A medicine for chronic constipation when laxatives have not worked
Prucalopride
A daily tablet used for chronic constipation when ordinary laxatives have not worked well enough.
What is Prucalopride?
Prucalopride is a medicine taken by mouth for long-term (chronic) constipation in adults, used when ordinary laxatives have not given enough relief. It works by helping the bowel muscles move stool along more effectively. It is taken once a day. The most common side effects are headache, nausea and diarrhoea, which are often most noticeable in the first few days and then tend to settle, and overall it is usually well tolerated. If it has not helped after a reasonable trial, it is reviewed and may be stopped.
Education and reference only. This is a plain-language guide to Prucalopride — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Prucalopride is a medicine used for chronic constipation in adults when laxatives have not worked well enough. Unlike laxatives that mainly soften stool or draw in water, prucalopride is a 'prokinetic': it encourages the natural muscular movement of the bowel that pushes stool along. It is taken by mouth as a once-daily tablet. It is generally tried after simpler measures and ordinary laxatives have not given adequate relief, and it is reviewed after a few weeks to see whether it is helping enough to continue.
How it works
The bowel moves stool along by waves of muscle contraction, partly controlled by a chemical messenger called serotonin (5HT) acting on a particular receptor (the 5HT4 receptor). Prucalopride stimulates this receptor, encouraging these natural waves of movement so that stool passes through the bowel more readily. This makes bowel movements more regular and easier in people with stubborn constipation. Because it works by promoting the bowel's own movement rather than simply softening stool, it offers a different approach when ordinary laxatives have not worked. Its effects often begin within the first week.
Company & origin
Originated / developed by: Specialist manufacturer.
A medicine used in the UK for chronic constipation in adults when other laxatives have not given enough relief.
Practical use
How to take Prucalopride
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take one tablet by mouth once a day, with or without food, at about the same time each day.
- Give it a fair trial; if it has not helped after a few weeks, your prescriber will review whether to continue.
- Expect headache, nausea or loose stools mainly in the first few days, which usually settle.
- Tell your prescriber if you have kidney problems or are older, as a lower dose may be used.
- Mention new symptoms such as bleeding from the back passage or unexplained weight loss.
Weighing it up
Advantages & disadvantages of Prucalopride
Advantages
- Helps chronic constipation by encouraging the bowel's own movement, a different approach from ordinary laxatives.
- Usually well tolerated, with side effects that often settle after the first few days.
- Taken as a simple once-daily tablet, with or without food.
Disadvantages
- Commonly causes headache, nausea or diarrhoea, especially in the first few days.
- Not a first choice; it is used when ordinary laxatives have not worked.
- May need a lower dose in older people or those with kidney problems.
Practical use
Good to know
Prucalopride is generally well tolerated, and the most common side effects, headache, nausea and diarrhoea, are often most noticeable in the first few days and then tend to ease. Taking it can become part of a daily routine, as it is a once-a-day tablet. It is used when ordinary laxatives have not given enough relief, so it is not usually a first choice. If it has not helped after a reasonable trial of a few weeks, your prescriber will review it and may stop it rather than continue something that is not working. As with any change in bowel habit, mention new symptoms such as bleeding or unexplained weight loss, which need checking. It is for adults, and the dose may be lowered in older people or those with kidney problems.
Who should not take it / use with caution
- People who have had a serious allergic reaction to prucalopride should not take it.
- It should not be used if there is a known or suspected blockage or serious problem in the bowel.
- It is used with care, and often at a lower dose, in older people and those with significant kidney problems.
Monitoring
- Reviewing after a few weeks whether it is helping enough to continue.
- Watching for side effects such as headache, nausea and diarrhoea.
- Taking account of age and kidney function when judging the dose.
Side effects
- Headache, which is common, especially early in treatment.
- Nausea and diarrhoea, often most noticeable in the first few days.
- Tummy pain or dizziness in some people.
- Rarely, more troublesome effects, which should be discussed with your prescriber.
Key interactions
- It has relatively few well-established interactions, but always tell your prescriber what you take.
- Other medicines that loosen the bowel may add to the chance of diarrhoea.
- Your prescriber will take account of kidney function when deciding the right dose.
Available as: Tablets taken by mouth.
Answers
Prucalopride: frequently asked questions
What is prucalopride used for?
It is used for chronic constipation in adults when ordinary laxatives have not given enough relief, by encouraging the bowel's own muscular movement.
How is it different from a laxative?
Rather than mainly softening stool or drawing in water, it is a prokinetic that stimulates the natural waves of bowel movement that push stool along.
What are its common side effects?
Headache, nausea and diarrhoea are most common and are often noticeable in the first few days before settling; overall it is usually well tolerated.
How long before I know if it works?
Its effects often begin within the first week, and your prescriber will review it after a few weeks to decide whether to continue.
Is the dose the same for everyone?
No. A lower dose may be used in older people or those with kidney problems, so tell your prescriber about these.
The wider class
About Prokinetic for constipation (5HT4 agonist)
Prucalopride belongs to the prokinetic for constipation (5ht4 agonist) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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