Korean J Med.
2015 Jan;88(1):9-14. 10.3904/kjm.2015.88.1.9.
New Generation Laxatives
- Affiliations
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- 1Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 2Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
- 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- 4Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea.
- 5Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
- 6Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
- 7Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
- 8Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
- 9Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea. seenae99@dsmc.or.kr
- 10Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea.
- KMID: 2269163
- DOI: http://doi.org/10.3904/kjm.2015.88.1.9
Abstract
- A significant proportion of chronic constipation patients are dissatisfied with their treatment. Recently, a number of new medications have been introduced for patients refractory to conventional laxatives, such as prucalopride, lubiprostone, linaclotide, and elobixibat. Prucalopride is a novel gastrointestinal prokinetic agent that acts as a 5-hydroxytryptamine type 4 (5-HT4) agonist. Compared with older nonselective 5-HT4 agonists, the higher selectivity of prucalopride for 5-HT4 receptors can reduce the risk of significant adverse cardiovascular events. Prucalopride improves stool frequency and consistency, and reduces the need for rescue medications. Lubiprostone, a chloride channel activator, increases the secretion of intestinal fluid, improves the stool frequency and consistency, and reduces straining. Linaclotide, a guanylate cyclase-C agonist, is effective in treating patients with chronic constipation and its effect on visceral sensitivity, as shown mainly in animal studies, provides an attractive pharmaceutical option for patients with irritable bowel syndrome with constipation. Elobixibat is an ileal sodium-dependent bile acid transporter inhibitor that blocks the enterohepatic circulation of bile acids, increasing the bile acid concentration in the intestine, which accelerates colonic transit and softens the stool. A phase III trial of the treatment of chronic constipation and irritable bowel syndrome with constipation is underway. The clinical application of new-generation laxatives will contribute to the management of chronic constipation refractory to conventional laxatives.
Keyword
MeSH Terms
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Animals
Bile
Bile Acids and Salts
Chloride Channels
Colon
Constipation
Enterohepatic Circulation
Humans
Intestines
Irritable Bowel Syndrome
Laxatives*
Receptors, Serotonin, 5-HT4
Serotonin
Serotonin 5-HT4 Receptor Agonists
Lubiprostone
Bile Acids and Salts
Chloride Channels
Laxatives
Receptors, Serotonin, 5-HT4
Serotonin
Serotonin 5-HT4 Receptor Agonists
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