Prucalopride is recommended by NICE (TA 211; December 2010) as an option for treating chronic idiopathic constipation in women in whom treatment with at least 2 laxatives from different classes, at the highest tolerated recommended doses for at least 6 months, has failed to provide adequate relief.
Chronic idiopathic (not due to underlying disease) constipation is defined as 2 or more of the following symptoms for at least 6 months: straining; lumpy or hard stools; a sensation of incomplete evacuation; a sensation of obstruction or blockage, and/or less than 3 spontaneous bowel movements/wk.
Prucalopride stimulates serotonin (5-HT4) receptors in the bowel and increases colonic movement.
In high quality clinical trials prucalopride led to an increase in spontaneous bowel movements in about 60% of patients. Abdominal bloating, discomfort, stool consistency and straining also improved with prucalopride.
2 mg taken once daily for adult women (up to 65 years old) and 1 mg once daily for older women (over 65 years old) and in patients with liver or kidney disease. The dose for older women can be increased to 2 mg once daily if needed.
It should be used with caution in patients with co-existing heart disease.
The benefits of prucalopride should be evident within 1-2 weeks in most patients. If treatment is not effective by 4 weeks it should be stopped.
Most common side effects are headache and gastrointestinal symptoms (abdominal pain, nausea or diarrhoea). These tend to occur at the start of treatment and usually subside within a few days of continued treatment.
It is not recommended in pregnancy, in patients planning a pregnancy and should be avoided if breastfeeding.
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