Sorbitol

J01 - Antibacterials for systemic use Small molecule approved 1982 Natural product

JFDA label: Synolis VA 40/80 Mg (Intra-articular)

Mechanism of Action

A polyalcoholic sugar with osmotic cathartic actions

Indications

Approved

Constipation — Constipation

Off-label

Charcot-Marie-Tooth Disease
Non-alcoholic Fatty Liver Disease
Osteoarthritis, Knee
Severe Acute Respiratory Syndrome
Wounds and Injuries

Contraindications

Source: Lexicomp

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 Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Cardiac disorders (1)

Not Known Edema

Metabolism and nutrition disorders (4)

Not Known Electrolyte depletion · hyperglycemia · hypovolemia · lactic acidosis

Gastrointestinal disorders (5)

Not Known Abdominal distress · diarrhea · nausea · vomiting · xerostomia

Dosing

Source: Lexicomp

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 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

(For additional information see "Sorbitol: Pediatric drug information") Hyperosmotic laxative (as single dose, at infrequent intervals): Children 2 to 11 years: Rectal enema: 30 to 60 mL as 25% to 30% solution Children ≥12 years and Adolescents: Oral, Rectal enema: Refer to adult dosing.

Refer to adult dosing.

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

Warnings & Precautions

Source: Lexicomp

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.

Renal impairment

Use with caution in patients with renal impairment.

Unable to metabolize sorbitol

Use with caution in patients unable to metabolize sorbitol.

Pregnancy & Lactation

Pregnancy

FDA category C

Animal reproduction studies have not been conducted.

Lactation

The manufacturer recommends that caution be exercised when administering sorbitol to nursing women.

Monitoring

Clinical pearl	Monitor for fluid overload and/or electrolyte disturbances following large volumes; GI distress (bloating, flatulence)

Chemistry & Properties

Formula	C6H14O6
Molecular weight	182.17 g/mol
IUPAC name	(2R,3R,4R,5S)-hexane-1,2,3,4,5,6-hexol
CAS	50-70-4
PubChem CID	5780
InChIKey	`FBPFZTCFMRRESA-JGWLITMVSA-N`
logP	-3.59 (XLogP -3.1)
Polar surface area	121.38 Å²
H-bond acceptors / donors	6 / 6
Drug-likeness (QED)	0.26
Lipinski violations	1

SMILES

OC[C@@H](O)[C@@H](O)[C@H](O)[C@@H](O)CO

Biology & Pharmacokinetics

Pharmacokinetics predicted

Bioavailability	70.0%
Half-life	1.77 h
Volume of distribution	0.333 L/kg
Protein binding	29.4%
BBB penetrant	No

Enzyme interactions

Enzyme	Role	Detail
CYP2C8	Inhibitor	—
CYP2C9	Substrate	—

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)

Drug–drug interactions (2, DDInter)

Interacting drug	Severity	Management
Tolevamer	major
Lamivudine	moderate

Registered Products (1)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
Synolis VA 40/80 Mg (Intra-articular)	Gel 40.0 mg, 20.0 mg	2 ml	Aptissen S.A	—