolonged use should be avoided due to the risk of dehydration and electrolyte imbalance. Consult a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Generally considered low risk for occasional use.
Second Trimester:
Generally considered low risk for occasional use.
Third Trimester:
Generally considered low risk for occasional use, but monitor for dehydration.
Lactation
Sorbitol is poorly absorbed systemically, and significant amounts are not expected to pass into breast milk. It is generally considered compatible with breastfeeding for occasional use.
Infant Risk:
Low risk of adverse effects on the breastfed infant.
Pediatric Use
Use with caution. Dosing must be carefully calculated based on weight and age to avoid dehydration and electrolyte disturbances. Not recommended for routine use in infants without medical supervision. Avoid in neonates unless specifically indicated and supervised by a specialist.
Geriatric Use
Use with caution in elderly patients due to increased susceptibility to dehydration and electrolyte imbalances. Start with lower doses and monitor fluid status and electrolytes closely. Avoid prolonged use.
Clinical Information
Clinical Pearls
- Sorbitol 70% solution is a highly concentrated osmotic agent; ensure proper dilution if a lower concentration is required (e.g., for urologic irrigation).
- For laxative use, adequate fluid intake is crucial to maximize efficacy and prevent dehydration.
- Avoid concurrent use with sodium polystyrene sulfonate (Kayexalate, Kionex) due to the risk of intestinal necrosis.
- Not intended for long-term or chronic constipation management; address underlying causes of constipation.
- Patients should be advised that abdominal cramping and gas are common side effects due to the osmotic action.
- When used as a urologic irrigant, monitor for signs of systemic absorption, such as fluid overload, electrolyte disturbances, and hyperosmolality, especially in patients with compromised renal function or prolonged procedures.
Alternative Therapies
- Other osmotic laxatives (e.g., Polyethylene Glycol (PEG), Lactulose, Magnesium Hydroxide)
- Stimulant laxatives (e.g., Bisacodyl, Senna) - different mechanism of action
- Bulk-forming laxatives (e.g., Psyllium, Methylcellulose) - different mechanism of action
- Stool softeners (e.g., Docusate Sodium) - different mechanism of action
- For urologic irrigation: Glycine solution, Mannitol solution
Cost & Coverage
Average Cost:
Low cost per liter
Generic Available:
Yes
Insurance Coverage:
Often covered by insurance as a generic or over-the-counter (OTC) item if prescribed. For hospital/surgical use, it's part of procedure costs.
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide information about the medication taken, the amount, and the time it happened.