Sorbitol (Agarol) is a type of sugar that has got cathartic properties and is also used as an artificial sweetener. It is used for bladder irrigation during urethral procedures.

Sorbitol Uses:

• It is used as a bladder irrigant in patients undergoing transurethral resection of the prostate, or other transurethral surgical procedures.
• It is also used as a laxative (as an osmotic laxative) and to facilitate the passage of kayexalate (sodium polystyrene sulfonate) through the intestinal tract.
• It may be used for the following purposes as well
  • used as a diuretic.
  • Humectant
  • Sweetening agent;

Sorbitol (Agarol) Dose in Adults

Sorbitol (Agarol) Dose in the treatment of Hyperosmotic laxative (single dose, at infrequent intervals):

• Oral: 30 to 45 mL (as 70% solution)
• Rectal enema: 120 mL as 25% to 30% solution

• Adjunct to sodium polystyrene sulfonate:

  • 15 mL as 70% solution orally until diarrhea occurs (10 to 20 mL/2 hours) or
  • 20 to 100 mL as an oral vehicle for the sodium polystyrene sulfonate resin

• Transurethral surgical procedures:

  • Irrigation: Topical: 3% to 3.3% as transurethral surgical procedure irrigation

Sorbitol (Agarol) Dose in Childrens

Sorbitol (Agarol) Dose in the treatment of Constipation:

• Oral: 70% solution:

• Manufacturer's labeling:
  • Children ≥12 years and Adolescents:
    • Usual dose: 30 to 45 mL once a day as needed;
    • The maximum dose: 60 mL/dose;
    • Higher daily doses (60 to 90 mL in divided doses) may be required in some patients.
• Alternate dosing: Limited data available:
  • Infants, Children, and Adolescents:
    • 1 to 3 mL/kg/day in divided doses, once or two times a day
    • The usual dosage range in adolescents is: 30 to 90 mL/day

Rectal enema: 25% to 30% solution:

• Children 2 to <12 years:

  • 30 to 60 mL once a day as needed

• Children ≥12 years and Adolescents:

  • 120 mL once a day as needed

Sorbitol (Agarol) Dose in the treatment of slow fecal disimpaction: Oral: 70% solution:

• Infants, Children, and Adolescents:

  • 2 mL/kg two times a day for 7 days.

Sorbitol (Agarol) Dose in the treatment of Toxic ingestion as an 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.

Pregnancy Risk Factor C

• Studies on animal reproduction have not been done.

Use during breastfeeding:

• Manufacturers recommend that lactating mothers use the drug with caution.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Side effects of Sorbitol (Agarol):

• Cardiovascular:

  • Edema

• Endocrine & Metabolic:

  • Electrolyte Depletion
  • Hyperglycemia
  • Hypovolemia
  • Lactic Acidosis

• Gastrointestinal:

  • Abdominal Distress
  • Diarrhea
  • Nausea
  • Vomiting
  • Xerostomia

Contraindications to Sorbitol (Agarol):

• Anuria (for irrigation).

OTC labeling

• Self-medication should not be used for longer than seven days. Avoid using the medication if you have abdominal pain, nausea or vomiting.

Warnings and precautions

• Fluid and electrolyte imbalances:

  • Fluid overload or electrolyte changes can occur if you use a large amount of the drug.

• Cardiopulmonary disease

  • Patients suffering from severe cardiopulmonary disease must be cautious.

• Renal impairment

  • It should be used with caution by patients with impaired renal function.

• Incapable to metabolizesorbitol

  • Patients who are unable to metabolize sorbitol must be advised not to use it.

Sorbitol: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Monitor for fluid overload and/or electrolyte disturbances following large volumes;
• Monitor for gastrointestinal distress such as bloating and flatulence.

How to administer Sorbitol (Agarol)?

Sorbitol Syrup:

• It is administered after meals with a glass of water or mixed with a beverage.

Sorbitol for Rectal administration:

• The 70% sorbitol solution is mixed with water in a ratio of 1:2.3 to make a solution of 25% - 30% concentration.
• The final mixture is then administered rectally gently with the tubings provided by the manufacturer.

Urethral administration:

• A 3.3% urethral solution is used for bladder irrigation. Follow the manufacturer's drug prescribing information manual.

Mechanism of action of Sorbitol (Agarol):

It is a sugary polyalcoholic that can be used for osmotic cathartic purposes.

The beginning of action:

• Rectal: 0.25 to 1 hour

Absorption:

• Oral, rectal: Poor

Metabolism:

• Primarily metabolized in the liver to fructose.

International Brand Names of Sorbitol:

• Agarol
• Ardeanutrisol SO
• Cystosol
• klysma Sorbit
• Medevac
• Progras
• Resulax
• Sladial
• Sorbilande
• Sorbilax
• Sorbit Fresenius
• Sorbit Leopold
• Sorbit Mayrhofer
• Sorbitol Aguettant
• Sorbitol Baxter
• Sorbitol Delalande
• Sorbitol-Infusionslosung
• Syn M.D.

Sorbitol Brand Names in Pakistan:

No Brands Available in Pakistan.