Dawaa Reference

Clinical reference

Constipation (acute and chronic)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

NICE Guideline ES35 (2017) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph) · Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897)

Verified against5 documents
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph)
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65)
  • Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897)
  • Constipation - disease-level clinical article (constipation-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (10)

  • Altered day-to-day bowel pattern compared with the patient's usual habit, such as missing a day
  • Patient describes the stools as hard
  • Straining with bowel movements
  • Sense of incomplete rectal emptying
  • Needing to manually remove stool from the rectum
  • Painful defecation reported in a child
  • Blood seen on the stool or on toilet paper
  • Soiling that can be mistaken for diarrhea [diarrhoea · faecal incontinence]
  • Inability to pass gas (flatus) [flatulence]
  • Unexplained weight loss [weight loss]

Signs — what you find (7)

  • Abdominal distention, altered bowel sounds, tenderness, or a palpable mass [abdominal distension]
  • Rectal exam may reveal a mass, hemorrhoids, fissures, prolapse, or hard stool in the ampulla [haemorrhoids]
  • Fecal soiling evident on examination [faecal incontinence]
  • Bloody diarrhea in a constipated infant raises concern for Hirschsprung disease [bloody diarrhoea · constipation · diarrhoea]
  • A palpable lower-abdominal mass may be felt in a child [abdominal mass]
  • Impacted stool or an intrarectal mass found on rectal exam in children
  • Anal inspection checks the size and position of the anus and looks for rectal prolapse [rectal prolapse]

Tests (11)

  • CBC may show anemia from chronic rectal bleeding
  • Fecal occult blood testing to rule out an obstructing colon neoplasm
  • Elevated white cell count with fever or abdominal pain may point to underlying ileus
  • TSH is checked to rule out hypothyroidism when constipation resists dietary management
  • A metabolic panel may reveal hypokalemia or hypercalcemia as a cause
  • Plain abdominal x-ray can show fecal loading in the colon
  • Abdominal CT can establish the diagnosis of an intra-abdominal abscess
  • An empty rectal vault with a dilated proximal colon on imaging suggests large bowel obstruction
  • Anorectal manometry assesses motor and sensory function of the anorectum
  • Colonic transit studies use radiopaque markers to time how fast stool moves through the gut
  • Defecography can show an anorectal angle change, transient prolapse, intussusception, or pelvic floor weakness

If not this — what else fits (10)

  • Colorectal cancer is on the differential list for constipation
  • Hirschsprung disease is a differential, particularly relevant in infants
  • Hypothyroidism is a recognized cause of constipation to rule out
  • Irritable bowel syndrome is on the differential for chronic constipation
  • Crohn disease can present with constipation and must be distinguished
  • Rectal prolapse is a differential to look for on rectal exam
  • Rectocele is included in the differential list
  • Toxic megacolon must be considered among the differentials
  • Cystic fibrosis should be considered as a cause of constipation in children
  • Cow's milk protein allergy is a pediatric differential for constipation

SourceStatPearls "Constipation" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Oral stimulant | Rectal - fast relief

MAIN TREATMENT - choose one

1

LACTULOSE

1st line

Formoral.liquid

Adult dose and duration

15-30 mL daily in 1-2 divided doses, adjust to produce soft stool - Short-term or chronic under supervision

Paediatric dose

(Infant under 1 year: up to 5 mL daily. Child 1-6 years: 5-10 mL daily. Child 7-14 years: start 15 mL daily, maintenance 10-15 mL daily. Adjust to produce a soft stool without diarrhoea.)

Dose by age
Under 1 year:Up to 5 mL daily
1 to 6 years:5 to 10 mL daily
7 to 14 years:15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea.
Choice

Lactulose is the first choice here; polyethylene glycol is a further option.

Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)

Why

Safe first-line osmotic laxative suitable for all age groups

Cautions
  • Takes 48 hours to act; advise patient not to exceed recommended dose prematurely.
  • Caution in lactose intolerance or galactosemia.
  • Maintain adequate hydration.
  • Gastrointestinal obstruction.
  • Digestive-perforation or risk of digestive perforation.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCOLAC 667GM/L SYRUP 120 MLPHARCO7.50 EGP
LACTOLINE 50% SYRUP 200MLALEXANDRIA9.25 EGP
LAEVOLAC 67GM/100ML SYRUP 120 MLSIGMA > FRESENIUS KABI12.00 EGP
SEDALAC 3.35GM/5ML SYRUP 120MLSEDICO20.00 EGP
LAXOLAC 3.35GM/5ML SYRUP 300MLMUP40.00 EGP
LAXOLAC 3.35GM/5ML SYRUP 120MLMUP50.00 EGP
DUPHALAC 667GM/L SYRUP 200MLABBOTT LABORATORIES143.00 EGP
LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320MLAUG PHARMA170.00 EGP
VILLAPURG 67% SYRUP 120 ML? strength differs? different route - not oral liquidAL ESRAA PHARMACEUTICAL OPTIMA12.00 EGP
VILLAPURG 67% SYRUP 200 ML? strength differs? different route - not oral liquidAL ESRAA PHARMACEUTICAL OPTIMA17.75 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Constipation - disease-level clinical article (constipation-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Look for alarm features and concerning historical features in the evaluation of constipation.
3

MACROGOL 3350

1st line

Formoral.liquid

Adult dose and duration

1-3 sachets daily in divided doses, adjusted up or down as required to produce regular soft stools (maximum 4 sachets a day) - the 13.125 g adult sachet

Paediatric dose

(Child 2-6 yrs: starting dose 1 sachet daily; Child 7-11 yrs: 2 sachets daily - the 6.563 g paediatric sachet, not the adult one. Adjust to produce regular soft stools.)

Dose by age
2 to 6 years:1 sachet daily to start - the 6.563 g paediatric sachet, not the adult one
7 to 11 years:2 sachets daily - the 6.563 g paediatric sachet, not the adult one
Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65)

Why

First-line osmotic laxative recommended for maintenance treatment and disimpaction in chronic constipation.

Cautions
  • Not recommended in children under 2 years of age for chronic constipation.
  • Ensure adequate hydration during treatment.
  • The sachet sizes are not interchangeable, and the doses above are counted in sachets. ENDF verbatim: "Products containing 6.563 grams per sachet: 1. For the treatment of chronic constipation in children 2 to 11 years of age" and "Products containing 13.125 grams per sachet: 4. Treatment of chronic constipation in adults". MOVICOL PAEDIATRIC is the 6.563 g sachet; MOVICOL is the 13.125 g one. Handing an adult pack to a child dosed at 1 sachet daily doubles it.
  • NOT the colonoscopy preparation, which is the same drug at eight times the pouch. ENDF verbatim: "Products containing 100 grams per pouch: 5. Osmotic laxative indicated for cleansing of the colon in preparation for colonoscopy in adults". MOVIPREP and PREPAWEST are that product, and they are deliberately not among the Egyptian brands listed below.
Egyptian brands
Egyptian brandManufacturerIndicative price
MOVICOL PAEDIATRIC 30 SACHETS! also contains potassium chloride, sodium chloride, sodium hydrogen carbonateNORGINE LIMITED > ACINO221.00 EGP
MOVICOL 20 SACHETS! also contains potassium chloride, sodium bicarbonate, sodium chlorideNORGINE LIMITED > ACINO273.00 EGP

ORAL STIMULANT

4

BISACODYL

Oral stimulant

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

5-10 mg once daily at bedtime (acts in 6-12 hours) - Up to 5 days without medical advice

Paediatric dose

(Children over 12 years: 5 - 10 mg once daily before bedtime.)

Dose by age
Over 12 years:5 to 10 mg once daily before bedtime
Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph)

Why

Stimulant laxative for short-term relief of acute constipation

Cautions
  • CONTRAINDICATED in intestinal obstruction or acute surgical abdomen.
  • Do not take within 1 hour of antacids or milk (dissolves enteric coating).
  • Avoid prolonged continuous use due to risk of intestinal atony and electrolyte loss.
  • Acute inflammatory bowel diseases.
  • Patients with severe dehydration.
Egyptian brands
Egyptian brandManufacturerIndicative price
CONSTACODYL 5 MG 10 ENTERIC COATED TAB.SIGMA2.25 EGP
DULCOLAX 5MG 20 SUGAR COATED TAB..CID > SANOFI3.00 EGP
ABILAXINE 5 MG 20 COATED TAB.GLAXO SMITHKLINE4.50 EGP
BISADYL 5 MG 30 E.C.TABS.AMRIYA28.50 EGP
BISADYL 10MG/37ML ENEMA? strength differs? different route - not oral solidAMRIYA6.00 EGP

RECTAL - FAST RELIEF

5

GLYCERIN

Rectal - fast relief

2nd line

Formrectal

Adult dose and duration

1 suppository (4 g adult size) inserted rectally as required - Single use / as required

Paediatric dose

Children: One suppository (1.4 gm) rectally as needed. Infants: One suppository (0.7 gm) rectally as needed.

Dose source

Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897)

Why

Fast-acting rectal lubricant/stimulant laxative (acts in 15-30 minutes)

Cautions
  • Moisten suppository with water before insertion.
  • Avoid in presence of anal fissures or severe proctitis.
  • Dip the suppository in water before inserting it - dry glycerol drags and stings.
  • The three sizes are separate products, not fractions of each other: 4 g adult, 2 g child, 1 g infant. The adult suppository is explicitly not for a child.
  • Glycerin is for short-term rectal evacuation only.
Egyptian brands
Egyptian brandManufacturerIndicative price
GLYCERIN ADULT 6 SUPP. (EL-NILE)EL NILE.11.00 EGP (1.83/unit)
GLYCERIN INFANTILE 10 SUPP. (GLAXO)GLAXO SMITHKLINE19.00 EGP (1.90/unit)
GLYCERIN ADULT 10 SUPP. (GLAXO)SMITHKLINE BEECHAM > GLAXO SMITHKLINE22.00 EGP (2.20/unit)
GLYCERIN INFANTILE 6 SUPP. (EL-NILE)EL NILE.14.00 EGP (2.33/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.