What medications are used to treat constipation?

From the Guidelines

The most effective medications for treating constipation include polyethylene glycol, lubiprostone, linaclotide, plecanatide, and prucalopride, which should be used in conjunction with lifestyle modifications such as increased fiber, hydration, and physical activity. When considering treatment options for constipation, it is essential to evaluate the cause and severity of the condition, as well as the patient's overall health status 1. The American Gastroenterological Association recommends using linaclotide in patients with irritable bowel syndrome with constipation, with a strong recommendation and high certainty in the evidence of effects 1. Additionally, the AGA suggests that polyethylene glycol, magnesium oxide, lactulose, bisacodyl, and senna can be used to treat chronic idiopathic constipation, with varying mechanisms of action and dosing recommendations 1. Some key points to consider when selecting a medication for constipation include:

• The patient's medical history and current medications
• The presence of any underlying medical conditions, such as renal insufficiency or pregnancy
• The potential for side effects, such as bloating, abdominal discomfort, and diarrhea
• The need for lifestyle modifications, such as increased fiber and hydration, to support treatment
• The importance of monitoring and adjusting the treatment plan as needed to achieve optimal results. It is also crucial to note that treatment should begin with lifestyle modifications before progressing to medications, and that different medications work through various mechanisms, so the choice depends on the cause and severity of constipation 1.

From the FDA Drug Label

LINZESS is a prescription medicine used to treat: irritable bowel syndrome with constipation (IBS-C) in adults. a type of constipation called chronic idiopathic constipation (CIC) in adults. functional constipation in children and adolescents 6 to 17 years of age

RELISTOR is a prescription medicine used to treat constipation in adults that is caused by prescription pain medicines called opioids

Medications for Constipation:

• Linaclotide (LINZESS): used to treat irritable bowel syndrome with constipation (IBS-C), chronic idiopathic constipation (CIC), and functional constipation in adults and children 6 to 17 years of age.
• Methylnaltrexone (RELISTOR): used to treat constipation caused by opioids in adults with long-lasting (chronic) pain that is not caused by active cancer, and in adults with advanced illness or pain caused by active cancer. 2 3

From the Research

Medications for Constipation

Medications used to treat constipation include:

• Laxatives, such as senna, bisacodyl, and polyethylene glycol 3350 4
• Stool softeners, such as docusate 4
• μ-opioid receptor antagonists, such as methylnaltrexone, for opioid-induced constipation 5, 6
• Newer medications, such as lubiprostone, linaclotide, and prucalopride, for opioid-induced constipation or chronic constipation 5, 7
• Fiber supplements, such as psyllium and pectin, which can improve stool frequency and consistency 8

Treatment Options for Opioid-Induced Constipation

Treatment options for opioid-induced constipation include:

• Laxatives and stool softeners as first-line treatment 4
• Escalation to μ-opioid receptor antagonists, such as methylnaltrexone, if first-line treatment is ineffective 5, 6
• Use of newer medications, such as lubiprostone, linaclotide, and prucalopride, for opioid-induced constipation 5

Treatment Options for Chronic Constipation

Treatment options for chronic constipation include:

• Nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training 7
• Traditional pharmacologic agents, such as laxatives and fiber supplements 7
• Newer agents, such as tegaserod and lubiprostone, which have been approved for the treatment of chronic constipation 7