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Selective Serotonin (5-HT₄) Receptor Agonist — Prokinetic Pregnancy: Contraindicated — avoid in pregnancy (animal studies show reproductive toxicity; ensure contraception in women of childbearing age).

Prucalopride

Brand names: Constella, Resolor

Adult dose

Dose: 2mg once daily. Elderly (≥65 years): start at 1mg once daily; may increase to 2mg once daily if response inadequate.
Route: Oral
Frequency: Once daily (with or without food)
Max: 2mg/day
Licensed for chronic idiopathic constipation in adults where other laxatives have failed to provide adequate relief. Take at same time each day. Review at 4 weeks — if no response, reconsider diagnosis and discontinue.

Paediatric dose

Route: N/A
Frequency: N/A
Max: Not licensed in children
Not licensed in patients under 18 years. Seek specialist opinion.

Dose adjustments

Renal

eGFR 30–89: no adjustment. eGFR <30: 1mg once daily (reduced clearance).

Hepatic

Severe hepatic impairment: 1mg once daily (Child-Pugh C).

Clinical pearls

  • Highly selective 5-HT₄ agonist — stimulates colonic peristalsis (high-amplitude propagating contractions). Not cardiac (unlike tegaserod which was withdrawn for cardiovascular risk).
  • NICE TA211: recommended only after failure of at least two standard laxatives (from different classes) at adequate doses for at least 6 months.
  • First-week headache: very common and usually self-limiting — warn patients. Take paracetamol if needed.
  • Discontinue after 4 weeks if no response — do not continue without clear clinical benefit.

Contraindications

  • Intestinal perforation or obstruction
  • Crohn's disease or ulcerative colitis (active)
  • Toxic megacolon or megarectum
  • Renal dialysis patients

Side effects

  • Headache (most common — especially on day 1 of treatment)
  • Nausea, diarrhoea, abdominal pain (common on initiation, usually settle after 1–2 weeks)
  • Palpitations
  • Dizziness

Interactions

  • No clinically significant pharmacokinetic interactions identified

Monitoring

  • Stool frequency (reassess at 4 weeks)
  • Symptoms

Reference: BNFc; BNF 90; NICE TA211 Prucalopride for Chronic Constipation. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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