For those who’re nonetheless backed up every week after being on OTC laxatives, discuss along with your healthcare supplier, Lacy says. Your physician might be able to decide an underlying trigger in your signs. For instance, medical situations resembling diabetes or an underactive thyroid could cause constipation, as can many widespread drugs, together with sure antacids, antidepressants, antihistamines, blood stress medication, ache relievers, and medicines for urinary incontinence.
Your physician also can advise you on doses and timing of OTC merchandise to get higher outcomes. If none of these approaches work, it’s time to think about a prescription answer. However don’t count on a miracle.
Prescribed drugs to deal with constipation are relative newcomers to the market. Since 2017 the FDA has permitted plecanatide (Trulance), tenapanor (Ibsrela), prucalopride (Motegrity), and lactitol (Pizensy) in addition to naldemedine (Symproic) for opioid-induced constipation.
As well as, prescribed drugs price way more than their OTC counterparts. With out insurance coverage, they price about $450 to $550 a month, in accordance with GoodRx. And except some older osmotic laxatives, none of these medication can be found but as a low-cost generic. So even with insurance coverage, it’s possible you’ll be on the hook for a large co-pay.
For all these causes, most individuals ought to think about prescribed drugs solely after OTC treatments haven’t labored. “You don’t go on to these medication till you’ve failed at what’s low cost and available,” Wald says.
Right here’s a abstract of prescription drugs that the FDA has permitted for treating persistent constipation:
Secretory laxatives together with linaclotide (Linzess), lubiprostone (Amitiza), and plecanatide (Trulance) work by inflicting the intestines to secrete extra fluid and may assist block belly ache. All of the medication on this class are additionally FDA-approved for treating irritable bowel syndrome with constipation.
“The worst facet impact for all three [available] brokers is diarrhea,” Lacy says. About 5 p.c of individuals taking Linzess expertise extreme diarrhea, analysis suggests, in contrast with about 1 to 2 p.c with the opposite medication on this class. Amitiza is extra doubtless than the opposite medication to trigger nausea. Almost 30 p.c of individuals taking the really helpful dose of the drug reported feeling nauseous in contrast with solely 3 p.c within the placebo group. Taking the drug with meals can scale back that facet impact, Lacy says.
Prucalopride (Motegrity) stimulates muscle groups within the G.I. tract to maneuver issues alongside. Widespread unwanted side effects embody belly ache, diarrhea, headache, and nausea. Most individuals experiencing diarrhea or headache reported that the signs bought higher in just a few days. As well as, Motegrity carries a warning that it might trigger suicidal ideas or conduct, though the FDA has not conclusively linked the drug to that danger.
Osmotic laxatives resembling lactulose (Constulose, Enulose, and generic) work equally to OTC polyethylene glycol and aren’t essentially any higher than the cheaper drugstore product Wald says.
Few research have in contrast constipation drugs head-to-head. To get an concept of relative effectiveness, researchers from the U.S. and the U.Ok. analyzed knowledge from 33 research evaluating a drug with a placebo. Results printed on-line in August 2019 in The Lancet Gastroenterology & Hepatology discovered that after 4 weeks, the OTC stimulant laxatives bisacodyl and sodium picosulfate ranked first in effectiveness however final when it comes to unwanted side effects; after 12 weeks, Motegrity got here out on prime.
The selection for which prescription drug to take usually comes all the way down to what’s lined below a affected person’s medical health insurance, Lacy says. Because of the warning, some insurers gained’t cowl prucalopride except a affected person hasn’t responded to one of many secretory laxatives.
