The safety of available treatments for chronic constipation

ABSTRACT

Introduction: Chronic constipation is a frequent syndrome which, not only causes an appreciable deterioration in quality of life, but also entails a high economic cost due, among other things, to its treatment. This is because of the widespread use of laxatives, even by subjects who have not sought medical care, as well as little patient satisfaction with the treatment. Although this generally involves the use of drugs regarded as safe, there is no clear evidence about their short- and long-term effects, something that complicates appropriate prescription and follow-up by health professionals and hinders therapeutic compliance.

Objective: To review the adverse effects which have been associated with laxatives based on scientific evidence, and ascertain the safety profile of the treatments used for constipation.

Expert opinion: While all the drugs currently available for treatment of constipation are generally safe when used at established doses under medical supervision, more rigorous data on their long-term safety are nonetheless required, in view of the fact that constipation is a chronic condition. Their long-term use should be monitored by health professionals to optimize treatment on an individualized basis, with the aim of enhancing efficacy and minimizing adverse effects.

KEYWORDS:

• Constipation
• laxatives
• prucalopride
• linaclotide
• lubiprostone
• adverse effects

Article highlights

• All the medications currently available for the treatment of constipation are drugs with an appropriate safety profile when used at established doses under medical supervision.

• Nonetheless, objective data sourced from efficacy and safety studies are very limited in the laxative group.

• PEG is the only drug with a sufficient number of studies within the laxative group to conclude objectively that it is safe, even in the long term. Attention should be drawn to the lack of objective data from well-designed safety studies on other osmotic and stimulant laxatives.

• The most modern treatments whose development and marketing have been marked by strict government agency (EMA and FDA) requirements to demonstrate their efficacy and safety, e.g., drugs such as prucalopride, lubiprostone and linaclotide, yield objective knowledge of a good safety profile after 6 months of treatment.

• The use of long-term treatments for constipation should be monitored by health professionals, with the dual aim of verifying their efficacy, and identifying and minimizing potential adverse effects.

This box summarizes key points contained in the article.

Declaration of interest

E Rey is on the advisory board and receives research funds from Norgine Iberia, Almirall and Allergan. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper has not been funded.