Constipation Medication

Overview

Chronic constipation is very often difficult to treat successfully. There are a number of lifestyle changes as well over the counter remedies that can help, but many times, a stronger and more effective medication is necessary for relief.


Luckily, there have been new drugs released in the past few years that may be a good option for the right patient. In this article, we will discuss 3 of the newer drugs released: Trulance (Plecanatide), Linzess (Linaclotide) & Amitiza (Lubiprostone).


The most important point to know before reading this article is that prescription medication should NOT be considered a first line option for constipation. The key, of course, is to try and pin down what exactlyis causing the constipation in the first place. Is it your diet? Current medications (e.g. opioids, iron, calcium etc...)? It is important to try and discern the root cause for treatment to be successful.


Constipation Treatment

In terms of initial treatment for adults, it is first suggested to consume an adequate amount of fluids and fiber. Physical activity has also been shown to relieve constipation due to increases in metabolism. If lifestyle changes aren't successful, OTC medications are recommend including osmotic laxative such as PEG 3350 (Miralax, etc) or a saline laxative such as magnesium hydroxide. Adding a stimulant laxative such as senna or bisacodyl for fast relief can help as well.​


Prescription Drugs

If the therapies above aren't successful, it may be time to talk with your doctor regarding prescription medication. Three of the newer drugs on the market are Trulance, Linzess & Amitiza. They are all indicated for the treatment of chronic constipation and work by increasing fluid secretion in the intestine to help speed up GI transit time. 


Trulance & Linzess are in the same drug class and have the same mechanism of action. Amitiza is a unique medication and does not belong in any other drug class. Since the medications are so new, there have not been any studies comparing one to the others so it's too soon to say if one is superior than the rest.  What we can do however, is to dig into the clinical trial data published for each drug and see how effective they are.​


Trulance (Plecanatide)


Trulance

How It Works:

Guanylate cyclase-C agonist. This stimulates secretion of chloride and bicarbonate into the intestine, which results in increased intestinal fluid and accelerated gastrointestinal (GI) transit. 

How To Take:

One tablet by mouth once daily, with or without food.

How Well Does It Work:

Two studies showed patient improvements in the frequency of complete spontaneous bowel movements per week. These improvement were seen as early as week 1 with improvement maintained through week 12. On average, complete spontaneous bowel movements were increased by 1.1 per week versus placebo. In addition, improvements were observed in stool frequency, and/or stool consistency,  and/or in the amount of straining with bowel movements.


​Linzess (Linaclotide)



Linzess

How It Works:

Linzess has the same mechanism of action as Trulance as it is also a cyclase-C agonist. There is a secretion of chloride and bicarbonate into the intestine, which results in increased intestinal fluid and accelerated gastrointestinal (GI) transit. 


How To Take:

One capsule by mouth once daily, 30 minutes before the first meal of the day.


How Well Does It Work:

The results for Linzess are remarkably similar to Trulance in regards to efficacy in treating chronic constipation. On average, patients who received LINZESS across 2 trials had significantly greater improvements compared with patients receiving placebo in stool frequency and stool consistency. On average, complete spontaneous bowel movements were increased by 1.5 per week.


Amitiza (Lubiprostone)



Amitiza1


How It Works: While Amitiza increases intestinal fluid secretions similar to Trulance and Linzess, it has a unique mechanism of action.  It works by activating what is known as ClC-2 chloride channels. Activating these channels produces a chloride-rich intestinal fluid secretion, which softens the stool, increases motility in the intestine and promotes spontaneous bowel movements.

How To Take:

Take one capsule by mouth twice daily with food.


How Well Does It Work:

Two studies showed that over a 4 week period, spontaneous bowel movements increased on average of about 2 per week. This is pretty much in line with the results of the other two drugs.


As we mentioned at the beginning of the article, there have been no head to head studies regarding the comparative efficacy of all of these medications. They all have showed positive results in studies and you should speak with your doctor regarding the best possible option for you.


In terms of side effects, all the medications are fairly well tolerated. The most common side effects are diarrhea, abdominal pain, flatulence, abdominal distension and upper respiratory tract infections.