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Thread: lactulose versus miralax

  1. #1

    lactulose versus miralax

    I find lactulose works faster (within 3 hours when taking 50 ml) than miralax, which takes a few days. Lactulose also seems harsher, but works better.

    I thought lactulose and miralax were the same kind of drug. So why does lactulose work faster?

    If it's dosage, can I take a high enough dose of miralax - which tastes much less bad - to replicate the effect of taking 50 ml of lactulose?

  2. #2
    While Lactulose and Miralax are both osmotic laxatives, they are not the same drug. Miralax is chemically the same as Golytely. Both should be avoided for routine long term use, and instead, used to manage short periods of constipation or impaction.

    (KLD)

  3. #3
    My Dad takes Miralax every day. When he gets backed up, the first step his physiatrist and GI told him to do is take Miralax twice that day.

  4. #4
    No studies have been done on the use of Miralax routinely over the long term, but we do know that those with SCI who use laxatives and stimulants routinely for years are in the highest risk group for developing obstructive megacolon.

    (KLD)

  5. #5
    This is pretty frightening to me. My colorectal surgeon said that regular low dose Miralax was safe. I've been doing about half a capful every other day with such citrucel every night. My bowel function after 27 years is not bad (magic bullet and taking about an hour and 15 minutes) but I have severe pelvic pain which I cannot put a source to and I've been wondering if it is related to my bowels in any way. It could be my bladder but I still have the pain on a full bladder or empty. I've had reconstructive surgery on my bladder (augment) and thought that this could be part of the reason. I've also had a small bowel obstruction that required surgery.

    The pain is quite severe, a regular lancinating deep spasmodic pain that prevents falling asleep, staying asleep or getting back to sleep after I awake.

    I think I will discontinue Miralax based on what I'm reading here. Perhaps too much fiber is part of my problem as well.

  6. #6
    Quote Originally Posted by SCI-Nurse View Post
    No studies have been done on the use of Miralax routinely over the long term, but we do know that those with SCI who use laxatives and stimulants routinely for years are in the highest risk group for developing obstructive megacolon.

    (KLD)
    Perhaps people who take laxatives and stimulants are the ones with the most troublesome bowels, and it is the latter, not the former, that is causing obstructive megacolon?

    I personally don't care about safety, as I don't really have any good options.
    Last edited by xsfxsf; 11-08-2015 at 09:15 AM.

  7. #7
    Quote Originally Posted by xsfxsf View Post
    Perhaps people who take laxatives and stimulants are the ones with the most troublesome bowels, and it is the latter, not the former, that is causing obstructive megacolon?

    I personally don't care about safety, as I don't really have any good options.

    I agree.

    There aren't any studies that show long term use of Miralax causes clinically dangerous obstructive megacolon. Correlation does not equal causation.

    My Dad's SCI physiatrist also agrees. He told him to take Miralax. My Dad was also separately told to take Miralax by his gastroenterologist who is an expert in neurogenic bowel. He tried to get my Dad to try Miralax daily for years before my Dad broke down and agreed. It works pretty well for him.

    If some with SCI can manage the bowels with only dietary management then that's amazing. But many (most?) cannot. Also, every person is different. Level of injury, other contributing medical problems and medication, age, and desire for independence can differ from one SCI to another and all have to be considered.

    At some point, you have to live your life using the best information you can to guide you. Everything has a risk/benefit. You balance them the best you can. Optimize your diet. Drink plenty of water. Get off medications/supplements that can worsen constipation unless you truly need them. Use suppositories etc... if you can tolerate them and they work for you. And then these days, Miralax seems to be the most popular laxative out there.

    Otherwise, I guess colostomy is always an option! But it seems a bit much to jump to that... for many.

  8. #8
    I did not say that Miralax causes obstructive megacolon. Indeed there are NO long term studies on Miralax at all that show it is safe for long term use. There is a correlation between long term use of strong stimulants and laxatives and megacolon. Miralax is a laxative.

    (KLD)

  9. #9
    Quote Originally Posted by SCI-Nurse View Post
    I did not say that Miralax causes obstructive megacolon. Indeed there are NO long term studies on Miralax at all that show it is safe for long term use. There is a correlation between long term use of strong stimulants and laxatives and megacolon. Miralax is a laxative.

    (KLD)

    Yeah, I hear you. It's just hard for a lot of people to read your statement and not read into it that they shouldn't take laxatives. Your point is well taken.

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