Elobixibat for Chronic Constipation
Recommended Dosage
Elobixibat should be administered at 10 mg once daily before breakfast for the treatment of chronic constipation. 1
- The 10 mg dose was identified as the clinically optimal dose in phase II dose-finding studies, where it significantly increased spontaneous bowel movements to 6.4 per week compared to 2.6 per week with placebo 2, 3
- Patients may titrate between 5 mg, 10 mg, or 15 mg daily based on response and tolerability, though 10 mg represents the standard starting dose 3
- The medication must be taken before breakfast, as food consumption reduces systemic exposure by approximately 80% while paradoxically increasing the therapeutic effect 4
Clinical Role in Treatment Algorithm
The American Gastroenterological Association recommends elobixibat as a second-line therapy for chronic idiopathic constipation when first-line treatments (such as polyethylene glycol or other osmotic laxatives) provide inadequate relief. 1
- Elobixibat is equally effective in patients with or without constipation-predominant irritable bowel syndrome, making it versatile across constipation phenotypes 1, 2
- The drug works through a unique mechanism as an ileal bile acid transporter inhibitor, increasing bile acid delivery to the colon to stimulate both colonic motility and secretion 5
Efficacy Timeline
- Therapeutic effects begin during the first week of treatment, with the primary endpoint showing significant improvement in spontaneous bowel movement frequency by week 1 3
- Long-term efficacy is maintained through 52 weeks of continuous treatment without tachyphylaxis 3, 6
Safety Profile and Common Pitfalls
The most frequent adverse effects are mild gastrointestinal symptoms that are dose-dependent: abdominal pain occurs in 19-24% of patients and diarrhea in 13-15%. 1, 3
- In the 52-week safety study, 48% of patients experienced adverse drug reactions, predominantly mild gastrointestinal disorders, with no serious adverse events directly attributed to elobixibat 1, 3
- Critical administration error to avoid: Patients must take elobixibat before breakfast on an empty stomach; taking it with food dramatically reduces absorption while increasing bile acid effects, potentially worsening gastrointestinal side effects 4
- If gastrointestinal side effects occur, dose reduction to 5 mg daily is appropriate before discontinuation 3