Sorbitol Content of Selected Oral Liquids

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Abstract
OBJECTIVE: Excipients in pharmaceuticals usually are considered inert, and may be overlooked in the differential diagnosis of diarrhea. Sorbitol-containing medicinal liquids are capable of inducing osmotic diarrhea. We reviewed the oral liquids in our formulary to determine their sorbitol content and to evaluate the availability of this information. DESIGN: The oral liquids stocked by our hospital were determined through a computer search and manual inspection of the pharmacy storeroom. Three common sources of drug information were consulted to determine each product's sorbitol content: Manufacturers' product information, American Hospital Formulary Service (AHFS) Drug Information 91, and Facts and Comparisons Drug Information. We then contacted each manufacturer by mail or telephone to verify the information. SETTING: The study was conducted at the University of Cincinnati Hospital, a tertiary-care, teaching hospital. RESULTS: A total of 129 products (98 chemical entities) were reviewed. Fifty-four (42 percent) of the products examined contained sorbitol. The frequency of sorbitol presence by liquid type was: Solutions (33 percent), suspensions (43 percent), syrups (59 percent), elixirs (43 percent), concentrates (67 percent), drops (33 percent), tinctures (0 percent), and emulsions (0 percent). The percentage of listings indicating the presence of sorbitol was: Manufacturer's product information (79 percent), Facts and Comparisons (52 percent), and AHFS Drug Information 91(13 percent). Only three of the 54 products had the exact sorbitol content stated in any source. CONCLUSIONS: Based on literature data, single doses greater than 10 g and total daily doses greater than 50 g of sorbitol would produce adverse gastrointestinal effects in a sizable number of adults. Many of the marketed products reviewed could deliver an adult laxative dose. Current labeling is insufficient for healthcare providers to assess the risk for individual patients.