Treatment of Constipation with Medicines Including Latest Drugs

The Treatment of Constipation with Medicines Including the Latest Drugs is discussed here.

It is important to note that lifestyle modification including adequate water intake, regular exercise, and adequate fiber intake is essential before initiating treatment of constipation with medicines and drugs.

Constipation definition:

Constipation is the passage of stools that are either harder than the individual’s usual stools or the frequency of passing stools is less than usual.

If a person feels that the frequency of passing stools or consistency of stools has changed especially if the change is combined with a feeling of discomfort, then lifestyle intervention and/ or medical intervention may be required.

Laxatives are drugs that Relieve constipation

The treatment of Constipation with Medicines includes the following classes of drugs (laxatives):

  • Bulk-forming laxatives
  • Stimulant laxatives
  • Stool softeners
  • Osmotic Laxatives
  • Newer drugs

Bulk Forming Laxatives to Relieve Constipation:

Bulk-forming laxatives are medicines that increase the stool content and may be used in patients with small hard stools. Bulk-forming stools should be taken with an adequate amount of fluids to reduce the chances of intestinal obstruction.

Unprocessed wheat bran taken with fresh juice is considered the best natural bulk-forming laxative.

Bulk-forming laxatives to relieve constipation include:

  • Isphaghul Husk
  • Methylcellulose
  • Sterculia
  • Sterculia with Frangula

Osmotic Laxatives to relieve constipation:

These drugs act by retaining water in the gut that was ingested while eating or drawing fluid into the bowel.

These agents are commonly used to treat constipation in children and adults. Sodium phosphate is used as a rectal enema for bowel cleansing before a diagnostic colorectal procedure.

List of drugs used as osmotic laxatives include:

  • Lactulose
  • Macrogol 3350 with potassium chloride, sodium bicarbonate, and sodium chloride
  • Magnesium Hydroxide
  • Sodium acid phosphate with sodium phosphate

Stool Softeners used to relieve constipation:

Stool softeners have a surfactant-like effect. Bulk-forming agents may also have a stool-softening effect.

When used as suppositories or enemas these drugs may be used in patients with impacted stools and for the treatment of hemorrhoids.

Stool-softeners that are commonly used to relieve constipation include:

  • Arachis oil
  • Docusate Sodium
  • Liquid Paraffin
  • Liquid Paraffin with magnesium hydroxide

Stimulant Laxatives used to treat constipation:

These drugs cause intestinal smooth muscle contractions increasing gut motility. This pushes the stools forward.

These medications should be used only if the patient is eating enough and the intestines are not empty.

Patients with a reduced appetite should not use stimulant laxatives to relieve constipation. If used, they should be used in combination with bulk-forming laxatives.

Commonly used stimulant laxatives include bisacodyl (Dulcolax), senna, and Sodium Picosulfate. Strong stimulant laxatives like castor oil and cascara are currently not recommended to treat constipation.

Stimulant Laxatives should be used with caution in the elderly as they may cause intussuseption

 List of Stimulant Laxatives to relieve constipation:

  • Bisacodyl
  • Co-danthramer
  • Co-danthrusate
  • Glycerol (Glycerine)
  • Senna
  • Senna with Isphagul husk
  • Sodium Picosulfate
  • Cascara
  • Castor oil
  • Bethanechol
  • Neostigmine and pyridostigmine bromide

Opioid Receptor antagonists used to treat constipation:

These medicines are used in patients who are on concomitant opioid medications for chronic pains.

  • Methylnaltrexone bromide
  • Naloxegol

Newer Drugs that are used to treat constipation:

Chloride channel activator: Chloride channel activators are used to treat patients with chronic idiopathic constipation that has not adequately responded to dietary modification and lifestyle changes. It is also approved for the treatment of IBS-C (irritable bowel syndrome with constipation)

  • Lubiprostone

Guanylate cyclase-C receptor agonist: These medicines are recommended in patients with irritable bowel syndrome with predominant constipation.

These drugs act by increasing intestinal secretion of fluids, increasing transit of stools and reducing visceral pain.

These drugs are totally metabolized in the gastrointestinal tract and do not enter the plasma after full therapeutic doses.

An available drug in this category includes:

  • Linaclotide (Linzess)

Linaclotide is approved for the treatment of IBS-C

Selective 5 HT-4 receptor agonists: This class of medicine is used especially in women with chronic constipation who have not responded to other laxatives. These drugs act by increasing gut motility.

  • Prucalopride

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