The safety of stimulant laxatives has been under close review by the MHRA for several years following concerns relating to misuse and abuse. Excessive doses of laxatives may cause diarrhoea, which if prolonged can result in electrolyte disturbances such as hypokalaemia. There have been rare case reports of misuse and overdose resulting in fatality. 

There are three main groups of patients who are likely to suffer from laxative misuse or overuse:

• People (often elderly) with chronic constipation who get into a vicious cycle by using stimulant laxatives, which eventually results in damage to the nerves in the bowel and muscle paralysis (atonic colon)
• Those who take laxatives in the belief that they will control weight; for example, people dieting or those with eating disorders (anorexia nervosa or bulimia), who may take very large quantities of laxatives
• Children: MHRA highlighted inappropriate use in children as a particular concern.