Which medications and newer therapies are used in the treatment of constipation?

Updated: Jul 05, 2019
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Medications to treat constipation include the following:

  • Bulk-forming agents (fibers; eg, psyllium): arguably the best and least expensive medication for long-term treatment

  • Emollient stool softeners (eg, docusate): Best used for short-term prophylaxis (eg, postoperative)

  • Rapidly acting lubricants (eg, mineral oil): Used for acute or subacute management of constipation

  • Prokinetics (eg, tegaserod): Proposed for use with severe constipation-predominant symptoms

  • Stimulant laxatives (eg, senna): Over-the-counter agents commonly but inappropriately used for long-term treatment of constipation

Newer therapies for constipation include the following:

  • Prucalopride is a prokinetic selective 5-hydroxytryptamine-4 (5-HT4) receptor antagonist that stimulates colonic motility and decreases the transit time

  • The osmotic agent lubiprostone is FDA approved for constipation caused by IBS [3] and opioid-induced constipation [4] in adults with chronic, noncancer pain

  • Linaclotide [5] and plecanatide [6, 7] are guanylate cyclase C (GC-C) agonists; they are indicated for chronic idiopathic constipation. Additionally, linaclotide is indicated for constipation caused by IBS in adults

  • Several peripherally-acting mu-opioid receptor antagonists (PAMORA) have been approved by the FDA for opioid-induced constipation in adults with chronic noncancer pain and/or for palliative care (eg, naloxegol, methylnaltrexone, naldemedine)

See Treatment and Medication for more detail.


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