Prucalopride for Chronic Constipation

Woman with irritable bowel syndrome. Credit: Credit: Peter Dazeley

Prucalopride is a medication designed to treat chronic constipation - a health problem characterized by infrequent and difficult passage of stools over a prolonged period, along with a range of other distressing symptoms such as abdominal bloating, flatulence, and even vomiting. Traditional treatment options for chronic constipation involve mostly diet and lifestyle changes and/or laxatives. 

Prucalopride is currently only available in Europe, under the name brand name "Resolor" and in Canada as "Resotran".

The European Medicines Agency (EMA) has approved the use of prucalopride (Resolor) only for the treatment of chronic constipation in women who have not responded to the use of laxatives. Studies are being conducted to obtain approval through the EMA for use of prucalopride in men who suffer from chronic constipation.

How Does Prucalopride Work?

Prucalopride is characterized as a 5-HT4 agonist. This means that it activates the 5-HT4 receptors for the neurotransmitter serotonin. This activation is thought to increase the motility of the intestinal system by increasing peristalsis, or the muscle movements of the intestines that propel stool out of the body, making stools easier to pass and resulting in more frequent bowel movements.

Prucalopride is of the same class of medications as Zelnorm. However, prucalopride has been designed to have a different action on the body so as to reduce the likelihood of the rare but serious cardiovascular symptoms that resulted in Zelnorm being pulled off of the market.

How Effective Is Prucalopride at Treating Chronic Constipation?

In clinical trials to date, prucalopride has been shown to be superior to placebo in the following areas:

  • Increasing the frequency of spontaneous and complete bowel movements.
  • Improving patient perception of quality of life.
  • Resulting in patient perception that constipation is less of a problem.

    What Are the Side Effects of Prucalopride?

    In studies to date, the following side effects have been experienced:

    Does Prucalopide Help IBS?

    In its latest research review, the American College of Gastroenterology concludes that research supports the effectiveness of prucalopride for both chronic constipation and IBS-C. The ACG researchers note that prucolopride does not carry Zelnorm's risk of serious cardiovascular events.

    Who Shouldn't Take Prucalopide?

    Certain people are at higher risk for developing dangerous side effects or complications from taking prucalopride. These include people:

    • Known hypersensitivity to the drug or any of its ingredients
    • Renal impairment requiring dialysis
    • Intestinal perforation or obstruction
    • Obstructive ileus
    • Severe inflammatory conditions of the intestinal tract
    • Severe and clinically unstable concomitant diseases, in particular arrhythmias or ischaemic cardiovascular disease.

    Sources:

    Ford, A., et.al. "American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation" American Journal of Gastroenterology 2014 109:S2-S26.

    Ford, A. & Suares, N. "Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis" Gut 2011 60:209-218.

    Maneerattanaporn, M., Chang, L., & Chey, W. "Emerging Pharmacological Therapies for the Irritable Bowel Syndrome" Gastroenterology Clinics of North America 2011 40:22-243.

    "Movetis starts phase III clinical trial with prucalopride in male patients with chronic constipation" Movetis NV Press Release September 24, 2010.

    "Resolor" European Medicines Agency Accessed March 17, 2011.

    Quigley, E. "Prucalopride: safety, efficacy and potential applications Therapeutic Advances in Gastroenterology 2012 5:23-30.

    Continue Reading