Version May 2024
Infrequent stool:
Note: Although several trials have been conducted, data supporting the use of glycerin enemas for rapid meconium evacuation or the treatment of constipation in neonates is inconclusive and not supported in guidelines (Haiden 2007; NASPGHAN/ESPGHAN [Tabbers 2014]; Shah 2011). The suppository dosage form is available in 2 strengths: Pediatric (for use in <6 years of age) and adult (for use in ≥6 years of age); use caution with product selection.
Neonates: Limited data available; dosing regimens variable:
Solid suppository: Pediatric suppository: Rectal: A tip or chip of the pediatric suppository (Butler-O'hara 2017; Livingston 2020; Patel 2017; Zenk 1993). Some trials have estimated the chip to be ~250 to 300 mg (Butler-O'hara 2017; Livingston 2020).
Enema: Rectal: 0.2 mL of an 80% solution of glycerin; dosing from one trial of premature neonates (n=13; PNA: 0 to 35 days; weight: 0.86 to 1.9 kg) with no stool output for >24 hours who were given 0.2 mL glycerin solution or glycerin suppository chip; enema solution was as effective as the suppository chip (Zenk 1993).
Note: The suppository dosage form is available in 2 strengths: Pediatric (for use in <6 years of age) and adult (for use in ≥6 years of age); use caution with product selection.
Constipation, occasional or fecal impaction:
Infants and Children <2 years: Limited data available: Pediatric suppository: Rectal: 1 pediatric suppository once; may repeat daily for up to 3 days if needed (Blackmer 2010; Bolia 2020).
Children 2 to <6 years: Pediatric suppository: Rectal: 1 pediatric suppository once daily as needed.
Children ≥6 years and Adolescents: Adult suppository: Rectal: 1 adult suppository once daily as needed.
(For additional information see "Glycerin: Drug information")
Constipation: Rectal: One adult suppository once daily as needed or as directed.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Gastrointestinal: Abdominal cramps, rectal irritation, tenesmus
Other warnings/precautions:
• Appropriate use: For rectal use only. Discontinue use and consult a health care provider if rectal bleeding occurs or if no bowel movement is produced after use; may indicate serious condition.
• Self-medication (OTC use): Consult a health care provider prior to use if stomach pain, nausea, vomiting, or a sudden change in bowel movements lasting >2 weeks occurs, or if you have already used a laxative >1 week. Use may cause stomach discomfort, faintness, rectal burning, and mild cramps. Discontinue use and consult a health care provider if use >1 week is needed.
Frequent use of laxatives may lead to bowel dependence and should be avoided (NASPGHAN/ESPGHAN [Tabbers 2014]).
Use suppository with caution in patients with abdominal pain, nausea, or vomiting; physician should be consulted prior to use. In children, if bowel movement does not occur within 1 hour of use or rectal bleeding occurs, consult a physician.
Each Pedia-Lax liquid suppository applicator contains 4 mL but delivers 2.7 mL (2.8 g) per dose.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Enema, Rectal:
Fleet Liquid Glycerin Supp: 5.4 g/dose (7.5 mL) [contains edetate (edta) disodium]
Suppository, Rectal:
Avedana Glycerin (Adult): 2 g (25 ea, 100 ea)
Glycerin Childrens: 1.2 g (12 ea, 25 ea)
Pedia-Lax: 1 g (12 ea [DSC]); 2.8 g (4 mL) [contains edetate (edta) disodium]
Generic: 1 g (12 ea, 25 ea); 2 g (12 ea, 24 ea, 25 ea, 50 ea, 100 ea)
May be product dependent
Enema (Fleet Liquid Glycerin Supp Rectal)
5.4 g/dose (per mL): $0.21
Suppository (Avedana Glycerin (Adult) Rectal)
2 g (per each): $0.12
Suppository (Pedia-Lax Rectal)
2.8 g (per mL): $0.22
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Rectal:
Solid suppository: Insert suppository in the rectum and retain 15 minutes; suppository does not need to melt to produce response. If suppository needs to be cut to obtain appropriate dose, cut suppository lengthwise with a sharp knife/blade prior to administration (Bowden 2010).
Liquid suppository/Enema: Administer with patient lying on left side and knees bent or with patient kneeling and head and chest leaning forward until left side of face is resting comfortably. Remove protective shield; gently insert tip into rectum with light side to side movement with tip pointing toward navel; have patient bear down if possible. Squeeze the bottle until nearly all liquid is expelled; a small amount of liquid will remain in unit after use. Gently remove the unit.
Liquid suppository/enema: Remove protective shield; insert tip into rectum with slight side to side movement; squeeze the bulb until nearly all liquid expelled. Gently remove the unit; a small amount of liquid will remain in unit after use.
Solid suppository: Insert suppository high in the rectum and retain ~15 minutes; suppository does not need to melt to produce response.
Store at room temperature; protect from heat.
Treatment of constipation (OTC product: Rectal: FDA approved in ages ≥2 years and adults).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Dichlorphenamide: Laxatives may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy
Glycerin suppositories are generally considered acceptable for use during pregnancy (Cullen 2007; Wald 2003).
Evacuation of stool.
Osmotic dehydrating agent which increases osmotic pressure; draws fluid into colon and thus stimulates evacuation
Onset of action: Constipation: Suppository: 15 to 30 minutes.
Absorption: Poorly absorbed.
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