Try this one first:  OTC (over the counter):  docusate/ Colace – sold generically as docusate sodium— adult dose is 100 to 500mg per day; usually sold in 100mg gel capsules–usual dose is 2 a day--but it is very safe and a lot more can be taken.    It may take a few days before it is working well; this is a “stool softener” which causes stool to retain water.

You can take a large amount of these pills, as docusate actually doesn’t enter the body.  It stays in the intestine and draws more water in.

 

OTC: Peri-Colace is a little stronger than plain Colace– sold generically as docusate sodium 100mg with casanthranol 30mg– usually one or two at bedtime; the casanthranol is an irritant which makes the bowel move faster.

  • try to avoid this one—the one with the stimulant/ irritant—because your bowel can get “dependent” on it.

Metamucil type preparations are to be mixed with water; they provide bulk:

otc—Citrucel:   (and various generics) is 2 grams of methylcellulose and the dose is one tablespoon twice a day.

otc –Metamucil: (and various generics) is 3.4 grams of psyllium.  One packet is put in liquid to drink, three times a day or less.  It is said to help reduce lipids.

Note: I am told that if you are using both a docusate / Colace-type medication (i.e., water retaining) with one of the Metamucil-type medications (i.e., bulk inducing), it works better if you do not take both types at the same time of day—i.e., try to take them at least a few hours apart.

This is a medication that also provides bulk:   Konsyl

Another type:   MiraLax (polyethylene glycol) 1 tbsp in 8 ounces of water daily, as needed

Align – a probiotic.

 

 

 

 

 

 

 

For  excessive  gas

[flatus]:   simethicone 125mg 4 times a day or less;  two chewable tablets are  Extra Strength Gas-X and Maximum Strength Mylanta Gas. The generic name is simethicone.

Phasyme

 

 

Lactulose (pronounced /ˈlæktjʉloʊz/) is a synthetic, non-digestible sugar used in the treatment of chronic constipation[1] and hepatic encephalopathy, a complication of liver disease. It is a disaccharide (double-sugar) formed from one molecule each of the simple sugars (monosaccharides) fructose and galactose. The commercial syrup used for treatment of constipation is dyed yellow-orange. It is produced commercially by isomerization of lactose.

In the treatment of chronic constipation,[2] the metabolites of lactulose draw water into the bowel, causing a cathartic effect through osmotic action. It is safe for people of all ages, except for those in a very small percentage of the population that are galactose intolerant. Dosage may have to be adjusted over time to produce the desired effect because the laxative effect can decline with daily treatment.[citation needed]

In treating constipation lactulose works by increasing the water content and volume of the stools in the bowel, making them softer and easier to pass. Lactulose is made up of sugar molecules and is partly broken down by the bacteria that live in the lower part of the gut. This leads to the contents of the gut becoming more acidic because there are carboxylic acids among its metabolites, which are not absorbed from the lower bowel. That in turn causes water to be retained in the lower bowel. This increases the amount of water in the stools, softening them and making them easier to pass. The added volume of gas and flatulence caused by fermentation of the lactulose adds to the volume of the fecal material, and makes it easier to expel. The slightly acidic condition of the colon caused by the presence of acids causes active peristalsis. The combined effect of all of these processes relieves constipation in a very effective manner.

Common side effects are abdominal cramping, borborygmus, gas and pungent flatulence that some people find difficult to control in social situations. Excessively high dosage can cause explosive and uncontrollable diarrhea. In normal individuals, overdose is considered uncomfortable, but not life threatening. Uncommon normal side effects are nausea and vomiting.    In sensitive individuals, such as the elderly or people with reduced kidney function, excess dosage can result in dehydration and electrolytic disturbances such as high sodium levels.

Prescribers should remember that, although it has less potential to cause dental caries than sucrose, lactulose is a sugar and therefore has that potential, especially when prescribed to children or older people. However, the risk is minimal under normal conditions of use.[13]

Psyllium seed husks also known as ispaghula, isabgol, or psyllium, are portions of the seeds of the plant Plantago ovata, (genus Plantago), a native of India. They are hygroscopic, expanding and become mucilaginous.

Psyllium seed husk are indigestible and are a source of soluble dietary fiber. They are used to relieve constipation, irritable bowel syndrome, and diarrhea. They are also used as a regular dietary supplement to improve and maintain regular GI transit. The inert bulk of the husks helps provide a constant volume of solid material irrespective of other aspects of the diet or any disease condition of the gut. Some recent research is also showing them to be promising in lowering cholesterol and controlling diabetes.[1]

Other uses include gluten-free baking, where ground psyllium seed husks bind moisture and help make breads less crumbly.   The husks are used whole in their natural state, or dried and chopped or powdered for easier consumption. In either of these forms, one takes them by mixing them with water or another fluid.    They are also available in capsules. Over-the-counter laxatives and fiber supplements such as Metamucil, Colon Cleanse, Serutan, Fybogel, Bonvit, Effersyllium, and Konsyl have psyllium husks as their main ingredient.

 

Lubiprostone

From Wikipedia, the free encyclopedia

(Redirected from Amitiza)

Lubiprostone
Systematic (IUPAC) name
7-[(1R,3R,6R,7R)-3-(1,1-difluoropentyl)-3-hydroxy-
8-oxo-2-oxabicyclo[4.3.0]non-7-yl]heptanoic acid
Clinical data
Trade names Amitiza
AHFS/Drugs.com monograph
MedlinePlus a607034
Licence data US FDA:link
Pregnancy cat. C (US)
Legal status ℞-only (US)
Routes Oral
Pharmacokinetic data
Bioavailability Negligible
Protein binding 94%
Metabolism Extensive, CYP not involved
Half-life Unknown (lubiprostone)
0.9–1.4 hours (main metabolite)
Excretion Renal (60%) and fecal (30%)
Identifiers
CAS number 136790-76-6 
ATC code A06AX03
PubChem CID 157920
DrugBank DB01046
ChemSpider 138948 
UNII 7662KG2R6K 
KEGG D04790 
ChEMBL CHEMBL1201134 
Synonyms Amitiza
RU-0211
SPI-0211
Chemical data
Formula C20H32F2O5 
Mol. mass 390.462 g/mol
SMILES[show]
InChI[show]
  (what is this?)  (verify)

Lubiprostone (rINN, marketed under the trade name Amitiza) is a medication used in the management of chronic idiopathic constipation and irritable bowel syndrome. It was approved by the U.S. Food and Drug Administration (FDA) for this purpose on 31 January 2006.

By James Heilman, MD - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=6876565

By James Heilman, MD – Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=6876565

Medical uses    Lubiprostone is used for the treatment of chronic constipation of unknown cause in adults, as well as irritable bowel syndrome associated with constipation in women.[1]

As of 20 July 2006, Lubiprostone has not been studied in children. There is current research underway to determine the efficacy in postoperative bowel dysfunction, and opioid-induced bowel dysfunction.

Adverse effects

In clinical trials, the most common adverse event was nausea (31%). Other adverse events (≥5% of patients) included diarrhea (13%), headache (13%), abdominal distention (5%), abdominal pain (5%), flatulence (6%), sinusitis (5%) and vomiting (5%).

Contraindications   There are no current data on use in people with liver or kidney complications. The effects on pregnancy have not been studied in humans but testing in Guinea pigs resulted in fetal loss. Amitiza is not approved for use in children. (FDA) consensus Amitiza is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in WOMEN (emphasis added) ≥ 18 years old. (FDA) (not yet men, by, FDA ?, needs checking) Lubiprostone is contraindicated in patients exhibiting chronic diarrheabowel obstruction, or diarrhea-predominant irritable bowel syndrome.

Mechanism of action

Lubiprostone is a bicyclic fatty acid derived from prostaglandin E1 that acts by specifically activating ClC-2 chloride channels on the apical aspect of gastrointestinal epithelial cells, producing a chloride-rich fluid secretion. These secretions soften the stool, increase motility, and promote spontaneous bowel movements (SBM).

Symptoms of constipation such as pain and bloating are usually improved within one week, and SBM may occur within one day.

Pharmacokinetics

Unlike many laxative products, Lubiprostone does not show signs of tolerancedependency, or altered serum electrolyte concentration. There was no rebound effect following withdrawal of treatment, but a gradual return to pre-treatment bowel movement frequency should be expected.

Minimal distribution of the drug occurs beyond the immediate gastrointestinal tissues. Lubiprostone is rapidly metabolized by reduction/oxidation, mediated by carbonyl reductase. There is no metabolic involvement of the hepatic cytochrome P450 system. The measurable metabolite, M3, exists in very low levels in plasma and makes up less than 10% of the total administered dose.

Data indicate that metabolism occurs locally in the stomach and jejunum.