Agents Used to Treat Constipation
Agent | Some Adverse Effects |
|---|---|
Fiber* | |
Bran | Bloating, flatulence, iron and calcium malabsorption |
Psyllium | Bloating, flatulence |
Methylcellulose | Less bloating than with other fiber agents |
Calcium polycarbophil | Bloating, flatulence |
Emollients | |
Docusate sodium | Ineffective for severe constipation |
Glycerin | Rectal irritation |
Mineral oil | Lipid pneumonia, malabsorption of fat-soluble vitamins, dehydration, fecal incontinence |
Osmotic agents | |
Sorbitol | Transient abdominal cramps, flatulence |
Lactulose | Same as for sorbitol |
Polyethylene glycol | Fecal incontinence (related to dosage) |
Magnesium | Magnesium toxicity, dehydration, abdominal cramps, fecal incontinence, diarrhea |
Sodium phosphate | Rare cases of acute renal failure |
Stimulants | |
Anthraquinones | Abdominal cramps, dehydration, melanosis coli, malabsorption, possible deleterious effects on intramural nerves |
Bisacodyl | Fecal incontinence, hypokalemia, abdominal cramps, rectal burning with daily use of suppository form |
Lubiprostone†‡ | Nausea, particularly on empty stomach, and headache |
Prucalopride† | Headache, abdominal pain, increased risk of depression and suicidal attempts |
Secretagogues | |
Plecanatide† | Dizziness, uncommonly urinary tract infection |
Linaclotide† | Abdominal pain, flatulence Contraindicated in children < 2 years and in patients with known or suspected mechanical gastrointestinal obstruction |
NHE3 Inhibitors | |
Tenapanor† | Severe diarrhea, dehydration, abdominal distension, flatulence, and dizziness |
Enemas | |
Mineral oil/olive oil retention | Fecal incontinence, mechanical trauma |
Tap water | Mechanical trauma |
Phosphate | Accumulated damage to rectal mucosa, hyperphosphatemia§, mechanical trauma |
Soapsuds | Accumulated damage to rectal mucosa, mechanical trauma |
Peripherally acting mu-opioid receptor antagonists (PAMORAs) | |
Alvimopan | Contraindicated in patients with bowel obstruction Possibility of increased risk of cardiovascular events (eg, myocardial infarction) |
Methylnaltrexone | Weight-based subcutaneous dosing in patients with advanced illness If no improvement after 3 days, reinitiate prior laxative therapy Contraindicated in known or suspected bowel obstruction |
Naldemedine | Contraindicated in known or suspected bowel obstruction |
Naloxegol | Contraindicated in known or suspected bowel obstruction |
* The dose of fiber supplements should be gradually increased over several weeks to the recommended dose. Fiber supplements are given orally. | |
† This agent is available by prescription only. | |
‡ Lubiprostone is approved for long-term use. | |
§ Because of the risk of hyperphosphatemia, phosphate should not be used in patients with kidney disease. | |
Adapted from Romero Y, Evans JM, Fleming KC, Phillips SF. Constipation and fecal incontinence in the elderly population. Mayo Clin Proc. 1996:71(1):81–92. doi: 10.4065/71.1.81; by permission. | |
