Version October 2024
Constipation:
Note: Sorbitol is also found in some juices (eg, pear, apple, prune) and fruits (especially pureed or dried peaches or prunes), which may be recommended for use in infants and children before utilizing pharmacologic therapy (Blackmer 2010; Bolia 2020; Loening-Baucke 2005).
Oral: 70% solution: Note: Dietary sorbitol more commonly recommended:
Infants and Children <12 years: Limited data available: Oral: 1 to 3 mL/kg/day in divided doses once or twice daily; maximum daily dose 60 mL/day (Maqbool 2020).
Children ≥12 years and Adolescents: Oral: 30 to 60 mL in divided doses once or twice daily; maximum daily dose: 60 mL/day.
Rectal enema: 25% to 30% solution:
Children ≥12 years and Adolescents: Rectal: 120 mL once daily as needed.
Toxic ingestion, adjunct with charcoal: Children and Adolescents: Oral: 35% solution: 4.3 mL/kg; Note: Current guidelines recommend limiting use to a single dose administered with the initial charcoal dose of 1 g/kg (AACT/EAPCCT 2004).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Sorbitol: Drug information")
Hyperosmotic laxative (as single dose, at infrequent intervals):
Oral: 30 to 45 mL (as 70% solution).
Rectal enema: 120 mL as 25% to 30% solution.
Transurethral surgical procedures: Irrigation: 3% to 3.3% as transurethral surgical procedure irrigation; volume needed will vary with the nature and duration of the procedure.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Irrigation is contraindicated in patients with anuria.
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.
Cardiovascular: Edema
Endocrine & metabolic: Electrolyte depletion, hyperglycemia, hypovolemia, lactic acidosis
Gastrointestinal: Abdominal distress, diarrhea, nausea, vomiting, xerostomia
Anuria (for irrigation).
OTC labeling: When used for self-medication, do not use for longer than 7 days or when abdominal pain, nausea, or vomiting is present.
Concerns related to adverse effects:
• Fluid/electrolyte imbalance: Large volumes may result in fluid overload and/or electrolyte changes.
Disease-related concerns:
• Cardiopulmonary disease: Use with caution in patients with severe cardiopulmonary disease.
• Diabetes: Use with caution in patients with diabetes; may cause hyperglycemia.
• Fructose intolerance: Avoid use in patients with known or suspected fructose intolerance.
• Renal impairment: Use with caution in patients with renal impairment.
• Unable to metabolize sorbitol: Use with caution in patients unable to metabolize sorbitol.
Other warnings/precautions:
• Self-medication (OTC use): Constipation: When used for self-medication (OTC), notify health care provider prior to use if sudden change in bowel habits has persisted over a period of 2 weeks or if taking mineral oil. Discontinue use and notify health care provider if rectal bleeding or unable to have a bowel movement after use.
Excessive amounts of sorbitol may cause hypernatremic dehydration in pediatric patients; use with caution in infants; other causes of constipation should be evaluated prior to initiating therapy.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Irrigation:
Generic: 3% (3000 mL); 3.3% (2000 mL, 4000 mL [DSC])
Solution, Oral:
Generic: 70% (30 mL [DSC], 474 mL [DSC], 480 mL, 3840 mL)
Solution, Rectal:
Generic: 70% (473 mL)
Yes
Solution (Sorbitol Irrigation)
3% (per mL): $0.01
Solution (Sorbitol Oral)
70% (per mL): $0.01
Solution (Sorbitol Rectal)
70% (per mL): $0.01
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.
Oral: May administer without regard to food.
Rectal: Administer as a prepared enema.
Irrigation: For irrigation only; not for injection. Prior to use, may warm in overwrap to near body temperature in a water bath or oven heated to ≤45°C (≤113°F). Use with irrigation set; see manufacturer labeling for complete instructions on use.
Oral: May administer without regard to food.
Rectal: Administer as a prepared enema; a 25% to 30% solution may be made by diluting one part 70% sorbitol with 2.3 parts water.
Irrigation solution: Avoid storage in temperatures >150°F; do not freeze.
Oral solution: Store at 15°C to 30°C (59°F to 86°F); do not freeze; below 15°C (59°F) cloudiness and thickening may occur; warming will restore clarity and fluidity without affecting product quality.
Solution:
Oral: Hyperosmotic laxative; sweetening agent (OTC product: FDA approved in ages ≥12 years and adults); has also been used to facilitate the passage of charcoal-toxin complex through the intestinal tract.
Rectal: Hyperosmotic laxative (OTC product: FDA approved in ages ≥12 years and adults); refer to product specific information for detail on ages for pediatric patients.
Irrigation solution: Genitourinary irrigant in transurethral prostatic resection or other transurethral resection or other transurethral surgical procedures; irrigant for indwelling catheter to maintain patency (FDA approved in 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 drug interactions program by clicking on the “Launch drug interactions program” link above.
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 drug interactions program
Calcium Polystyrene Sulfonate: Sorbitol may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of these agents may increase the risk for intestinal necrosis. Risk X: Avoid combination
LamiVUDine: Sorbitol may decrease the serum concentration of LamiVUDine. Management: When possible, avoid chronic coadministration of sorbitol-containing solutions with lamivudine, but if this combination cannot be avoided, monitor patients more closely for possible therapeutic failure associated with decreased lamivudine exposure. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: Sorbitol may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. More specifically, concomitant use of these agents may increase the risk for intestinal necrosis. Risk X: Avoid combination
Animal reproduction studies have not been conducted.
Stool frequency and consistency, fluid status; serum electrolytes (as clinically appropriate or with prolonged use).
A polyalcoholic sugar with osmotic cathartic actions
Onset of action: Rectal: 0.25-1 hour
Absorption: Oral, rectal: Poor
Metabolism: Primarily hepatic to fructose
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