Management of Chronic Constipation for Community Pharmacist
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Abstract
Chronic constipation is a common disorder in drug store and an important problem which affects to public health system. Chronic constipation is classified into two types, 1) primary constipation is a symptom-based disorder that results from slow transit constipation, dyssynergic defecation or constipation-predominant irritable bowel syndrome 2) secondary constipation results from various factors such as neurological diseases or some medications. Treatment of secondary constipation focuses on management of causes of constipation. The role of community pharmacists for patients with chronic constipation including to assess the medical history, symptom severity and investigate alarm symptoms to consider about treatment settings of patients between drug store or referral to hospital. Treatment of chronic constipation should provide both lifestyle modification with pharmacotherapy. Goal of therapy included relief symptom, prevent complications, improve quality of life and provide satisfaction to patient for short and long term care. Therefore, selection of laxatives should focus on long term efficacy and safety. Osmotic laxatives, such as lactulose or polyethylene glycol, are first-line treatment. Strategies of switching or add-on stimulant laxatives can be used in patients with nonresponse to osmotic laxatives. Patients with chronic constipation, who still do not response to treatment, should consider novel laxatives that have specific mechanism such as serotonin receptor agonists.
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