Prucalopride

Well-studied prokinetic with a cleaner cardiac safety profile than cisapride or tegaserod. Effective for chronic constipation with potential gut-brain axis implications.

A rough internal score reflecting quantity, quality, and consistency of human evidence. Not a clinical recommendation.

Large Phase III trials demonstrated significant improvement in spontaneous complete bowel movements versus placebo. Selective for 5-HT4 over hERG channels, avoiding the QT prolongation that plagued earlier prokinetics. Emerging interest in gut-brain applications and gastroparesis.

• FDA-approved for chronic idiopathic constipation
• Superior cardiac safety profile versus older prokinetics
• Effective improvement in bowel movement frequency

2 mg once daily (1 mg in patients over 65 or with severe renal impairment).

• Headache (very common initially)
• Abdominal pain
• Nausea
• Diarrhea

Headache is very common in the first days. Diarrhea and abdominal pain occur. Caution in severe renal or hepatic impairment.

Primarily a GI motility drug. Cognitive or mood effects via the gut-brain axis are speculative.

• Recovery30