In draft guidance published, NICE recommends prucalopride (Resolor, Movetis) as an option for the treatment of chronic constipation in women, in whom laxatives have failed to provide adequate relief.
Prucalopride[1] should only be considered for women who have tried at least two different types of laxatives from different classes (at the highest tolerated recommended doses) for at least six months, but have not had relief from constipation, and invasive treatment is being considered.
Prucalopride should only be prescribed by a clinician with experience of treating chronic constipation, who has supervised the woman’s previous course of laxatives. If treatment with prucalopride is not effective after four weeks, the patient should be re-examined and the benefit of continuing treatment reconsidered.
Constipation is defined as passing abnormally delayed or infrequent dry, hardened faeces (stools), often accompanied by straining and/or pain. People with chronic constipation have no more than two spontaneous complete bowel movements per week, and one or more of the following symptoms, for at least six months:
– straining, lumpy or hard stools
– a sensation of incomplete evacuation
Constipation may be caused by dietary changes, stress, or immobility. It may also be the consequence of an underlying condition. Other known causes of constipation include: not eating enough fibre, not drinking enough fluids, and various medical conditions, such as an underactive thyroid, irritable bowel syndrome, some gut disorders, and conditions that cause poor mobility, particularly in the elderly.
The first step in managing constipation should be appropriate diet and lifestyle changes. If this does not work, laxatives may relieve the symptoms and restore normal bowel function. Prucalopride is recommended for those women with long term constipation, whose condition has not responded to standard laxatives.
Chronic constipation affects on average two to three times as many women as men, with prevalence rates of around 10% in women under 65 years of age in the UK. Rates are often higher (around 20%) in women over 65 years of age.
Professor Peter Littlejohns, Clinical and Public Health Director at NICE said: “We are pleased to be able to provisionally recommend prucalopride as a clinically and cost effective treatment for women with chronic constipation who have not had adequate relief from at least two prior laxative treatments.
The evidence presented to the Appraisal Committee shows prucalopride is a helpful addition in treating women with chronic constipation which has not been managed with standard laxatives.”
Source: NICE