Free Download Available | Summary Slides for Chronic Constipation Treatment Drugs (For Training and Education)
Concerns for Training Coordinators
Have you ever been assigned to lead a training session within the pharmacy department and struggled with choosing a theme or creating slides?
When you are busy with daily tasks, finding training material, checking literature, organizing key points, and putting them into slides is more burdensome than you might imagine.
Therefore, I have created slides that organize the pharmacological actions and characteristics of major drugs for chronic constipation, a condition frequently encountered in clinical practice and an easy theme to adopt for training.
In this article, we will cover osmotic laxatives, secretagogues, IBAT inhibitors, and naldemedine for opioid-induced constipation (OIC).
First, here are the completed slides.
You can download them here👇https://www.docswell.com/s/yakusura/ZPGVM8-2026-02-15-083103
You are free to use and share these slides (please credit "Yakusura" as the source when redistributing).
Osmotic Laxatives
These are the most fundamental drug group for treating chronic constipation. They draw water into the intestinal tract, soften the stool, and promote natural bowel movements.
Magnesium Oxide
A representative laxative used for a long time.
While it is inexpensive and easy to use, caution is required regarding hypermagnesemia in elderly patients and those with renal impairment.Polyethylene Glycol (PEG: Movicol®)
Contains electrolytes and retains water through osmotic action in the intestinal tract. It has almost no effect on water movement in the body, and is considered safer and more suitable for long-term use than magnesium oxide.Lactulose (Lagnos Jelly®)
In addition to osmotic action, it has an effect of improving the intestinal environment through the production of organic acids by intestinal bacteria. It is also characterized by being a jelly preparation that is portable and easy to take.
The effect is mild, and there are reports that the bowel movement promotion effect is slightly weaker than that of PEG.
While any of these drugs can be used as a first-line treatment, I believe magnesium oxide, which has a lower drug price, is often chosen first based on the notification from the Health Insurance Bureau's Medical Division (Ho-i-hatsu). On the other hand, if renal impairment or drug interactions are a concern, other drugs may be prioritized.
Secretagogues
These promote water secretion in the intestinal epithelium, soften the stool, and improve bowel movements.
They are an option to add or switch to if osmotic laxatives are not sufficiently effective.
Lubiprostone (Amitiza®)
Activates Cl⁻ channels to increase intestinal fluid secretion.
Post-meal administration is standard, and caution is required regarding nausea as a side effect.
There is also evidence for its use in opioid-induced constipation (OIC), and it is sometimes used for that purpose.Linaclotide (Linzess®)
Stimulates GC-C receptors to increase cGMP, thereby promoting water secretion and suppressing pain.
Pre-meal administration is standard, and caution is required regarding diarrhea as a side effect.
It is considered particularly effective in cases accompanied by constipation-predominant irritable bowel syndrome (IBS-C).
IBAT Inhibitors
These inhibit the ileal bile acid transporter (IBAT) and suppress the reabsorption of bile acids. As a result, the bile acids remaining in the large intestine promote water secretion and peristalsis, improving bowel movements.
Elobixibat (Goofice®)
Since bile acids are released after meals, pre-mealadministration is the standard. Because bile acids promote not only water secretion but also peristalsis,
caution regarding abdominal painis necessary as a side effect.
Opioid-Induced Constipation (OIC)
OIC is a frequent side effect of opioids and can hinder the continuation of pain control. Therefore, it is recommended to introduce laxatives prophylactically at the same time as starting opioid administration.
Naldemedine
Selectively blocks opioid receptors in the intestinal tract, relieving the inhibition of intestinal peristalsis caused by opioids. A major advantage is that it can be used safely in combination while maintaining analgesic effects, as it does not affect central analgesic action. Transient diarrhea may be observed after the initial dose, but it usually resolves spontaneously within 1 to 2 days.
Summary
The first choice is osmotic laxatives.
In accordance with the notification from the Medical Economics Division of the Health Insurance Bureau (Ho-i-hatsu), magnesium oxide is the first choice.If the effect is insufficient, consider combining or switching to epithelial function modifiers or IBAT inhibitors.
Use stimulant laxatives on an as-needed basis and avoid long-term continuous use.
For OIC, naldemedine is the primary treatment.
The slides corresponding to this article organize the above content with a focus on charts and diagrams, making them ready for immediate use in education and training.
Please make use of them as a time-saving tool for training coordinators and as teaching materials for new staff.
References
Japanese Society of Neurogastroenterology, ed.
Clinical Practice Guidelines for Functional Gastrointestinal Disorders 2023 - Chronic Constipation -. 2023. Nankodo.Riku Matsumoto.
How to Think About and Use Gastrointestinal Therapeutic Drugs, 2nd Revised Edition. Chugai Igakusha, 2025Hiromu Kataoka.
Decoding the 'Clinical Practice Guidelines for Functional Gastrointestinal Disorders 2023: Chronic Constipation'.
Pain Clinic 45(12):1299–1304, 2024Harue Ogino, Yoshimasa Tanaka, Eikichi Ihara.
New Drugs Appearing One After Another, Clinical Practice Guidelines for Functional Gastrointestinal Disorders 2023 - Functional Constipation and Functional Diarrhea -.
Yakkyoku 76(1):36-40, 2025.Kenji Hyaku.
Side Effects and Drug Interaction Management of Constipation Drugs.
Yakkyoku 70(6):1344-1350, 2019.Momoko Tsuda.
Management of Constipation and Diarrhea During Cancer Treatment.
Gekkan Yakuji 67(4):779-783, 2025
※ This article is a summary compiled for the personal study and training of pharmacists. While we strive for accuracy, we do not guarantee that the information is the latest. Please always follow the guidelines of your facility and the judgment of the attending physician for actual clinical practice and prescriptions.