Agents Used to Treat Constipation

Fiber*

Bran

Bloating, flatulence, iron and calcium malabsorption

PsylliumPsyllium

Bloating, flatulence

MethylcelluloseMethylcellulose

Less bloating than with other fiber agents

Calcium polycarbophilCalcium polycarbophil

Bloating, flatulence

Emollients

Docusate sodiumDocusate sodium

Ineffective for severe constipation

GlycerinGlycerin

Rectal irritation

Mineral oilMineral oil

Lipid pneumonia, malabsorption of fat-soluble vitamins, dehydration, fecal incontinence

Osmotic agents

SorbitolSorbitol

Transient abdominal cramps, flatulence

LactuloseLactulose

Same as for sorbitolSame as for sorbitol

Polyethylene glycolPolyethylene 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

BisacodylBisacodyl

Fecal incontinence, hypokalemia, abdominal cramps, rectal burning with daily use of suppository form

Linaclotide†Linaclotide†

Abdominal pain, flatulence

Contraindicated in children < 2 years and in patients with known or suspected mechanical gastrointestinal obstruction

Lubiprostone†‡Lubiprostone†‡

Nausea, particularly on empty stomach, and headache

Plecanatide†Plecanatide†

Dizziness, uncommonly urinary tract infection

Prucalopride†Prucalopride†

Headache, abdominal pain, increased risk of depression and suicidal attempts

Tenapanor†Tenapanor†

Severe diarrhea, dehydration, abdominal distension, flatulence, and dizziness

Enemas

Mineral oil/olive oil retentionMineral 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)

AlvimopanAlvimopan

Contraindicated in patients with bowel obstruction

Possibility of increased risk of cardiovascular events (eg, myocardial infarction)

MethylnaltrexoneMethylnaltrexone

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

NaldemedineNaldemedine

Contraindicated in known or suspected bowel obstruction

NaloxegolNaloxegol

Contraindicated in known or suspected bowel obstruction