Prucalopride

Prucalopride is a selective serotonin (5-HT4) receptor agonist that predominantly stimulates colonic motility

• prucalopride has a UK marketing authorisation for the 'symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief
• prucalopride is administered orally
• the summary of product characteristics (SPC) states that the recommended dose of prucalopride is 2 mg once daily for adult women (up to 65 years old) and 1 mg once daily for older women (over 65 years). The dose for older women can be increased to 2 mg once daily if needed
  • if once-daily prucalopride is not effective after 4 weeks, the patient should be re-examined and the benefit of continuing treatment reconsidered
  • the SPC reports that the most common adverse effects that may be associated with prucalopride treatment include headache and gastrointestinal symptoms (abdominal pain, nausea or diarrhoea)
    • most adverse effects occur at the start of treatment and usually subside within a few days of continued treatment

NICE guidance states that (1)

• prucalopride is recommended as an option for the treatment of chronic constipation only in women for whom treatment with at least two laxatives from different classes, at the highest tolerated recommended doses for at least 6 months, has failed to provide adequate relief and invasive treatment for constipation is being considered
• if treatment with prucalopride is not effective after 4 weeks, the woman should be re-examined and the benefit of continuing treatment reconsidered
• prucalopride should only be prescribed by a clinician with experience of treating chronic constipation, who has carefully reviewed the woman's previous courses of laxative treatments

Reference:

• 1) NICE (decmber 2010). Prucalopride for the treatment of chronic constipation in women