Best Drugs for Constipation - ConsumerReports.org

If you're still backed up a week after being on OTC laxatives, talk with your healthcare provider, Lacy says. Your doctor may be able to determine an underlying cause for your symptoms. For example, medical conditions such as diabetes or an underactive thyroid can cause constipation, as can many common medications, including certain antacids, antidepressants, antihistamines, blood pressure drugs, pain relievers, and drugs for urinary incontinence. 

Your doctor can also advise you on doses and timing of OTC products to get better results. If none of those approaches work, it's time to consider a prescription solution. But don't expect a miracle.

Prescription drugs to treat constipation are relative newcomers to the market. Since 2017 the FDA has approved plecanatide (Trulance), tenapanor (Ibsrela), prucalopride (Motegrity), and lactitol (Pizensy) as well as naldemedine (Symproic) for opioid-induced constipation. 

In addition, prescription drugs cost much more than their OTC counterparts. Without insurance, they cost about $450 to $550 a month, according to GoodRx. And with the exception of some older osmotic laxatives, none of those drugs are available yet as a low-cost generic. So even with insurance, you may be on the hook for a sizable co-pay.

For all those reasons, most people should consider prescription drugs only after OTC remedies haven't worked. "You don't go on to those drugs until you've failed at what's cheap and readily available," Wald says.

Here's a summary of prescription medications that the FDA has approved for treating chronic constipation: 

Secretory laxatives including linaclotide (Linzess), lubiprostone (Amitiza), and plecanatide (Trulance) work by causing the intestines to secrete more fluid and may also help block abdominal pain. All the drugs in this category are also FDA-approved for treating irritable bowel syndrome with constipation. 

"The worst side effect for all three [available] agents is diarrhea," Lacy says. About 5 percent of people taking Linzess experience severe diarrhea, research suggests, compared with about 1 to 2 percent with the other drugs in this class. Amitiza is more likely than the other drugs to cause nausea. Nearly 30 percent of people taking the recommended dose of the drug reported feeling nauseous compared with only 3 percent in the placebo group. Taking the drug with food can reduce that side effect, Lacy says. 

Prucalopride (Motegrity) stimulates muscles in the G.I. tract to move things along. Common side effects include abdominal pain, diarrhea, headache, and nausea. Most people experiencing diarrhea or headache reported that the symptoms got better in a few days. In addition, Motegrity carries a warning that it could cause suicidal thoughts or behavior, although the FDA has not conclusively linked the drug to that risk.

Osmotic laxatives such as lactulose (Constulose, Enulose, and generic) work similarly to OTC polyethylene glycol and aren't necessarily any better than the cheaper drugstore product Wald says.

Few studies have compared constipation medications head-to-head. To get an idea of relative effectiveness, researchers from the U.S. and the U.K. analyzed data from 33 studies comparing a drug with a placebo. Results published online in August 2019 in The Lancet Gastroenterology & Hepatology found that after four weeks, the OTC stimulant laxatives bisacodyl and sodium picosulfate ranked first in effectiveness but last in terms of side effects; after 12 weeks, Motegrity came out on top. 

The choice for which prescription drug to take often comes down to what's covered under a patient's health insurance, Lacy says. Due to the warning, some insurers won't cover prucalopride unless a patient hasn't responded to one of the secretory laxatives.

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