From the Guidelines
For constipation, the most effective first-line medication is polyethylene glycol (MiraLAX), which should be taken at a dose of 17 grams (about 1 tablespoon) dissolved in 8 ounces of water once daily for up to 7 days, as recommended by the most recent and highest quality study 1.
Key Considerations
- Stimulant laxatives such as bisacodyl (Dulcolax) or senna (Senokot) can be used more sparingly, typically 5-10 mg for bisacodyl or 8.6-17.2 mg for senna tablets at bedtime, but are not the first choice due to potential side effects and lower efficacy compared to polyethylene glycol 1.
- Stool softeners like docusate sodium (Colace) are not recommended as they have not shown benefit in preventing constipation 1.
- For more severe cases, prescription medications like lubiprostone (Amitiza) or linaclotide (Linzess) may be needed, with linaclotide being a strong recommendation for IBS with constipation due to its high efficacy and quality of evidence 1.
Additional Recommendations
- Increase water intake to at least 8 glasses daily and add more fiber to your diet through fruits, vegetables, and whole grains to help prevent constipation.
- If constipation persists beyond a week or recurs frequently, consult a healthcare provider to rule out underlying conditions.
- The use of peripherally acting mu opioid receptor antagonists such as oral methylnaltrexone, naloxegol, or naldemedine may be considered as a rescue for opioid-induced constipation, but only when clearly related to opioid therapy and under the guidance of a healthcare provider 1.
From the FDA Drug Label
Lubiprostone is indicated for the treatment of chronic idiopathic constipation (CIC) in adults. Lubiprostone is indicated for the treatment of opioid-induced constipation (OIC) in adult patients with chronic non-cancer pain. Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
The best medication for constipation is Lubiprostone (PO), as it is indicated for the treatment of:
- Chronic Idiopathic Constipation (CIC) in adults
- Opioid-Induced Constipation (OIC) in adult patients with chronic non-cancer pain
- Irritable Bowel Syndrome with Constipation (IBS-C) in women at least 18 years old 2
From the Research
Medication Options for Constipation
- Various agents are used for the medical management of chronic constipation, including bulk and fiber products, lubricating agents, stimulants, and osmotic laxatives 3
- Popular therapeutic options for initial treatment of chronic constipation are dietary fiber and medicinal bulk, with subsequent treatments including saline osmotic laxatives, lactulose, or stimulants like senna or bisacodyl 3
- Polyethylene glycol (PEG) laxative has been shown to be safe and effective as an initial or second-line agent for chronic constipation 3, 4, 5
Fiber Supplementation
- Increasing fiber intake may improve symptoms of chronic constipation, with soluble fibers like psyllium being more effective than insoluble fibers like wheat bran 4, 6, 7
- Psyllium has been shown to be 3.4 times more effective than insoluble wheat bran for increasing stool output in patients with chronic idiopathic constipation 7
- Fiber supplementation can improve stool frequency, consistency, and quality of life in adults with chronic constipation, with higher doses (>10g/d) and longer treatment durations (≥4 weeks) being more effective 6
Laxative Effects
- Not all fibers have a laxative effect, and some may even be constipating 7
- PEG has been shown to be an effective and well-tolerated laxative, with a low risk of side effects 4, 5
- The combination of psyllium and PEG may be an important therapeutic option for patients suffering from chronic constipation, combining the advantages of fiber and isotonic solutions 4