From the Guidelines
Chronic constipation associated with GLP-1 receptor agonist treatment should be managed with lifestyle modifications and medication, prioritizing osmotic laxatives like polyethylene glycol (Miralax) 17g daily, as it is effective and has a low risk of dependency 1. To manage chronic constipation in patients on GLP-1 receptor agonists, the following steps can be taken:
- Lifestyle modifications:
- Increase water intake to at least 2 liters daily
- Increase dietary fiber to 25-30g daily from fruits, vegetables, and whole grains
- Encourage regular physical activity
- Medication management:
- Start with an osmotic laxative like polyethylene glycol (Miralax) 17g daily, which has been shown to be effective in increasing bowel movements and improving constipation symptoms 1
- If needed, add a stimulant laxative such as bisacodyl (Dulcolax) 5-10mg or senna 8.6-17.2mg at bedtime for short-term use, as recommended by the American Gastroenterological Association 1
- For severe cases, consider prescription medications like lubiprostone (Amitiza) 24mcg twice daily or linaclotide (Linzess) 145-290mcg daily It is essential to address constipation promptly, as it may impact medication adherence and quality of life, but most patients can achieve relief with appropriate management while continuing their GLP-1 therapy. The mechanism of GLP-1 agonists, which slows gastric emptying and intestinal transit time, contributes to constipation symptoms, but this can be mitigated with the right management approach 1.
From the Research
Chronic Constipation and GLP-1 Treatment
- Chronic constipation is a common gastrointestinal symptom in patients with diabetes, occurring more frequently than in healthy individuals 2.
- The primary aim of intervention in diabetic patients with chronic constipation is to better manage the diabetes along with management of constipation 2.
- Treatment goals for chronic constipation include improving symptoms and restoring bowel function by accelerating colonic transit and facilitating defecation 2.
- GLP-1 has been implicated to have a beneficial role in the gastrointestinal tract, with possible beneficial mechanisms for intestinal diseases including its influence on gastric emptying, anti-inflammatory properties, and intestinotrophic effect 3.
Treatment Options for Chronic Constipation
- Food and dietary change with exercise and lifestyle change should be the first step in management of chronic constipation 2.
- Laxatives should be the next step of treatment for patients recalcitrant to dietary and lifestyle changes, starting with bulking agents such as psyllium, bran, or methylcellulose 2.
- Psyllium has been shown to be superior to docusate sodium for treatment of chronic constipation, increasing stool water content and having greater overall laxative efficacy 4.
- Fiber supplementation, particularly psyllium, has been found to be effective in improving constipation symptoms, with higher doses (>10 g/d) and longer treatment durations (≥4 weeks) appearing optimal 5.
GLP-1 and Chronic Constipation
- There is limited direct evidence on the use of GLP-1 treatment for chronic constipation, but GLP-1 has been shown to have beneficial effects on the gastrointestinal tract 3.
- GLP-1 agonists may have a potential role in the treatment of intestinal diseases, including chronic constipation, although more research is needed to fully understand their effects 3.