Medication shows promise for patients with severe chronic constipation

May 28, 2008

A new medication appears to offer significant relief to patients with severe chronic constipation while minimizing the likelihood of cardiac-related side effects, according to results of a study published this week in the New England Journal of Medicine.

The trial involved 38 medical centers and was led by Michael Camilleri, M.D., a Mayo Clinic gastroenterologist. Patients who met the study criteria were randomly assigned to receive either of two dosage levels of prucalopride, a medication that stimulates protein receptors involved in contraction of the colon, or a placebo.

“Many more of the patients taking prucalopride were able to have spontaneous bowel movements without having enemas or taking laxatives, as compared to those who were given placebo,” says Dr. Camilleri. “The time it took to have a first bowel movement was much shorter, and quality of life and other abdominal symptoms also were improved for those taking the study drug.”

Constipation is a common medical problem, affecting about 15 percent of Americans who spend several billion dollars each year on laxatives and other treatments. Prevalence is higher among women and African-Americans and is particularly increased in the elderly. This study involved patients with an extreme but common version of constipation called severe chronic constipation. To
participate, patients had to have at least six months of constipation, defined as an average of fewer than three bowel movements a week. Those who had more than four bowel movements during the two-week “run-in” period before treatment began were not eligible.

“The normal range of bowel movements is anywhere from three per day to three per week,” explains Dr. Camilleri. “The 620 patients studied in this trial were severely constipated, averaging only one bowel movement during the two weeks before entering treatment, and most had struggled with the problem for several years, not merely months.”

The 2 milligram (mg) and 4 mg doses of prucalopride appeared roughly equal in benefit, with about 30 percent of patients averaging three bowel movements per week during the 12-week study. Only 12 percent of patients on placebo averaged three bowel movements per week. Nearly half (47.3 and 46.6 percent, respectively) of the patients taking prucalopride increased their bowel movements by at least one per week, while about a quarter (25.8 percent) of those on placebo had a similar improvement.

The most common adverse effect from the drug was diarrhea, which tended to occur in the early stages of treatment, but most patients later settled into a more normal routine of bowel movements. Increased bowel movements and diarrhea are expected effects of the drug. Only 1.5 percent and 4.4 percent of patients treated with 2 mg and 4 mg of prucalopride, respectively, stopped the drug due to diarrhea. “This suggests that the diarrhea was less bothersome than the constipation had been,” Dr. Camilleri says. Headaches were a less frequent side effect.

Dr. Camilleri says the cardiac risk issues that have been raised about related drugs for constipation including tegaserod, appear to be less of a concern for prucalopride. “Prucalopride is highly selective in its effect, and doesn’t interact significantly with other protein receptors, such as those involved in regulating heart rhythm,” he explains. “We conducted electrocardiogram testing during the study and did not find heart rhythm issues, although two of the three patients who withdrew from the study did have symptoms, palpitations and dizziness that may have been attributable to an effect on the cardiovascular system.”

Source: Mayo Clinic

Explore further: Evidence lacking for long-term opioid use in low back pain

add to favorites email to friend print save as pdf

Related Stories

Kids still swallowing magnets despite warning labels

Oct 23, 2012

(HealthDay)— Warning labels do little to prevent children from swallowing high-powered magnets that can tear holes in the stomach and bowel and cause severe, life-threatening complications, a new study ...

Curry spice could offer treatment hope for tendinitis

Aug 09, 2011

(PhysOrg.com) -- A derivative of a common culinary spice found in Indian curries could offer a new treatment hope for sufferers of the painful condition tendinitis, an international team of researchers has shown.

New medication more potent, longer lasting than morphine

Jan 04, 2011

(PhysOrg.com) -- A little-known morphinelike drug is potentially more potent, longer lasting and less likely to cause constipation than standard morphine, a study led by a Loyola University Health System anesthesiologist ...

Banana plantain fibers could treat Crohn's disease

Aug 25, 2010

Crohn's is a condition that affects one in 800 people in the UK and causes chronic intestinal inflammation, leading to pain, bleeding and diarrhoea. Researchers are working with biotechnology company, Provexis, to test a ...

Recommended for you

Drug watchdog urges vigilance in cancer drug theft

1 hour ago

Europe's medicine watchdog urged doctors Thursday to be vigilant in administering the cancer drug Herceptin, vials of which had been stolen in Italy and tampered with before being sold back into the supply chain.

Pyridoxine-doxylamine drug safety data lacking

Apr 16, 2014

(Medical Xpress)—The most commonly prescribed drug for pregnant women suffering from morning sickness in their first trimester does not prevent birth defects even though drug safety data says it does, according to research ...

User comments : 2

Adjust slider to filter visible comments by rank

Display comments: newest first

vlam67
3 / 5 (1) May 28, 2008
To all constipated: Eat a 100g of roasted pumpkin seeds and come back and ask me for how to stop visiting the loo. Hopeless "modern" humans who are being robbed blind by the medicos!
westonprice
not rated yet May 29, 2008
I agree. These people have to stop eating concrete (or more likely junk food) and start eating real food. I can't imagine going more than two days without defecating let alone two weeks.

More news stories

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Is Parkinson's an autoimmune disease?

The cause of neuronal death in Parkinson's disease is still unknown, but a new study proposes that neurons may be mistaken for foreign invaders and killed by the person's own immune system, similar to the ...