People’s Pharmacy: Why did constipation drug cause anxiety?
Q. I recently started taking Motegrity for severe constipation. It does a great job alleviating the constipation. (Herbs and other pharmaceuticals I tried didn’t work.)
After taking a low dose for a few days, I began to feel anxious and agitated. Could Motegrity be causing serotonin overdrive? Because it works so well for constipation, I’m motivated to find a solution.
A. Prucalopride (Motegrity) was approved in Europe in 2009 and by the Food and Drug Administration in 2018. The official indication is for “the treatment of chronic idiopathic constipation (CIC) in adults.” That is long-lasting constipation with no obvious cause. Frequently, it is associated with irritable bowel syndrome. Gastroenterologists would not be surprised that you have found it so effective.
The most common side effects are digestive, including nausea, diarrhea and stomachache (Cureus, April 5, 2021). Many people also report headache.
The drug works through serotonin receptors in the digestive tract. By stimulating those nerve cells to release another neurotransmitter called acetylcholine, Motegrity encourages the digestive tract into a series of contractions (peristalsis) that move the bowels.
Other people who have taken Motegrity have reported psychiatric side effects: “Suicide, suicide attempts, suicidal ideation, self-injurious ideation, depression, anxiety, insomnia, nightmares, and visual hallucinations.”
Such side effects are somewhat similar to those experienced with antidepressants such as fluoxetine (Prozac) and sertraline (Zoloft). They work by blocking serotonin reuptake.
The FDA advises physicians to monitor patients on Motegrity and alert caregivers and family members to be aware of changes in mood or behavior.
Q. You recently answered a letter from a woman whose daughter had a reaction after anesthesia while taking a type of diabetes medication. In your response, you referred to gastroparesis.
I am a recovery room nurse. While gastroparesis might be a concern, it is nothing compared to euglycemic ketoacidosis that has been associated with surgery and taking SGLT2 drugs.
At our hospital, we won’t do surgery on anyone who has taken any medication in the GLP-1 or SGLT2 classes within 72 hours unless the condition is life threatening. We have canceled many surgeries due to this. Please inform your readers of this risk and suggest they follow instructions before surgery, or they might have their operation canceled.
A. Thank you for a helpful warning. To help people understand it, we need to offer some explanations.
The original question centered on semaglutide (Ozempic, Wegovy), a GLP-1 agonist that helps manage insulin and appetite. SGLT2 medicines like empagliflozin (Jardiance) keep the kidneys from reabsorbing sugar from the blood stream, so that excess sugar is removed in the urine.
Gastroparesis is essentially stomach paralysis. Food retained in the stomach can be regurgitated under anesthesia, leading to life-threatening pneumonia.
The ketoacidosis you refer to occurs when the body uses fat rather than sugar as its fuel. In some cases, the blood becomes acidic, a life-threatening complication.
People with Type 2 diabetes can learn more about the medications used for blood sugar control in our “eGuide to Preventing & Treating Diabetes.” This online resource can be found under the Health eGuides tab at PeoplesPharmacy.com.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”