New treatment options for chronic constipation: mechanisms, efficacy and safety.
The present review has several objectives, the first of which is to review the pharmacology and selectivity of serotonergic agents to contrast the older serotonergic agents (which were withdrawn because of cardiac or vascular adverse effects) with the newer generation serotonin receptor subtype 4 agonists. Second, the chloride ion secretagogues that act through the guanylate cyclase C receptor are appraised and their pharmacology is compared with the approved medication, lubiprostone. Third, the efficacy and safety of the application of bile acid modulation to treat constipation are addressed. The long-term studies of surgically induced excess bile acid delivery to the colon are reviewed to ascertain the safety of this therapeutic approach. Finally, the new drugs for opiate-induced constipation are introduced. Assuming these drugs are approved, practitioners will have a choice; however, patient responsiveness will be based on trial and error. Nevertheless, the spectrum of mechanisms and demonstrated efficacy and safety augur well for satisfactory treatment outcomes.
College of Medicine, Mayo Clinic, Rochester, MN, USA. email@example.com
SourceCanadian journal of gastroenterology = Journal canadien de gastroenterologie 25 Suppl B: 2011 Oct pg 29B-35B
Bile Acids and Salts
Organic Anion Transporters, Sodium-Dependent
Receptors, Serotonin, 5-HT4
Serotonin 5-HT4 Receptor Agonists
Pub Type(s)Journal Article
Research Support, Non-U.S. Gov't