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Norwegian Institute of Public Health
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All agents used for treatment of constipation (regardless of indication) are classified here.
The agents are mainly subdivided according to mode of action. All enemas are classified in A06AG, regardless of mode of action.
Some combination products are classified at separate levels. These are mentioned in the respective ATC group.
Otherwise combination products are classified at separate 5th levels using the corresponding 50-series.
Laxatives in combination with centrally acting antiobesity agents are classified in A08A - Antiobesity preparations, excl. diet products.

A06AA Softeners, emollients

This group comprises preparations containing liquid paraffin, docusate sodium etc. Docusate potassium is classified at the same 5th level as docusate sodium.
Combinations with contact laxatives are classified in A06AB, except all liquid paraffin combinations, which are classified in A06AA.

DDDs for e.g. liquid paraffin and castor oil are given using the following unit: g (gram), (1 g = 1 ml for all practical purposes). Preparations classified in A06AA51 - liquid paraffin, combinations, are all given the same DDD = 3 UD (15 ml), independent of liquid paraffin concentration.

A06AB Contact laxatives

This group comprises agents, which mainly inhibit the absorption of electrolytes and water through a specific pharmacological mechanism.
Combinations with osmotically acting laxatives are classified here.
Combinations with bulk producing laxatives are classified in A06AC - Bulk-forming laxatives.
Gas producing rectal preparations and glycerol suppositories, see A06AX - Other drugs for constipation.
Phenolphthalein in combination with liquid paraffin, see A06AA.
Combined packages with tablets and enemas are classified in A06AG.
A major part of the products classified in this group are various combinations of two or more contact laxatives. These are classified at separate 5th levels:
A06AB20 - contact laxatives in combination
A06AB30 - contact laxatives in combination with belladonna alkaloids
Otherwise combination products are classified at separate 5th levels using the corresponding 50-series.
Preparations containing bark (cortex) of Rhamnus pursiana and Rhamnus frangula are classified in A06AB07 cascara.

A06AC Bulk-forming laxatives

This group comprises linseed and psylla seed products, methyl cellulose etc.
Lactulose, see A06AD.
Products containing linseed in combination with antacids are classified in A02A.
Products containing sterculia in combination with alverine are classified in A03AX.

A06AD Osmotically acting laxatives

This group comprises various saline purgatives and e.g. lactulose, which is primarily considered as an osmotically acting substance.
Combinations with contact laxatives are classified in A06AB.
Mineral salts in combinations are classified in A06AD10.
Combinations of lactulose with liquid paraffin should be classified in A06AD61.
Macrogol in combination with electrolytes is classified in A06AD65.
Magnesium hydroxide is classified as an antacid in A02AA.
Magnesium in combination with albumin tannate are classified in A07XA.

The DDD for macrogol refers to macrogol 4000.

A06AG Enemas

All enemas and laxative rectal solutions are classified in this group, regardless of mode of action.
Combined packages containing tablets and enemas are classified in this group.
Some 5th levels for plain substances also include combinations, e.g.:
A06AG10 - docusate sodium- and e.g. sorbitol or glycerol
A06AG11 - sodium lauryl sulfoacetate and e.g. sodium citrate
Sodium laurilsulfate is also classified in A06AG11.

The DDDs for enemas classified in this group are 1 enema.

A06AH Peripheral opioid receptor antagonists
A06AX Other drugs for constipation

This group comprises all agents, which cannot be classified in the preceding groups, e.g. lubiprostone, linaclotide, tenapanor and prucalopride.

The DDD for linaclotide is based on treatment of irritable bowel syndrome with constipation.

Last updated: 2024-01-26