From the Guidelines
For a patient experiencing constipation while on Wellbutrin, I recommend starting with polyethylene glycol (Miralax) 17g daily, as it is the most effective and recent recommendation 1. This medication works by drawing water into the intestines to soften stool. If this is insufficient, bisacodyl (Dulcolax) 5-10mg daily or senna 8.6-17.2mg at bedtime can provide stimulant effects. Some key points to consider when treating constipation in patients on Wellbutrin include:
- Increasing fluid intake, dietary fiber, and physical activity alongside medication treatment
- Considering prescription medications like lubiprostone (Amitiza) 24mcg twice daily or linaclotide (Linzess) 145-290mcg daily for more severe cases
- Noting that constipation is a known side effect of Wellbutrin (bupropion) due to its norepinephrine reuptake inhibition, which can decrease gut motility
- Consulting with the prescribing physician about adjusting the Wellbutrin dosage or switching to an alternative antidepressant with fewer gastrointestinal side effects if constipation persists despite these interventions 1. It's also important to rule out other causes of constipation, such as impaction, obstruction, or other treatable causes, and to consider the use of peripherally acting μ-opioid receptor antagonists like methylnaltrexone for opioid-induced constipation 1.
From the Research
Treatment Options for Constipation
The patient's constipation, potentially caused by Wellbutrin, can be addressed through various treatment modalities.
- Nonpharmacologic approaches, such as increased exercise or fluid intake and bowel habit training, are generally recommended as first-line treatments 2.
- Pharmacologic agents, including laxatives and fiber supplements, may also be beneficial, although their efficacy can vary 2, 3, 4.
Recommended Medications
Some studies suggest that the following medications may be effective in treating chronic constipation:
- Psyllium, a soluble fiber that can help improve digestive symptoms 3, 4.
- Polyethylene glycol (PEG), an inert and non-absorbable molecule that can increase the volume of intestinal contents and facilitate transport and evacuation 3, 4.
- Lubiprostone, a medication that can exert beneficial effects on chloride secretion and may be used as an adjunctive agent in diagnostic and management strategies 5.
- Tegaserod, a medication with a well-established clinical profile for the treatment of chronic constipation 2, 4.
Combination Therapies
Combining different medications or therapies may also be effective in treating chronic constipation.
- The combination of psyllium and PEG may combine the advantages of fiber and isotonic solutions and represent an important therapeutic option for patients suffering from chronic constipation 3.