What are the medications for constipation?

From the Guidelines

The most effective treatment for constipation is a combination of lifestyle modifications and medication, with osmotic laxatives like polyethylene glycol (MiraLAX, 17g daily) being a first-line option, as recommended by the most recent study 1. When treating constipation, it's essential to start with gentler options like stool softeners or osmotic laxatives before trying stimulants, which can cause cramping.

• Osmotic laxatives, such as polyethylene glycol or lactulose, can be administered safely during pregnancy and are effective in treating constipation 1.
• Stimulant laxatives, such as bisacodyl (Dulcolax, 5-10mg) or senna (Senokot, 8.6-17.2mg), should be avoided in pregnancy due to conflicting safety data 1.
• Bulk-forming laxatives, such as psyllium (Metamucil, 1 tablespoon 1-3 times daily), can help promote regular bowel movements and prevent constipation, but may not be effective in severe cases 1.
• Prescription medications, such as lubiprostone (Amitiza, 24mcg twice daily), linaclotide (Linzess, 145-290mcg daily), plecanatide (Trulance, 3mg daily), and prucalopride (Motegrity, 2mg daily), can be effective in treating constipation, especially in severe cases 1. Adequate hydration is essential when taking any constipation medication, especially bulk-forming laxatives.
• Most constipation medications work within 12-72 hours, but chronic use of stimulant laxatives should be avoided as they can lead to dependence 1. Underlying causes of constipation, such as insufficient fiber intake, dehydration, or medication side effects, should also be addressed for long-term management 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Oral Adult: The usual adult, oral dosage is 2 to 3 tablespoonfuls (30 mL to 45 mL, containing 20 grams to 30 grams of lactulose) three or four times daily. Uses for relief of occasional constipation (irregularity). This product generally produces bowel movement in 12 to 72 hours.

Medications for Constipation:

• Lactulose (PO): used to produce 2 or 3 soft stools daily 2
• Psyllium (PO): used for relief of occasional constipation (irregularity) 3

From the Research

Medications for Constipation

• The medications for constipation include laxatives, fiber supplements, and other agents that help stimulate bowel movements or soften stool 4, 5, 6.
• Polyethylene glycol (PEG) or macrogol is a commonly used laxative that has been shown to be effective in treating chronic constipation with minimal side effects 4, 5, 6.
• Psyllium is a type of fiber supplement that can help increase stool output and improve stool consistency, and is often used in combination with PEG for optimal results 4, 5, 7, 8.
• Other medications that have been shown to be effective in treating chronic constipation include lactulose, tegaserod, and lubiprostone 5, 6.
• The choice of medication for constipation depends on the individual's specific needs and medical history, and should be guided by a healthcare professional 5, 6.

Types of Fiber Supplements

• Psyllium is a soluble fiber that can help increase stool output and improve stool consistency, and is often used to treat chronic constipation 4, 7, 8.
• Wheat bran is an insoluble fiber that can help increase stool bulk, but may not be as effective as psyllium in treating chronic constipation 7.
• Pectin is a type of fiber that has been shown to be effective in improving stool frequency and consistency 8.

Efficacy and Safety of Medications

• Polyethylene glycol (PEG) has been shown to be effective and safe in treating chronic constipation, with minimal side effects 4, 5, 6.
• Psyllium has been shown to be effective in improving stool output and consistency, but may cause flatulence and other gastrointestinal side effects 7, 8.
• Lactulose and tegaserod have been shown to be effective in treating chronic constipation, but may have more side effects than PEG or psyllium 5, 6.