Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 520

Prosecretory agents can be used as second‐line treatment after standard laxative therapy. Currently, they include linaclotide, plecanatide, and lubiprostone. Lubiprostone selectively activates chloride C‐2 channels to increase intestinal fluid secretion. Lubiprostone does not affect colonic motility or sensation in humans. Patients reported more spontaneous bowel movements with lubiprostone than placebo (six versus four per week, p = 0.001), with the majority of patients experiencing a bowel movement within the first 24 hours.⁵⁵ The main side effect seen with lubiprostone was nausea. This effect is mitigated when the medication is taken with a meal and appears to be less problematic in elders.

Linaclotide and plecanatide increase cyclic guanosine monophosphate, stimulating chloride and bicarbonate secretion. This increases salt and water secretion into the intestinal lumen and attenuates visceral afferent pain signalling, leading to improved stool consistency and frequency. Linaclotide is available in many countries worldwide, but plecanatide is currently only available in the United States.⁵⁶