From the FDA Drug Label
Prucalopride, a selective serotonin type 4 (5-HT4) receptor agonist, is a gastrointestinal (GI) prokinetic agent that stimulates colonic peristalsis (high-amplitude propagating contractions [HAPCs]), which increases bowel motility In rats and dogs, prucalopride stimulated gastrointestinal motility with contractions starting from the proximal colon to the anal sphincter. An integrated analysis of 3 randomized, placebo-controlled, dose-finding studies in 280 patients with CIC showed that after once daily treatment with 2 mg of prucalopride, the mean colonic transit time was reduced by 12 hours from a baseline of 65 hours for prucalopride 2 mg, compared to an increase of 0. 5 hours from a baseline of 66 hours in the placebo group.
The best bowel regimen oral medication for paraplegia patients is prucalopride. It is a gastrointestinal prokinetic agent that stimulates colonic peristalsis, increasing bowel motility.
- Key benefits:
- Stimulates gastrointestinal motility
- Reduces colonic transit time
- Increases bowel movement frequency 1
From the Research
For patients with paraplegia, the best bowel regimen oral medication is bisacodyl 10mg daily, as it has been shown to be effective in stimulating intestinal contractions and promoting bowel movements, with a recent review confirming its efficacy in patients with chronic constipation 2. The choice of bisacodyl is based on its dual prokinetic and secretory action, which enhances motility, reduces transit time, and increases the water content of the stool, making it an ideal option for patients with paraplegia who often experience chronic constipation. Some key points to consider when implementing a bowel regimen for patients with paraplegia include:
- Combining oral medications with a high-fiber diet (25-30g daily) and adequate hydration (2-3 liters daily) to promote regular bowel movements
- Adding docusate sodium 100mg twice daily as a stool softener or senna 8.6-17.2mg at bedtime for patients with more severe constipation
- Taking medications consistently, typically 30 minutes before planned bowel movements, to establish a predictable routine
- Individualizing the regimen based on the patient's specific neurological level, mobility, and response to treatment, as noted in studies on spinal cord injury patients 3, 4
- Regular timing of bowel care (typically every 1-3 days) to prevent complications like impaction, autonomic dysreflexia, and reduced quality of life, as highlighted in the management of constipation in patients with quadriplegic cerebral palsy 5.