A lifetime of constipation issues, 15 years of Parkinson’s meds, and now the dire need for both hips to be replaced, has slowed me to a standstill - in more ways than one.
The upside is that I have been accepted at a hospital Functional Gut Center and have been working with experts who are taking my constipation very seriously.
So I have been prescribed Prucalopride, and my initial research has found scientific reports that clearly demonstrate positive results for people with Parkinson’s.
Does anybody have experience with this medication? I can’t find any references in this search engine.
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Protective effects of prucalopride in MPTP-induced Parkinson’s disease mice: Neurochemistry, motor function and gut barrier 2021 sciencedirect.com/science/a...
Abstract
Evidence suggests constipation precedes motor dysfunction and is the most common gastrointestinal symptom in Parkinson’s disease (PD). 5-HT4 receptor (5-HT4R) agonist prucalopride has been approved to treat chronic constipation. Here, we reported intraperitoneal injection of prucalopride for 7 days increased dopamine and decreased dopamine turnover. Prucalopride administration improved motor deficits in 1-methyl-4-phenyl-1,2,3,6-tetrathydropyridine (MPTP)-induced PD mouse models. Prucalopride treatment also ameliorated intestinal barrier impairment and increased IL-6 release in PD model mice. However, prucalopride treatment exerted no impact on JAK2/STAT3 pathway, suggesting that prucalopride may stimulate IL-6 via JAK2/STAT3-independent pathway. In conclusion, prucalopride exerted beneficial effects in MPTP-induced Parkinson’s disease mice by attenuating the loss of dopamine, improving motor dysfunction and intestinal barrier.
Excellent article. It also mentions Domperidone . I can vouch for the effectiveness that, of which I am prescribed for nausea with migraine. Also interested in trying Quercetin with black pepper. Thanks for that Bolt.
I have a history of migraines and the doctor said that she would not normally prescribe it to anyone who has them as Prucalopride can give you headaches. However she feels that the positive effects make it worth trying. She told me to it slowly and any headache should disappear in a week or so
Prucalopride is Motegrity in the U.S. It was a new drug and I've been on it and just got it refilled. I had to be seen by the doc who first prescribed it for me before the insurance company would refill it. So I had to drive across the state and sit in his exam for an hour before he was able to see me to ask if it was helping. I said yes it was so we were done and now I have a six-month refill. I still need fiber and occasionally Dulcolax stimulant laxative but I'm okay with that.
I hadn’t realized that it was Motegrity. Thanks for sharing that - I have seen quite a few references to it.
What a pain you had to travel so far. It is a little off-grid here - and a bit expensive- not yet on the Australian Pharmaceutical Benefits Scheme. Prescribed by gastroenterologist and very generally available here.
Everybody with Parkinson's should watch this. The constant harping on about constipation rather misses the bigger picture: the entire digestive system is compromised....and Prucalopride should be a first-line treatment for many.
I have been using prucalopride (also goes under the name Motegrity), for 4 years. My PD started with gastroparesis, a slowing down of digestion and chronic constipation. The drug worked great at first then my body got used to it so while it continues to work it’s not as good as the first month or so. But it definitely works. Good luck.
Thanks so much for passing on your experience. I’m glad it’s still helping you. I’m feeling more and more positive about it, but will be conscious of a honeymoon start!
Hi. This is a summary of the advice I give my PD patients regarding using magnesium for constipation:
Magnesium Oxide for Constipation in Parkinson’s Disease (PD)
Constipation is a common non-motor symptom in people with Parkinson's disease (PD), often due to autonomic dysfunction, reduced physical activity, dietary changes, and the effects of medications like anticholinergics and dopaminergic drugs. Managing constipation effectively is crucial for improving quality of life and optimising the absorption of Parkinson’s medications, particularly levodopa.
Mechanism of Action
Magnesium oxide is an osmotic laxative. It works by drawing water into the intestines, which softens the stool and stimulates bowel movements. This effect can be particularly beneficial for PD patients, who often experience slow colonic transit.
Dosage and Administration
Typical Dose: For adults, magnesium oxide is often started at 400–800 mg per day, taken once or twice daily with water.
Titration: The dose can be adjusted based on response, but it’s essential to avoid overuse, which may lead to diarrhoea and electrolyte imbalances.
Onset of Action: Magnesium oxide usually produces a bowel movement within 6 hours to several days.
Advantages in PD
Effective Osmotic Action: Helps counteract slow colonic transit common in PD.
Non-Stimulant: Unlike stimulant laxatives, it doesn’t cause dependency or worsen dysautonomia.
Simple Regimen: Easy to administer, especially for patients with cognitive decline.
Potential Concerns and Side Effects
Hypermagnesemia: Particularly in patients with renal impairment, as magnesium is excreted through the kidneys. Symptoms can include muscle weakness, hypotension, and cardiac arrhythmias.
Diarrhoea and Dehydration: Overuse may lead to fluid and electrolyte imbalances, exacerbating orthostatic hypotension, a common PD symptom.
Drug Interactions: May interfere with the absorption of certain medications, including antibiotics and bisphosphonates. It’s recommended to separate magnesium oxide from other drugs by at least 2 hours.
Considerations in PD Management
Fluid and Fibre Intake: Magnesium oxide should be part of a broader constipation management plan that includes adequate hydration and dietary fibre.
Physical Activity: Encouraging mobility can enhance bowel motility.
Medication Review: Check for PD medications that may worsen constipation (e.g., anticholinergics) and adjust if possible.
Alternative Options
For refractory constipation in PD, alternatives include:
Macrogol (Polyethylene Glycol): Another osmotic laxative, often preferred for long-term use.
Prokinetics: Like prucalopride, for severe cases.
Lubiprostone or Linaclotide: May be considered under specialist supervision.
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