The UK government has imposed a number of restrictions on the sales of over-the-counter (OTC) stimulant laxatives in an attempt to reduce abuse and overuse of the products.

Pharmacies will now be the only retailer with the power to supply OTC stimulant laxatives to patients aged 12 and over, while shops and supermarkets must not sell the products to anyone under the age of 18.

Under the Medicines and Healthcare products Regulatory Agency’s (MHRA) guidelines, larger packs of the products will also only be available in pharmacies going forward. Smaller packs will continue to be available for general sale in shops for the treatment of short-term constipation in adults.

Warnings highlighting the risk of overuse, as well as information explaining that the product does not help weight loss, must also be clearly visible on the drug packaging, the MHRA said

This change follows a national safety review, which investigated the benefits and risks of these medicines after evidence suggested that some people with eating disorders were abusing the OTC drug.

In line with clinical guidance, the Commission on Human Medicines’s (CHM) review said that healthcare professionals should not suggest the use of laxatives as a first-line for short-term constipation. Instead, dietary and lifestyle measures, such as increasing dietary fibre, fluid intake, and activity levels should be considered. Bulk laxatives may also be supplied as an alternative.

The Medicines and Healthcare products Regulatory Agency (MHRA) also said that anyone with regular constipation should be advised against the extended overuse of stimulant laxatives, which can cause long term damage to the digestive system.

‘Necessary measures’

In response to the development Sandra Gidley, president of the Royal Pharmaceutical Society, said: ‘We’re pleased to have worked with the MHRA on new guidance for community pharmacists and their teams so they can give patients the best advice.

‘As experts in medicines, pharmacists are well placed to help ensure patients do not overuse stimulant laxatives. If a patient has a question about different laxative products or are unsure about what they are currently taking, the pharmacy team will be permitted to help and signpost on if necessary.’

Dr Sarah Branch, director of MHRA’s Vigilance and Risk Management of Medicines Division, explained that ‘stimulant laxatives can provide short-term relief to some people with occasional constipation, and most people use these medicines safely. However, there is evidence of misuse by people with eating disorders, and of long-term use by the elderly, as well as inappropriate use in children.

‘Patient safety is our highest priority. We believe these new measures are necessary to address the risks associated with misuse while continuing to allow safe and appropriate access to these medicines without prescription to treat short-term constipation.’