Prucalopride

Key facts

• Prucalopride (sold as Motegrity) is a selective serotonin 5-HT4 receptor agonist. It stimulates the muscles of the colon to restore regular bowel movements in chronic constipation.
• You take it once daily, with or without food, usually in the morning. Some people notice an effect within the first day, though full benefit can take up to 4 weeks.
• Do not take prucalopride if you have a bowel obstruction, perforation, or severe inflammatory bowel disease with damage to the bowel wall. Stimulating a blocked or damaged gut can worsen the injury.
• Seek care if new or worsening low mood, anxiety, or thoughts of self-harm appear while you are taking it; this has been reported and should be reviewed promptly.

What prucalopride treats

Prucalopride treats chronic constipation, infrequent or difficult bowel movements that have lasted for months and have not responded to diet changes, fibre, or standard laxatives. It is used in adults, including those whose constipation has not improved with laxatives alone.

How prucalopride works

The lining of the gut contains 5-HT4 receptors that respond to serotonin and help trigger the coordinated muscle contractions that move stool through the colon. Prucalopride binds to these receptors directly, strengthening those contractions and speeding transit through the bowel, even when the natural serotonin signal is weak.

Before you take it

• Do not use it if you have a known or suspected bowel obstruction, perforation, or toxic megacolon.
• Tell your prescriber if you have severe kidney disease; your dose may need to be lower.
• Mention any heart rhythm problems, since caution is advised in people with significant cardiovascular disease.
• Mention other medicines that affect gut motility or serotonin levels, including certain antidepressants.

Side effects

Common effects are most noticeable in the first few days and usually settle: headache, nausea, abdominal pain or cramping, diarrhoea, dizziness, and fatigue.

Stop and seek urgent medical care for any of these:

• Severe or worsening abdominal pain, especially with fever or vomiting.
• Rectal bleeding or blood in your stool.
• New or worsening depressed mood, anxiety, or thoughts of harming yourself.
• Signs of an allergic reaction: rash, facial swelling, or difficulty breathing.

Safety essentials

• Never take prucalopride if a bowel obstruction or perforation is possible; stimulating gut movement in that situation can cause serious harm and needs a doctor's assessment first, not a laxative-type medicine.
• If diarrhoea is severe, drink enough fluids, since dehydration can affect kidney function and electrolyte balance.
• Tell your prescriber your kidney function before starting, since significant kidney impairment needs a reduced dose.
• If it does not help within four weeks, see your prescriber rather than increasing the dose yourself.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.