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Using Medication Wisely
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Prucalopride (Motegrity) is one of the newest prescription medications as of this writing. It works on serotonin receptors in the gut to stimulate motility and peristalsis. Of course, it can also cause abdominal pain, cramping, urgency, and diarrhea. But some people with chronic constipation who haven’t responded to much of anything else have responded well to this medication.
Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Prucalopride is a pro-kinetic agent acting at gut serotonin (5-HT4) receptors. Lubiprostone activates chloride channels in the intestinal wall to increase fluid and electrolyte secretion into the bowel. Linaclotide is a guanylate cyclise-C receptor agonist that promotes intestinal fluid secretion. There are few data to support either efficacy or safety of these drugs in frail older people.20,21
Chronic Constipation
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Charles H. Knowles, Adil E. Bharucha
Serotonin 5-HT4 receptor agonists (e.g. prucalopride) activate fast excitatory postsynaptic potentials in intrinsic neurons, release neurotransmitters such as the excitatory acetylcholine and induce mucosal secretion by activating submucosal neurons. The main development in the 5-HT4 agonist class is prucalopride. This drug has much greater selectivity to the 5-HT4 receptor than the withdrawn 5-HT4 agonists such as tegaserod and cisapride. In particular, it has no proven effect on QTc interval caused by activation of the cardiac conducting system channels that led to arrhythmias with less selective drugs. Prucalopride has been the subject of three rigorously conducted phase III pivotal trials with pooled data available on >2000 patients132 and has also been trialled in the elderly. Abundant cross-species data (including humans) show that prucalopride leads to increases in propagated colonic contractile activity leading to coordinated mass movements and spontaneous defaecation. It has an acceptable side effect profile and is now licensed in Europe and the United States for women with chronic constipation in which it has a some effect in approximately 50% patients.133 In particular, it has the significant advantage over laxatives in terms of reducing rather than increasing abdominal pain and bloating.
Current and emerging therapeutic options for the management of functional dyspepsia
Published in Expert Opinion on Pharmacotherapy, 2020
A. Vandenberghe, J. Schol, K. Van den Houte, I. Masuy, F. Carbone, J. Tack
Prucalopride is a highly specific and potent 5-HT4 agonist indicated for the treatment of refractory chronic constipation. Two doses are available on the market: 1 and 2 mg, the former being the starting dose in case of suspected lower kidney clearance. Nausea, abdominal pain, and diarrhea are the most frequently reported side-effects. Recently, 2 mg prucalopride was tested in gastroparetic patients in a controlled cross-over study [53]. Prucalopride enhanced gastric emptying rate, and symptom improvement was mainly observed in idiopathic gastroparesis and was less clear in diabetic gastroparesis. Prucalopride was generally well tolerated. If these results are confirmed, taking into account the similarity of the symptoms pattern in idiopathic gastroparesis and PDS, prucalopride should be evaluated in Rome IV PDS [53].
An overview of the efficacy and safety of prucalopride for the treatment of chronic idiopathic constipation
Published in Expert Opinion on Pharmacotherapy, 2019
Marzieh Daniali, Shekoufeh Nikfar, Mohammad Abdollahi
As mentioned in Table 4, four phase 4 clinical trials were performed to evaluate the efficacy of prucalopride in different cases and in long-term use [43]. The first clinical trial was studied in patients with gastroparesis that often-experienced constipation. Prucalopride, in its therapeutic dose (2 mg/day) showed improvements in total gastroparesis principal symptom and overall patient assessment of upper gastrointestinal disorders-quality of life score had been ameliorated in idiopathic gastroparesis patients [44]. In addition, the other study compared prucalopride with PEG 3350 in preparation for colonoscopy. This study highlighted the efficacy of prucalopride in constipation. However, the impact of prucalopride does not suit in cleansing the intestine for colonoscopy [45]. Despite the superiority of PEG in preparation for colonoscopy, in chronic constipation, prucalopride is preferred among lactulose and PEG [46].
A randomized controlled trial comparing the efficacy of 1-L polyethylene glycol solution with ascorbic acid plus prucalopride versus 2-L polyethylene glycol solution with ascorbic acid for bowel preparation
Published in Scandinavian Journal of Gastroenterology, 2018
Seong Ji Choi, Eun Sun Kim, Byeong Kwang Choi, Geeho Min, Woojung Kim, Jung Min Lee, Jae Min Lee, Seung Han Kim, Hyuk Soon Choi, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim
Both treatment arms exhibited similar adverse events. No serious adverse events occurred, and no patient was withdrawn from the study because of the adverse effects. As headache is one of the well-known side effects of prucalopride, we expected the patients in the 1LP/AP group to experience more headaches, but the result was insignificant (p=.127) [17,26]. Fifteen patients in the 1LP/AP group had a headache, and all of events were reported as mild and transient. Nausea and abdominal pain, which are also common adverse events of prucalopride, were not different among the two study groups, and these results support the safety of the 1LP/AP regimen. Although not statistically significant in our study, patients in 1LP/AP had a tendency of less gastrointestinal symptoms than the reference group.