Guidelines for the Use of Laxatives - Which Laxatives, When?

Shin, Jeong Eun; Hong, Kyoung Sup; Jung, Kee Wook; Lee, Tae Hee; Lee, Bong Eun; Park, Seon-Young; Hong, Sung Noh; Kim, Seong-Eun; Park, Kyung Sik; Choi, Suck Chei

doi:2015.88.1.22

Special Review

The Korean Journal of Medicine 2015;88(1):22-26.
Published online January 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.1.22

Guidelines for the Use of Laxatives - Which Laxatives, When?

Jeong Eun Shin¹, Kyoung Sup Hong², Kee Wook Jung³, Tae Hee Lee⁴, Bong Eun Lee⁵, Seon-Young Park⁶, Sung Noh Hong⁷, Seong-Eun Kim⁸, Kyung Sik Park⁹, Suck Chei Choi¹⁰, Constipation Research Group of the Korean Society of Neurogastroenterology and Motility

¹Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
²Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
³Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
⁴Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
⁵Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
⁶Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
⁷Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
⁸Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
⁹Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
¹⁰Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea

변비 약물 치료의 지침 – 어떤 약제를, 언제 사용해야 하는가?

신정은¹, 홍경섭², 정기욱³, 이태희⁴, 이봉은⁵, 박선영⁶, 홍성노⁷, 김성은⁸, 박경식⁹, 최석채¹⁰, 대한소화기기능성질환·운동학회 변비 및 항문직장기능 연구회

^¹단국대학교 의과대학 내과학교실
^²서울대학교 의과대학 내과학교실
^³울산대학교 의과대학 소화기내과학교실
^⁴순천향대학교 의과대학 소화기연구소
^⁵부산대학교 의과대학 내과학교실
^⁶전남대학교 의과대학 내과학교실
^⁷성균관대학교 의과대학 내과학교실
^⁸이화여자대학교 의학전문대학원 내과학교실
^⁹계명대학교 의과대학 내과학교실
^¹⁰원광대학교 의과대학 내과학교실 및 소화기질환 연구소

Correspondence:
Suck Chei Choi, Tel: +82-63-859-2563, Fax: +82-63-855-2025, Email: medcsc@wmc.wonkwang.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

To manage chronic constipation, dietary and lifestyle modifications should be tried before pharmacological intervention. Although there is no standardized treatment guideline for medical practice, the key considerations in the choice of laxative include the treatment duration, dosing schedule, type of agent, effects and side effects of the agent, and cost. The first-line treatment is a bulking or osmotic laxative. If the patient is still symptomatic, the physician can add or switch to other laxatives. Next, prucalopride, a highly selective 5-hydroxytryptamine 4 (5-HT4) receptor agonist, could be considered. If the constipation is refractory to combination therapy with conventional laxatives and prucalopride, patients should be referred for further evaluation, including physiological testing.

Key Words: Constipation; Laxatives