From the Research
The first-line treatment for constipation associated with GLP-1 receptor agonist medications is increased fluid intake, dietary fiber enhancement, and an osmotic laxative such as polyethylene glycol (PEG 3350, Miralax). Start with PEG 3350 at a dose of 17 grams (one capful) dissolved in 8 ounces of water once daily, which can be adjusted based on response 1. Patients should also aim to drink at least 2-3 liters of water daily and increase dietary fiber to 25-30 grams per day through fruits, vegetables, and whole grains. This approach addresses the underlying mechanism of GLP-1 agonist-induced constipation, which occurs due to delayed gastric emptying and reduced intestinal motility, as noted in studies on the effects of GLP-1 analogs on gastrointestinal motor functions 2.
Some key points to consider in managing constipation associated with GLP-1 receptor agonists include:
- Increasing fluid intake to help soften stool and make it easier to pass
- Enhancing dietary fiber to promote regular bowel movements
- Using an osmotic laxative like PEG 3350 as needed to help stimulate bowel movements
- Considering the addition of a stimulant laxative if the initial regimen is insufficient, as supported by general principles of managing constipation 3, 4
- Maintaining regular physical activity to help stimulate bowel motility
It's also important to note that while GLP-1 receptor agonists have various beneficial effects on metabolism and glucose control, their impact on gastrointestinal motility and constipation is a significant consideration in their use, as discussed in reviews of GLP-1 pharmacology and its therapeutic implications 5.
Given the most recent and highest quality evidence, the use of psyllium husk has also been shown to have a positive effect on intestinal microbiota in constipated patients, which could be an additional consideration in the management of constipation associated with GLP-1 receptor agonist medications 4. However, the primary approach remains focused on lifestyle modifications and the use of osmotic laxatives as first-line treatment.