Editorial

Managing Chronic Constipation From Constipating Medicines

Authors: Nicholas J. Talley, MD, PhD

Abstract

Chronic constipation is remarkably common; 10 to 15% of the US population reports infrequent stools, difficult stool passage or both, and this problem increases with advancing age.1 Presumably, the age association reflects a higher prevalence of other causes of constipation, such as medication use, although this remains poorly documented. Many medications have been associated with chronic constipation. In one large general practitioner database from the United Kingdom, opioids, diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants and aluminum antacids were associated with the highest risk of medication-induced constipation.2For patients with medication-induced constipation, therapy has been empirical; clinical trials have not usually been directed at this subset and indeed, many trials have excluded patients with medication-induced constipation when testing new therapies.

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References

1. Brandt LJ, Prather CM, Quigley EM, et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005;100(Suppl 1):S5–S21.
 
2. Talley NJ, Jones M, Nuyts G, et al. Risk factors for chronic constipation based on a general practice sample. Am J Gastroenterol 2003;98:1107–1111.
 
3. DiPalma JA, Cleveland MB, McGowan J, et al. A comparison of polyethylene glycol laxative and placebo for relief of constipation from constipating medications. South Med J 2007;100:1085–1090.
 
4. DiPalma JA, Cleveland MB, McGowan J, et al. A randomized multi-center, placebo-controlled trial of polyethylene glycol for chronic treatment of chronic constipation. Am J Gastroenterol 2007;102:1436–1431.
 
5. Dorval E, Jankowski JM, Barbieux JP, et al. Polyethylene glycol and prevalence of colorectal adenomas. Gastroenterol Clin Biol 2006;30:1196–1199.
 
6. Johanson JF, Ueno R. Lubiprostone, a locally acting chloride channel activator, in adult patients with chronic constipation: a double-blind, placebo-controlled, dose-ranging study to evaluate efficacy and safety. Aliment Pharmcol Ther 2007;25:1351–1361.
 
7. Thompson CA. Novartis suspends tegaserod sales at FDA's request. Am J Health Syst Pharm2007;64:1020.
 
8. Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006;130:657–664.