Fig. 4. Algorithm for medical treatment of patients with functional constipation. *Magnesium salts should not be used in cases of abnormal renal function, and nonabsorbable carbohydrate is recommended to be prescribed in the absence of gas or ileus to improve patient compliance. **Combination treatment with bulking laxatives and osmotic laxatives can be considered at the start of treatment. If clinically needed, consider combination therapy based on action mechanisms, benefits, and cautions of the laxatives. ***Stimulant laxatives can be considered as rescue therapy due to concerns about long-term safety and abuse. ****Prucalopride, lubiprostone, and linaclotide can be used as monotherapy or in combination with each other or with laxatives already used and may be selected as a first-line agent in some cases.
© J Neurogastroenterol Motil
