How do you prevent constipation while taking Zepbound?

Preventing Constipation While Taking Zepbound

To prevent constipation while taking Zepbound, implement a proactive regimen that includes increased fluid intake, dietary fiber, regular physical activity, and prophylactic use of a stimulant laxative or polyethylene glycol (PEG). 1

First-Line Prevention Strategies

Dietary and Lifestyle Modifications

• Increase fluid intake - Ensure adequate hydration throughout the day 1
• Increase dietary fiber - Gradually add fiber-rich foods to your diet 1
• Regular physical activity - Engage in appropriate exercise to promote bowel motility 1
• Establish regular toileting routines - Respond promptly to the urge to defecate 1

Prophylactic Medications

1. Fiber supplements:

   • Psyllium is the most effective fiber supplement (17g or 1 heaping tablespoon with 8oz water twice daily) 1, 2
   • Note: Fiber supplements are most effective when combined with adequate fluid intake 1

2. Osmotic laxatives:

   • Polyethylene glycol (PEG) - One capful in 8oz water twice daily 1
   • PEG has shown durable response over 6 months with moderate quality evidence 1

If Constipation Develops Despite Prevention

Step 1: Assessment

• Rule out bowel obstruction or impaction 1
• Review all medications that may contribute to constipation 1

Step 2: Treatment Escalation

1. Increase or add stimulant laxatives:

   • Bisacodyl 10-15mg daily to three times daily 1
   • Sennosides (without docusate, as studies show docusate adds no benefit) 1

2. Consider adding osmotic agents:

   • Magnesium-based products (avoid in renal insufficiency) 1
   • Lactulose 30-60mL twice to four times daily 1
   • Sorbitol 30mL every 2 hours × 3, then as needed 1

3. For persistent constipation:

   • Glycerine suppositories 1
   • Tap water enema until clear 1

Important Considerations

• Goal: Achieve one non-forced bowel movement every 1-2 days 1

• Common side effects of preventive measures:

  • Fiber supplements: Flatulence 1
  • PEG: Abdominal distension, loose stool, flatulence, nausea 1
  • Lactulose: Bloating and flatulence (dose-dependent) 1

• Avoid supplemental medicinal fiber alone without adequate fluid intake, as this may worsen constipation 1

• Avoid docusate sodium as a standalone treatment, as evidence shows limited benefit 1

Monitoring

• Regularly assess bowel movement frequency and consistency
• Adjust preventive strategies based on response
• If constipation persists despite these measures, consult with your healthcare provider for further evaluation

Remember that constipation is a common side effect of many medications, and patients do not typically develop tolerance to this effect, making prophylactic management essential 1.