New Drug to Treat Constipation Tested in Parkinson's Disease

One of the most common questions we receive is how to treat Parkinson's disease related constipation.  We have a constipation formula for success that we have discussed in previous blog posts, but it has come to my attention that many Parkinson's disease patients missed this recent study published in Neurology.  Below is the abstract:.  Lubriprostone didn't work for everyone, but the study was positive and because of its mechanism of action it is safe.  This is a drug you should definitely ask your doctor about, especially if you have tried everything else.  It is sold under the name Amitiza.

Neurology. 2012 May 22;78(21):1650-4. doi: 10.1212/WNL.0b013e3182574f28. Epub 2012 May 9.

Placebo-controlled trial of lubiprostone for constipation associated with Parkinson disease.

Ondo WG, Kenney C, Sullivan K, Davidson A, Hunter C, Jahan I, McCombs A, Miller A, Zesiewicz TA.

Source

Department of Neurology, University of Texas Health Science Center, Houston, TX, USA. William.Ondo@uth.tmc.edu

Abstract

OBJECTIVE:

To evaluate the efficacy and tolerability of lubiprostone (Amitiza) for constipation in Parkinson disease (PD) in a double-blind, randomized, controlled study.

METHODS:

Patients with PD and clinically meaningful constipation (constipation rating scale score > 10 [range: 0-28]) were recruited from 2 academic movement disorder centers to participate in the study. After enrollment, patients were initially followed for 2 weeks and then were randomly assigned 1:1 to lubiprostone, and the dose was titrated up to 48 μg/day. They returned 4 weeks later for a final assessment. Data included stool diaries and global impressions (co-primary endpoints), demographics, Unified Parkinson's Disease Rating Scale scores, constipation scale scores, visual analog scale (VAS) scores, a stool diary, and adverse events.

RESULTS:

Fifty-four subjects (39 male, mean age 67.0 ± 10.1 years, and mean duration of PD 8.3 ± 5.4 years) were randomly assigned to lubiprostone or placebo. One patient in the drug group discontinued the study because of logistics, and one patient in the placebo group discontinued the study because of lack of efficacy. A marked or very marked clinical global improvement was reported by 16 of 25 (64.0%) subjects receiving drug vs 5 of 27 (18.5%) subjects receiving placebo (p = 0.001). The constipation rating scale (p < 0.05), VAS (p = 0.001), and stools per day in the diary (p < 0.001) all improved with drug compared with placebo. Adverse events with drug were mild, most commonly intermittent loose stools.

CONCLUSION:

In this randomized controlled trial, lubiprostone seemed to be well tolerated and effective for the short-term treatment of constipationin PD.

PMID: 22573627 [PubMed - indexed for MEDLINE]

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD and https://www.tourettetreatment.com/