Chronic constipation is a disorder characterized by unsatisfactory defecation that results from infrequent stools, difficult stool passage, or both over a time period of at least 12 weeks. In this report, we review the general and comparative effectiveness, safety, and tolerability of drugs for chronic constipation. Our review covers the use of the following in adults and children with chronic constipation and Irritable Bowel Syndrome, constipation-predominant (IBS-C): docusate calcium, docusate sodium, lactulose, lubiprostone, polyethylene glycol 3350, psyllium, and tegaserod.

Contents

• Introduction
  • Background
  • Etiology
  • Approach to Management
  • Scope and Key Questions
• Methods
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Quality Assessment
  • Data Synthesis
  • Rating the Strength of a Body of Evidence
• Results
  • Key Question 1. What is the general efficacy and effectiveness of drugs used to treat chronic constipation and chronic constipation associated with Irritable Bowel Syndrome? Given general efficacy and effectiveness, what is the comparative effectiveness of drugs used to treat chronic constipation and chronic constipation associated with Irritable Bowel Syndrome?
  • Key Question 2. Does treatment duration influence the effectiveness of drugs used to treat chronic constipation and chronic constipation associated with Irritable Bowel Syndrome? When should treatments be switched in patients not responding to a given drug?
  • Key Question 3. What is the comparative tolerability and safety of drugs used to treat chronic constipation and chronic constipation associated with Irritable Bowel Syndrome?
  • Key Question 4. Are there subgroups of patients based on demographics (age, racial or ethnic groups, and gender), other medications, or co-morbidities, including Irritable Bowel Syndrome, for which one symptomatic treatment is more effective or associated with fewer adverse events?
• Summary and Discussion
• Addendum
• References
• Appendixes
  • Appendix A. Search Strategies
  • Appendix B. Abstract-only Studies
  • Appendix C. Quality Assessment Methods for Drug Class Reviews for the Drug Effectiveness Review Project
  • Appendix D. Excluded Studies
• Evidence Tables

Oregon Evidence-based Practice Center, Oregon Health & Science University, Mark Helfand, MD, MPH, Director

The funding source, the Center for Evidence-based Policy, is supported by 17 organizations, including 15 state Medicaid programs. These organizations selected the topic and had input into the Key Questions for this review. The content and conclusions of the review are entirely determined by the Evidence-based Practice Center researchers. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in this report.

Suggested citation:

Gartlehner G, Jonas DE, Morgan LC, Ringel Y, Hansen RA, Bryant CM, Carey T. Drug Class Review on Constipation Drugs. 2007. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm

The Agency for Healthcare Research and Quality has not yet seen or approved this report.

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.