Prucalopride
This new selective, high affinity 5-HT4 agonist appears to be one of the first new therapies to have really made a significant impact on the treatment of chronic constipation.
Presently in UK it is being offered in women only who have failed on standard laxatives.
Prucalopride 2mg od (or 1mg od for those over 65y)
If there has been no benefit after 1 month, it is unlikely that continuing any longer will be helpful .
In 3 seperate 12week trials it was shown to improve;-
a) regular bowel frequency to at least 1x/day in 67% (verses 39% on placebo)
b) abdominal pain and discomfort
c) bloating
d) straining
e) defaceation urgency
Benefits are seen with median time to spontaneous bowel movement within 3 hours.
Interestingly the improvement in quality of life was maintained for 2 years.
Side effects are mild (diarrhoea, nausease, headache, abdominal pain) and resolve swiftly (24 hrs).