Sorbitol

(USAN)

💊 Chemical information

E420; D-Sorbitol; Sorbitoli; Sorbitolis; Sorbitolum; Szorbit. D-Glucitol.
Chemical formula: C6H14O6 = 182.2.
CAS — 50-70-4.
ATC — A06AD18; A06AG07; B05CX02; V04CC01.
ATC Vet — QA06AD18; QA06AG07; QB05CX02; QV04CC01.

Pharmacopoeias.

In Chin., Eur., Jpn, and Viet. Also in USNF. US includes only Sorbitol Solution.

Ph. Eur. 6.2

(Sorbitol). A white or almost white crystalline powder. It exhibits polymorphism. Very soluble in water; practically insoluble in alcohol.

USNF 26

(Sorbitol). White, odourless, hygroscopic powder, granules, or crystalline masses having a sweet taste with a cold sensation. Soluble 1 in 0.45 of water; sparingly soluble in alcohol; practically insoluble in solvent ether. pH of a 10% w/w solution in water is between 3.5 and 7.0.

Incompatibility.

For reference to the incompatibility of sorbitol with hydroxybenzoates.

💊 Adverse Effects and Precautions

As for Fructose.

Effects on electrolyte balance.

Sorbitol is used as a vehicle in some proprietary preparations of activated charcoal intended to reduce drug absorption after poisoning; the sorbitol increases the palatability of the preparation and also produces an osmotic diarrhoea that facilitates elimination of the activated charcoal and adsorbed drug. Repeated doses of such preparations are often advocated but there have been reports1-3 of severe sorbitolinduced hypernatraemia in adults and children. In all cases, charcoal in a 70% sorbitol suspension had been given. It has been recommended that fluid and electrolyte balance be monitored closely, and that preparations with lower concentrations of sorbitol be used if possible.2,3 For debate about such multiple dose therapy see Poisoning, under Activated Charcoal.
1. Gazda-Smith E, Synhavsky A. Hypernatraemia following treatment of theophylline toxicity with activated charcoal and sorbitol. Arch Intern Med 1990; 150: 689 and 692
2. Allerton JP, Strom JA. Hypernatremia due to repeated doses of charcoal-sorbitol. Am J Kidney Dis 1991; 17: 581–4
3. Farley TA. Severe hypernatremic dehydration after use of an activated charcoal-sorbitol suspension. J Pediatr 1986; 109: 719–22.

Effects on the gast

rointestinal tract. Sorbitol is often used as a sweetener in sugar-free preparations and the risk of sorbitolinduced diarrhoea associated with such products has been highlighted.1-4 Chronic sorbitol-induced diarrhoea with associated pneumatosis intestinalis has been reported in a child given 21.7 g sorbitol daily in liquid medications.5 Colonic and upper gastrointestinal necrosis, including some fatalities, have been reported after use of sodium polystyrene sulfonate in sorbitol, and may have been associated with the sorbitol component. It has also been suggested that sorbitol contributed to the morbidity in a patient who developed septicaemia as a complication of intestinal pseudo-obstruction, after the use of charcoal with sorbitol to treat self-poisoning with theophylline.6 It was suggested that gaseous distension after bacterial metabolism of sorbitol had rendered the bowel wall ischaemic, facilitating passage of bacteria or of endotoxin into the systemic circulation.
1. Brown AM, Masson E. ‘Hidden’ sorbitol in proprietary medicines - a cause for concern? Pharm J 1990; 245: 211
2. Edes TE, et al. Diarrhea in tube-fed patients: feeding formula not necessarily the cause. Am J Med 1990; 88: 91–3
3. Johnston KR, et al. Gastrointestinal effects of sorbitol as an additive in liquid medications. Am J Med 1994; 97: 185–91
4. Bauditz J, et al. Severe weight loss caused by chewing gum. BMJ 2008; 336: 96–7
5. Duncan B, et al. Medication-induced pneumatosis intestinalis. Pediatrics 1997; 99: 633–6
6. Longdon P, Henderson A. Intestinal pseudo-obstruction following the use of enteral charcoal and sorbitol and mechanical ventilation with papaveretum sedation for theophylline poisoning. Drug Safety 1992; 7: 74–7.

💊 Pharmacokinetics

Sorbitol is poorly absorbed from the gastrointestinal tract after oral or rectal use. It is metabolised mainly in the liver, to fructose, a reaction catalysed by the enzyme sorbitol dehydrogenase. Some sorbitol may be converted directly to glucose by the enzyme aldose reductase.

💊 Uses and Administration

Sorbitol is a polyhydric sugar alcohol (polyol) with half the sweetening power of sucrose. It occurs naturally in many fruits and vegetables and is prepared commercially by the reduction of glucose. It has been given as a 30% solution as an alternative to glucose in parenteral nutrition but its use is not recommended because of the risk of lactic acidosis. Sorbitol may be given orally or rectally as an osmotic laxative in the management of constipation; doses of 20 to 50 g have been suggested. Solutions containing about 3% of sorbitol are used as irrigating fluids in transurethral surgical procedures. Sorbitol was formerly given intravenously as a 50% solution as an osmotic diuretic. Sorbitol also acts as a bulk sweetening agent. It is used in limited quantities as a sweetener in energy-reduced diabetic food products. It is also used as an alternative to sucrose in many sugar-free oral liquid preparations and in sugar-free foods as it is less likely to cause dental caries. Sorbitol also has humectant and stabilising properties and is used in various pharmaceutical and cosmetic products including toothpaste.

💊 Preparations

Ph. Eur.: Sorbitol, Liquid (Crystallising); Sorbitol, Liquid (Non-crystallising); Sorbitol, Liquid, Partially Dehydrated; USNF 26: Noncrystallizing Sorbitol Solution; USP 31: Sorbitol Solution.

Proprietary Preparations

Arg.: Progras†; Austral.: Sorbilax; Braz.: Minilax; Cz.: Ardeanutrisol SO†; Hung.: Szorbit†; Swed.: Cystosol†; Resulax. Multi-ingredient: Arg.: Humectante Bucal; Micronema; Austral.: Aquae; Carbosorb S; Fleet Micro-Enema; Medevac†; Microlax; Austria: Glandosane; Lemazol; Microklist; Resectal; Trommgallol; Yal; Belg.: Microlax; Spagulax Sorbitol; Braz.: Anekron; Biliflux†; Colachofra; Hepalin; Hepatobe†; Hepatox; Hormo Hepatico†; Canad.: Charac Tol; Charcodote; Microlax; Salivart; Chile: Salivart†; Secand; Tabletas Phillips; Cz.: Yal ; Denm.: Klyx; Fin.: Klyx; Microlax; Somanol + Ethanol; Fr.: Apilaxe†; Artisial; Exova†; Hepacholine†; Hepagrume; Hepargitol; Microlax; Nivabetol; Ornitaine; Parapsyllium; Schoum; Spagulax au Sorbitol; SST; Ger.: Flacar; Freka-Drainjet Purisole; Glandosane; Klysma Sorbit; Microklist; Tutofusin S†; Yal; Hong Kong: Aquae; Glandosane; Microlax; Salivart; Hung.: Balansol; Yal†; India: Alkasol-P; Livocip; Mecolin; Sorbiline; Sorliv; Indon.: Laxarec; Microlax; Israel: Charcodote; Spray Mint; Ital.: Citroepatina; Macrolax; Magisbile†; Novilax; Sorbiclis; Malaysia: Microlax†; Mex.: Clyss-Go; Neth.: Klyx; Microlax; Norw.: Klyx; Microlax; NZ: Carbosorb S†; Carbosorb XS; Medevac†; Microlax; Pol.: Purisole SM; Rektiolax; Port.: Clyss-Go; Glandosane; Purisole; Rus.: Microlax (Микролакс); S.Afr.: Agofell; Microlax†; Spain: Sugarbil; Vitaphakol; Swed.: Klyx; Microlax; Vi-Siblin S; Switz.: Agarol Soft; Cital†; Glandosane; Microklist; Pursana; Yal; Thai.: Glandosane†; Tu rk .: Charflo Sorbitol; Kansilak; Libalaks; Sabalax; UK: Glandosane; Luborant; Relaxit; Saliva Natura; SST; USA: Actidose with Sorbitol; Moi-Stir; Numoisyn; Plax; Salivart; Venez.: Clys-Go†.
Published January 26, 2019.