Laxative

Abstract: Objective. This multinational, Internet-based survey was designed to assess the prevalence, frequency, severity, and impact of opioid-induced bowel dysfunction (OBD) in patients receiving opioid therapy for chronic pain and taking laxatives. Design. In total, 322 patients taking daily oral opioids and laxatives completed the 45-item questionnaire. At the time of the survey, 45% of patients reported <3 bowel movements per week. The most prevalent opioid-induced side effects were constipation (81%) and straining to pass a bowel movement (58%). Those side effects considered most bothersome by patients were (in order of rank) constipation, straining, fatigue, small or hard bowel movements, and insomnia. Results. Most of the OBD symptoms specified in the questionnaire were experienced by the majority of patients ≥4 times a week. Constipation was the OBD symptom that was most often reported as severe. Most patients reported that their OBD symptoms had at least a moderate negative impact on their overall quality of life and activities of daily living. A third of patients had missed, decreased or stopped using opioids in order to make it easier to have a bowel movement. Conclusion. The survey findings confirm that OBD occurs frequently, despite the use of laxatives, in individuals taking daily oral opioids for chronic pain. These gastrointestinal symptoms add to the burden already experienced by chronic pain patients, negatively impacting quality of life and, in some cases, affecting opioid treatment itself.

Abstract: Background There has been no definitive systematic review and meta-analysis to date examining the effect of laxatives and pharmacological therapies in chronic idiopathic constipation (CIC). Objective To assess efficacy of these therapies systematically in CIC. Design Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (up to September 2010). Eligibility criteria for selecting studies Placebocontrolled trials of laxatives or pharmacological therapies in adult CIC patients were eligible. Minimum duration of therapy was 1 week. Trials had to report either a dichotomous assessment of overall response to therapy at last point of follow-up in the trial, or mean number of stools per week during therapy. Study appraisal and synthesis methods Symptom data were pooled using a random effects model. Effect of laxatives or pharmacological therapies compared to placebo was reported as RR of failure to respond to therapy, or a weighted mean difference (WMD) in mean number of stools per week, with 95% CIs. Results Twenty-one eligible RCTs were identified. Laxatives (seven RCTs, 1411 patients, RR¼0.52; 95% CI 0.46 to 0.60), prucalopride (seven trials, 2639 patients, RR¼0.82; 95% CI 0.76 to 0.88), lubiprostone (three RCTs, 610 patients, RR¼0.67; 95% CI 0.56 to 0.80), and linaclotide (three trials, 1582 patients, RR¼0.84; 95% CI 0.80 to 0.87) were all superior to placebo in terms of a reduction in risk of failure with therapy. Treatment effect remained similar when only RCTs at low risk of bias were included in the analysis. Diarrhoea was significantly more common with all therapies. Limitations Only two RCTs were conducted in primary care, and total adverse events data for laxatives and linaclotide were sparse. Conclusions Laxatives, prucalopride, lubiprostone and linaclotide are all more effective than placebo for the treatment of CIC.

Abstract: Objective: We aimed to determine the efficacy, impact on quality of life (QOL), and safety of prucalopride, a selective, high-affinity 5-HT4 receptor agonist, in patients with chronic constipation (CC). Methods: In this multi-centre, randomized, placebo-controlled, parallel-group, phase III study, patients with CC (≤2 spontaneous complete bowel movements ([SCBM]/week) received 2 or 4 mg prucalopride or placebo, once daily, for 12 weeks. The primary efficacy endpoint was the proportion of patients reaching ≥3 SCBM/week. The key secondary efficacy endpoint was the proportion of patients having an increase of ≥1 SCBM/week. The primary QOL endpoint was the Patient Assessment of Constipation (PAC)-QOL satisfaction subscale score. Safety parameters included adverse events, laboratory values, and cardiovascular events. Results: Efficacy was evaluated over 713 patients. Averaged over 12 weeks, higher proportions of patients on prucalopride 2 mg (19.5%; p Conclusion: Prucalopride significantly and consistently improved bowel function, associated symptoms and satisfaction in chronically constipated patients.