FDA warns on safety of commonly used medication for constipation

3am snacks afford me the opportunity to do things right now that I otherwise would not be able to do as thoroughly during the day – one of which is to read more into some of the medical-related updates that I receive! A quick note (since little L is already stirring and wanting his preggo-mamma back upstairs:

Concerns regarding Sodium Phosphate products

FDA has released a warning regarding use of over-the-counter sodium phosphate products. These medicines, marketed by Fleet, are sometimes given by mouth (PhosphoSoda) or as an enema (Fleets saline Enema, given by rectum) for children who have constipation. Giving sodium phosphate – especially in too high a dose, can cause an imbalance of salt and water in the body and thus can lead to severe heart and kidney problems – and sometimes even death.

While the effects of these medications are known, FDA has taken this step to make sure that parents who may be purchasing these from the stores – and that doctors like me who may recommend them – are extra careful in the use of these medications. Specifically, FDA warns, “Caregivers should not give the oral products to children 5 years and younger without first discussing with a health care professional. Health care professionals should use caution when recommending an oral dose of these products for children 5 years and younger. The rectal form of these products should never be given to children younger than 2 years.” The most serious effects reported occurred with a single dose that was higher than the recommended dose or in people who used the medication more than once a day.

In other words, parents, do not use a Fleets Enema in children under 2. If your child is under 5, be very careful about using any oral version of sodium phosphate and make sure to to discuss it with your doctor. Again, please go over any recommended dose with your doctor, AND avoid using more than once a day. And from my point of view – for ANY child in whom you are treating constipation, make sure that they are drinking their fluids. These fluids should have the right amount salt, water, and sugar in them to make sure that your child stays hydrated. Dehydration – loss of too much fluid and electrolytes from the medications – is what can lead to the severe side effects. Generally speaking, Pedialyte can be a good choice of fluid to take. If you are unsure or if your child has special health concerns, consult your doctor.

Now, constipation is one of the most common concerns, aside from colds, that I see in my patient population. There are many ways to treat constipation through healthy dietary moves – pushing hydration, giving pureed pears and prunes, trying some flaxseed oil. I will not reinvent the wheel tonight so I always recommend the following resource to my patients. While I don’t necessarily agree with Dr. Sears when it comes to vaccination regimens, I do like their page on constipation. A note – as a last resort they do mention enemas, but please, especially given this new warning, avoid enemas for your toddler.