Gastrointestinal Motility Disorders

Medication Overview

Prucalopride and itopride are distinct medications with different mechanisms of action and indications: prucalopride is a selective 5-HT4 receptor agonist for chronic idiopathic constipation, while itopride is a dopamine D2 antagonist with anti-acetylcholinesterase effects for functional dyspepsia, as recommended by the American Gastroenterological Association 1

The American Gastroenterological Association recommends starting with first-line treatments, such as polyethylene glycol (PEG) and lifestyle modifications, and considering prucalopride 2 mg once daily if there is an inadequate response after a sufficient trial (typically 4-8 weeks) 2, 1
Prucalopride is recommended as a second-line treatment for chronic idiopathic constipation in adults who have failed first-line treatments, with a significant increase in complete spontaneous bowel movements (CSBMs) 1

Prucalopride significantly increases complete spontaneous bowel movements (CSBMs), with a response rate 2.37 times higher than placebo, and an increase of 0.96 complete spontaneous bowel movements (CSBMs) per week compared to placebo 1
Prucalopride induces and increases the amplitude of colonic high-amplitude propagated contractions, effectively moving colonic contents, and promotes neurotransmission by enteric neurons, stimulates the peristaltic reflex, enhances intestinal secretions, and improves GI motility 1

The standard adult dose of prucalopride is 2 mg once daily, which can be taken with or without food, and for patients with severe renal impairment (creatinine clearance <30 mL/min), the reduced dose is 1 mg once daily, as recommended by the American Gastroenterological Association 1
No dose adjustment is required for elderly patients (≥65 years), with efficacy similar to the overall population 1

Prucalopride has common side effects such as headache, abdominal pain, nausea, diarrhea, dizziness, vomiting, flatulence, and fatigue, and most side effects occur within the first week of treatment and typically resolve within a few days 1
Prucalopride is contraindicated in patients with hypersensitivity to prucalopride, intestinal perforation or obstruction, severe inflammatory conditions of the intestinal tract (Crohn's disease, ulcerative colitis), and toxic megacolon/megarectum 1
Monitoring is required for new onset or worsening depression or suicidal thoughts, and discontinuation of treatment is recommended if patient experiences unusual mood changes or suicidal thoughts, with no increased risk of cardiovascular adverse events compared to placebo observed with prucalopride 1

The treatment response should be evaluated after 4 weeks, and if effective with tolerable side effects, treatment should be continued, according to the American Gastroenterological Association 1
Clinical trials evaluated prucalopride for 4-24 weeks, with long-term safety and efficacy data beyond 12 weeks being more limited 1