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## Liquid Paraffin
### Overview
Liquid paraffin is a highly refined mineral oil used as an emollient and laxative. It lubricates the intestinal tract, softening stool and facilitating its passage. It is poorly absorbed from the gastrointestinal tract.
### Primary Indications
* Constipation
### Adult Dosing
* **Laxative:** 10-30 mL once daily, typically at bedtime. Doses may be adjusted based on response. Higher doses may be used for short-term management of severe constipation, but prolonged use is generally discouraged.
### Pediatric Dosing
* **Constipation:** Dosing is highly variable and dependent on age and weight.
* **Under 1 year:** Generally not recommended due to risk of aspiration and potential for systemic absorption. If used, extreme caution is advised and usually under specialist guidance. Specific doses are not well-established and will depend on local pediatric protocols.
* **1-5 years:** 5-10 mL once daily.
* **6-12 years:** 10-15 mL once daily.
* **Over 12 years:** Adult dosing may apply (10-30 mL once daily).
### Dose Adjustments
* No dose adjustments are typically required for hepatic or renal impairment, as systemic absorption is minimal.
### Contraindications
* Allergic reaction to liquid paraffin.
* Patients with difficulty swallowing, due to the risk of aspiration.
* Concurrent use with docusate sodium (risk of increased absorption).
* Appendicitis or symptoms of intestinal obstruction.
* Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).
* Children under 1 year of age, unless specifically indicated and supervised by a healthcare professional.
### Adverse Effects
* **Common:** Abdominal cramping, anal leakage, diarrhea, nausea.
* **Less Common:** Steatorrhea (fatty stools), vitamin malabsorption (with prolonged, high-dose use, particularly fat-soluble vitamins A, D, E, K).
* **Rare:** Lipoid pneumonia (due to aspiration).
### Key Drug Interactions
* **Docusate Sodium:** Concurrent use may increase absorption of liquid paraffin.
* **Fat-soluble Vitamins (A, D, E, K):** Prolonged use may impair absorption. Separate administration by at least 2 hours.
* **Other Oral Medications:** May delay or reduce the absorption of other orally administered drugs due to its lubricating effect. Separate administration by at least 2 hours.
### Monitoring
* Monitor for bowel movements, stool consistency, and presence of abdominal pain or cramping.
* Assess for anal leakage or soiling, especially in children and the elderly.
* With prolonged use, consider monitoring for signs of vitamin deficiency, though this is rare with typical intermittent use.
### Clinical Pearls
* Administer at bedtime to minimize disruption and potential for anal leakage during waking hours.
* Advise patients to avoid lying down immediately after taking liquid paraffin to reduce the risk of aspiration.
* Educate patients that anal leakage can occur and suggest using a sanitary pad if necessary.
* Liquid paraffin is generally not recommended for long-term daily use due to potential for dependence and vitamin malabsorption. Intermittent use for occasional constipation is preferred.
* Ensure adequate hydration when using laxatives.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making clinical decisions.*
