Podcast
Questions and Answers
What is the suggested first-line therapy for constipation in adults with CIC?
What is the suggested first-line therapy for constipation in adults with CIC?
Which fiber supplement is deemed effective for CIC according to the recommendations?
Which fiber supplement is deemed effective for CIC according to the recommendations?
What side effects are commonly observed with the use of fiber supplements?
What side effects are commonly observed with the use of fiber supplements?
What is the duration of response shown in clinical trials for PEG in adults with CIC?
What is the duration of response shown in clinical trials for PEG in adults with CIC?
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In patients with renal insufficiency, which treatment should be avoided due to the risk of hypermagnesemia?
In patients with renal insufficiency, which treatment should be avoided due to the risk of hypermagnesemia?
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What is the panel's recommendation regarding the use of senna for adults with CIC?
What is the panel's recommendation regarding the use of senna for adults with CIC?
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What is a common side effect of linaclotide that may lead to treatment discontinuation?
What is a common side effect of linaclotide that may lead to treatment discontinuation?
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What dosage strategy is suggested for starting senna?
What dosage strategy is suggested for starting senna?
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What is the primary difference in the recommendations for lubiprostone and linaclotide?
What is the primary difference in the recommendations for lubiprostone and linaclotide?
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What is the strength of recommendation for the use of prucalopride in adults with CIC?
What is the strength of recommendation for the use of prucalopride in adults with CIC?
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Study Notes
Recommendations for Chronic Idiopathic Constipation (CIC) Management
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Fiber Supplements: For adults with CIC, fiber supplementation is suggested over management without fiber. Dietary assessment of total fiber intake is crucial. Psyllium is the only effective fiber supplement, while bran and inulin show limited/uncertain effectiveness. Adequate hydration is essential. Flatulence is a frequent side effect.
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Osmotic Laxatives (PEG): PEG use is recommended over no PEG for CIC. Trial of fiber supplements may be considered before or alongside PEG for mild constipation. PEG effectiveness is durable for at least 6 months. Side effects include abdominal distension, loose stools, flatulence, and nausea.
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Magnesium Oxide: Magnesium oxide is suggested over no magnesium oxide for CIC. Trials lasted 4 weeks, but longer-term use is likely appropriate. Start with a low dose, increasing as needed. Avoid in renal insufficiency due to hypermagnesemia risk.
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Lactulose: Lactulose is suggested for CIC patients intolerant or failing over-the-counter (OTC) therapies. Bloating and flatulence are dose-dependent side effects.
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Stimulant Laxatives (Bisacodyl/Sodium picosulphate): Short-term (4 weeks or less) usage or as rescue therapy for CIC is recommended. While longer-term use is likely appropriate, more data on long-term tolerance/side effects are needed. Good for occasional use or rescue therapy. Common side effects are abdominal pain, cramping, and diarrhea. Start with a low dose, titrating up as tolerated.
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Senna: Senna use is suggested over no senna for CIC. Trials were 4 weeks long, suggesting longer-term use is possible, but more data on side effects and long-term tolerance are required. Start lower than the doses in trials and increase up to effectiveness. Side effects may include abdominal pain and cramping when used in higher doses.
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Lubiprostone: Lubiprostone is suggested for CIC patients unresponsive to OTC agents. Can be either a primary treatment or adjunct to OTC agents. While trials were 4 weeks, no limit is specified by the drug label. Nausea, though present, is dose-dependent and lessened when taken with food/water.
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Linaclotide: Linaclotide is recommended for CIC if not responsive to OTC agents. Use can be as a primary treatment or adjunct to OTC agents. Trials lasted 12 weeks, though the labelled use period isn't defined. Diarrhea is a possible side effect and potentially lead to treatment discontinuation.
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Plecanatide: Plecanatide is recommended for CIC in cases of non-response to OTC agents. Can be primary or supplementary treatment to OTC medications. Trials lasted 12 weeks, though dosage guidelines are unspecified. Diarrhea is a possible side effect leading to cessation of treatment.
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Prucalopride: Prucalopride is recommended for CIC non-responsive to OTC agents. Can be primary or added to OTC treatment. Trial duration ranged from 4 to 24 weeks; however, no specific label guidelines are provided for treatment duration. Side effects can include headache, abdominal pain, and nausea.
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Description
Explore effective strategies for managing Chronic Idiopathic Constipation (CIC). This quiz covers the use of fiber supplements, osmotic laxatives like PEG, and magnesium oxide, emphasizing their benefits and potential side effects. Test your knowledge on dietary adjustments and other management recommendations.
