Usage of Prucomed 2
Prucomed 2 is indicated for:
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Chronic idiopathic constipation (CIC) in adults, particularly where laxatives have failed
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Constipation associated with irritable bowel syndrome (IBS-C) (off-label use in some regions)
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Useful in elderly or bedridden patients with slow colonic transit
Mechanism of Action
Prucalopride is a highly selective 5-HT₄ receptor agonist that:
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Stimulates colonic peristalsis
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Accelerates gastrointestinal transit
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Enhances frequency and completeness of spontaneous bowel movements
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Has minimal cardiovascular risk compared to older 5-HT₄ agents (e.g., cisapride, tegaserod)
Key Benefits
✅ Restores natural motility without dependence
✅ Effective in laxative-refractory constipation
✅ Reduces symptoms like straining, bloating, and incomplete evacuation
✅ Safe for long-term use
✅ Improves quality of life and bowel satisfaction scores
Common Side Effects
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Headache (most common)
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Nausea
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Abdominal pain or cramping
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Diarrhea (transient)
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Dizziness, flatulence (less frequent)
Most side effects are mild and occur during the first days of treatment.
Precautions
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Not recommended in patients with:
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Intestinal perforation or obstruction
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Severe inflammatory bowel disease
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End-stage renal disease without dialysis
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Monitor for severe persistent diarrhea
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Use cautiously in patients with a history of arrhythmia or cardiovascular disease
Drug Interactions
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Minimal CYP450 interaction — low risk of drug-drug interactions
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Can be safely co-administered with PPIs, H2 blockers, and iron supplements
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Avoid with potent P-gp inhibitors in renal impairment
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Alcohol may worsen GI side effects
Dosage and Administration
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Adult dose: 2 mg once daily, orally, with or without food
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Elderly (>65 yrs): Start with 1 mg once daily (may increase to 2 mg if needed)
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If no improvement after 4 weeks, consider discontinuation
Storage
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Store below 25°C, protected from moisture
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Keep out of reach of children
Patient Counseling Points
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Explain that this is not a laxative, but a motility enhancer
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Relief may take a few days; do not expect immediate effect
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Hydration and dietary fiber remain essential
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Report symptoms like severe diarrhea or abdominal pain
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Avoid self-escalating the dose
