Cisapride (Propulsid) is the original agent in this class and works by stimulating the stomach via 5-hydroxytryptamine (5-HT4) receptors. It is relatively free of CNS side effects and has been shown to improve gastric emptying of solids and liquids. Unfortunately, the unacceptably high rate of potentially fatal cardiac arrhythmias seen with this drug prompted the US Food and Drug Administration to restrict its use. Consequently, we rarely use this drug outside of special circumstances.
Tegaserod (Zelnorm) (Novartis Pharmaceutical Company) is the most recently approved prokinetic agent. It has recently been FDA-approved for treatment of women with constipation-predominant irritable bowel syndrome (IBS). It is a partial and selective 5-HT4 receptor agonist that possesses GI stimulatory effects from the esophagus to the rectum. Animal and human studies have shown stimulatory motor effects throughout the digestive tract, and it has been shown by Prather and colleagues (2000) to accelerate orocecal transit in patients with IBS. There are data showing improved gastric emptying times in patients with gastroparesis and clinical trials in this subgroup of patients are ongoing. Dosing is recommended as 6 mg po twice daily but in our experience dosing up to 4 times daily is well tolerated without loose stools. We will especially consider introducing this therapy for patients who complain of constipation in addition to their symptoms of gas-troparesis. Tegaserod does not have antiemetic properties, and, therefore, would need to be given in combination with standard antiemetics.
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Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.