Does Cosentyx Worsen Constipation?
No, Cosentyx (secukinumab) does not worsen constipation and is not associated with constipation as an adverse effect. The documented adverse effects of secukinumab focus on infections, gastrointestinal inflammation, and other immune-related complications, but constipation is notably absent from the safety profile 1, 2, 3.
Documented Adverse Effects of Secukinumab
The most common adverse events associated with secukinumab include 1, 2:
- Upper respiratory tract infections (very common, ≥1/10 patients)
- Oral herpes
- Headache
- Rhinorrhea
- Diarrhea (not constipation)
- Nausea
- Fatigue
Gastrointestinal Effects: The Real Concern
The primary gastrointestinal concern with secukinumab is inflammatory bowel disease (IBD), not constipation. Secukinumab has been associated with new-onset IBD or exacerbation of existing IBD 3, 4, 5, 6, 7:
- New cases of Crohn's disease and ulcerative colitis have been reported during secukinumab treatment 4, 7
- Lymphocytic colitis (a form of microscopic colitis characterized by diarrhea, not constipation) has been documented 5
- Approximately 1% of patients treated with secukinumab developed new-onset IBD in one regional survey 6
- Time to IBD onset ranges from 1 month to 5 years of exposure 6
Clinical Implications
If a patient on secukinumab experiences constipation, investigate alternative causes 1:
- Review concomitant medications (opioids, anticholinergics, 5-HT3 antagonists, vinca alkaloids) 8
- Assess for metabolic causes (hypercalcemia, hypokalemia, hypothyroidism) 8
- Evaluate disease activity changes or lifestyle factors 1
Monitoring Recommendations
Focus monitoring on documented risks rather than constipation 2, 3:
- Tuberculosis screening before initiation
- Baseline and periodic complete blood counts for neutropenia
- Clinical monitoring for signs of infection
- Assessment for inflammatory bowel disease symptoms (diarrhea, abdominal pain, rectal bleeding) in patients with risk factors
Patients can be reassured that constipation is not an expected side effect of Cosentyx therapy 1.