Lubiprostone for Chronic Constipation

Mechanism of Action and Indications

Lubiprostone is an orally active prostaglandin analog that activates select chloride channels in the intestinal epithelium, enhancing intestinal fluid secretion and promoting bowel movements without directly stimulating gastrointestinal smooth muscle 1, 2

The American Gastroenterological Association-American College of Gastroenterology clinical practice guideline suggests lubiprostone for adults with chronic idiopathic constipation who do not respond to over-the-counter agents (conditional recommendation, low certainty of evidence) 3, 4
Lubiprostone can be used either as a replacement for or as an adjunct to over-the-counter laxatives when those agents fail to provide adequate relief 4, 5

Standard dosing for chronic constipation: 24 mcg twice daily with food and water 6

Nausea is a common adverse effect, occurring in up to 30.9% of patients, and is dose-dependent, with a lower incidence when taken with food and water 7
Diarrhea is also a common adverse effect 2

The NCCN Palliative Care guidelines recognize lubiprostone as an effective option for treating constipation, particularly for opioid-induced constipation in patients with chronic non-cancer pain 1, 9
The American Gastroenterological Association includes lubiprostone as a recommended option for treating constipation associated with irritable bowel syndrome 1, 7
Lifestyle modifications, such as increased fluid intake and physical activity, and dietary fiber are first-line treatments for chronic constipation, and lubiprostone should be considered after failure of these treatments 8

The monthly cost of lubiprostone is approximately $374, which is higher than most over-the-counter options but comparable to other prescription medications for chronic constipation 6, 3