Abstract

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to review the pharmacology and selectivity of serotonergic agents to contrast the older serotonergic agents (which were withdrawn because of cardiac or vascular adverse effects) with the newer generation serotonin receptor subtype 4 agonists.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.

Authors

Camilleri M

Institution

College of Medicine, Mayo Clinic, Rochester, MN, USA. camilleri.michael@mayo.edu

Source

Canadian journal of gastroenterology = Journal canadien de gastroenterologie 25 Suppl B: 2011 Oct pg 29B-35B

MeSH

Alprostadil
Bile Acids and Salts
Chloride Channels
Chronic Disease
Constipation
Gastrointestinal Agents
Humans
Indoles
Organic Anion Transporters, Sodium-Dependent
Peptides
Receptors, Serotonin, 5-HT4
Serotonin 5-HT4 Receptor Agonists
Serotonin Agents
Symporters

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

22114755