Elobixibat for Chronic Constipation
The recommended treatment dosage of elobixibat for chronic constipation is 10 mg once daily taken before breakfast, positioned as a second-line therapy when first-line treatments provide inadequate relief. 1
Dosing Recommendations
- Elobixibat should be administered at 10 mg once daily before breakfast as the optimal clinical dose for chronic constipation 1, 2
- The medication must be taken before breakfast, as food consumption reduces systemic exposure by approximately 80% while paradoxically increasing the therapeutic bile acid response 3
- Dose titration is possible between 5 mg and 15 mg daily based on individual response and tolerability, though 10 mg represents the optimal balance of efficacy and safety 4
Clinical Positioning
- The American Gastroenterological Association recommends elobixibat as a second-line therapy for chronic idiopathic constipation when first-line treatments (such as fiber supplements or osmotic laxatives) fail to provide adequate relief 1
- Elobixibat is equally effective in patients with or without constipation-predominant IBS, making it versatile across constipation phenotypes 1, 2
Expected Efficacy
- At the 10 mg dose, patients can expect an increase to 6.4 spontaneous bowel movements per week from baseline 1, 4
- The therapeutic effect begins during the first week of treatment and is maintained durably over 52 weeks of continuous use 4, 5
- Both 10 mg and 15 mg doses demonstrate significant superiority over placebo (5.7 and 5.6 bowel movements per week respectively, versus 2.6 with placebo) 2
Safety Profile and Common Pitfalls
- The most frequent adverse effects are dose-dependent and gastrointestinal in nature: abdominal pain occurs in 19-24% of patients and diarrhea in 13-15% 1
- These side effects are typically mild and do not require treatment discontinuation in most cases 1, 4
- In long-term use (52 weeks), 48% of patients experienced adverse drug reactions, predominantly mild gastrointestinal disorders, with no serious adverse events directly attributed to elobixibat 1, 4
- Critical administration caveat: Ensure patients take elobixibat before breakfast on an empty stomach to maximize therapeutic effect, as food significantly reduces drug exposure while maintaining bile acid effects 3
Mechanism and Additional Benefits
- Elobixibat works through a unique mechanism by inhibiting the ileal bile acid transporter, increasing colonic bile acid delivery which stimulates both colonic motility and secretion 6
- As a secondary benefit, elobixibat reduces LDL cholesterol levels, which may be advantageous in patients with concurrent dyslipidemia 6, 3