Chronic Idiopathic Constipation Flashcards
In adults w/ CIC, suggest the use of fiber supplementation over management w/o fiber supplements
Considerations:
a) dietary assessment is important to determine total fiber intake from diet and supplements
b) fiber supplements can be used as first-line therapy for CIC, particularly for individuals w/ low dietary fiber intake
c) among the evaluated fiber supplements, only psyllium appears to be effective (w/ very limited data)
d) adequate hydration should be encouraged w/ the use of fiber
e) flatulence is a commonly observed side effect w/ the use of fiber
conditional, low evidence
In adults w/ CIC, recommend the use of PEG compared w/ management w/o PEG
Considerations:
a) a trial of fiber supplement can be considered for mild constipation before PEG use or in combination w/ PEG
b) response to PEG has been shown to be durable over 6 months
c) side effects include abdominal distention, loose stool, flatulence, and nausea
strong, moderate evidence
In adults w/ CIC, suggest the use of magnesium oxide over management w/o
Considerations:
a) trials were conducted for 4 wks, although longer term use is probably appropriate
b) suggest starting at a lower dose, which may be increased
c) avoid use in patients w/ renal insufficiency due to the risk of hypermagnesemia
conditional, very low evidence
In adults w/ CIC who fail or are intolerant to OTC therapies, suggest the use of lactulose over management w/o
Considerations:
a) bloating and flatulence are dose-dependent and common side effects, which may limit its use in clinical practice
conditional, very low evidence
In adults w/ CIC, recommend the use of bisacodyl or sodium picosulphate short term or as a rescue therapy over management w/o
Considerations:
a) short-term use is defined as daily use for 4wk or less, while long-term use is probably appropriate, data is needed to better understand tolerance and side effects
b) this is a good option for occasional use or rescue therapy in combination w/ other pharmacological agents for CIC
c) the most common side effects are abdominal pain, cramping and diarrhea, suggest starting at a lower dose and increasing as tolerated
strong, moderate evidence
In adults w/ CIC, suggest the use of Senna over management w/o
Considerations:
a) while the trials were conducted for 4 wks, longer term use is probably appropriate but data is needed to better understand tolerance and side effects
b) the dose evaluated in trials is higher than commonly used doses in practice, suggest starting at lower dose and increase if no response
c) abdominal pain and cramping may occur w/ a higher dose of senna
conditional, low evidence
In adults w/ CIC who do not respond to OTC agents, suggest the use of lubiprostone over management w/o
Considerations:
a) can be used as a replacement or as an adjunct to OTC agents
b) duration of treatment in trials was 4 wks but the drug label does not provide a limit
c) nausea may occur; however, the risk of nausea is dose-dependent and seems to be lower when taken w/ food and water
conditional, low evidence
In adults w/ CIC who do not respond to OTC agents, recommend the use of linaclotide over management w/o
Considerations:
a) can be used as a replacement or as an adjunct to OTC agents
b) duration of treatment in trials was 12wk but the label does not provide a limit
c) may be associated w/ side effects of diarrhea, leading to discontinuation
strong, moderate evidence
In adults w/ CIC who do not respond to OTC agents, recommend the use of plecanatide over management w/o
Considerations:
a) can be used as a replacement or as an adjunct to OTC agents
b) duration of treatment in trials was 12wk but label doesn’t provide a limit
c) may be associated w/ side effects of diarrhea, leading to discontinuation
strong, moderate evidence
In adults w/ CIC who do not respond to OTC agents, recommend the use of prucalopride over management w/o
Considerations:
a) duration in trials was 2-4wks but label doesn’t provide a limit
b) can be used as a replacement or adjunct to OTC agents
c) may be associated w/ side effects of headache, abdominal pain, nausea, and diarrhea
strong, moderate evidence
