# Motility Drugs vs. Laxatives?



## thomasw839 (Aug 21, 2002)

I recently came across a short list of motility drugs. Oddly, my gastrodoc has never suggested my using one. I am wondering if someone can explain to me the difference between a motility drug and a laxative? Thanks for any replies. I hope everyone is enjoying a pleasant weekend.Regards,Cyndie


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## hangingin (Sep 7, 2002)

Cyndie,This is a very interesting question.I hope you dont mind, but what motility drugs are you referring to, I wasnt aware that there were any?As far as laxatives are concerned, I'm assuming that you are referring to the irritant ones, like senna, cascara, aloe, Dulcolax, etc.? These are drugs that literally irritate the colon to work however they dont help with motility at all but actually have the total opposite effect by making the colon lazy and dependent on them, until ultimately motility in the colon may not function with continued use. Also, using laxatives lose their effect after a while after the colon becomes lazier and lazier, requiring higher doses. I guess this is one way of causing loss of motility in the colon.I wasnt aware that there were any motility drugs, something I guess so many of us are longing for and need so badly.(Of course I may be wrong) I would really be interested to know of the list of motility drugs you have heard about - that would really help a lot.Hope this helps and I look forward to hearing from you.


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## kamie (Sep 14, 2002)

Motility medications.Anti-spasmodics.Hyoscyamine.Relaxes gut spasms.Laxative. Osmotic Laxative helps to bind water to the stool.Miralax.Prescription needed.Produces a smooth move.No Cramping.Works for meKamie


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## hangingin (Sep 7, 2002)

Cyndie,The only "motility" agent listed above is laxatives, (although highly addictive and dangerous)Atismosmatics and Hyosscymanine decrease motility in the gut however can sometimes help spasm, especially in the case of diarrhea.Osmotic laxatives just draw water in the colon, however can help the colon to "move" but if motility is really bad, there could occasionally be problems getting the water out (only in severe cases.)Miralax is one of these agents which has been very successful for a lot of people. I guess osmotic laxatives would indirectly help with a motility problem is most cases. - Something worth trying and can be used long term without any harmful effects as far as I know.I'm just wondering if there are any drugs that directly affect motility that you may be referring to.







There are drugs such as Neostigmine, Coclchicine, and Misoprostol which are sometimes used "off label" to help with motility, however I have not experienced any results with these meds. There is also Zelnorm, which works for some people. Other than that, I dont know of any other motility drugs.Cyndie, by the way, what were your doctors recommendations? Do you suffer severe pain and or other symptoms with the constipation?


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## kamie (Sep 14, 2002)

post:I'm just wondering if there are any drugs that directly affect motility that you may be referring to. There are drugs such as Neostigmine, Coclchicine, and Misoprostol which are sometimes used "off label" to help with motility, however I have not experienced any results with these meds_____________________________________If you are not having results with the medications your doctor is prescribing for you, then it is possible that your doctor is not prescribing the right medication.As I mentioned. I take hyoscyamine.It works well for my IBS C.I've had emergency surgery for the big C and hyoscyamine is what helps keep me out of IBS C trauma.I am approved to take it up to 4x a day.When the right medication is prescribed for the discomfort of a perticular malady, you know when it's right because it works.Not all doctors are good at figuring out medication.It's worth the effort to keep asking for alternatives and help until you find the exact right formula to allow a good quality of life as pain and trauma free as possible.As both you and your doctor become more accquainted with the problems of your particular form of IBS you will learn which medicines work well for you and which simply don't.Additionally, sometimes the body response to one medication over another will help in uncovering some specifics about your particular situation.Regarding the addictiveness of a medication like hyoscyamine, well, with each and every doctor I've seen no one ever says anything bad about hyoscyamine.For some reason the doctors seem to think it's a relatively non addictive medication.They would much rather prescribe hyoscyamine for pain than a narcotic.___________________________________Post:Osmotic laxatives just draw water in the colon____________________________________Well, having been fortunate enought to have enjoyed the benefit of Miralax for the past 7 months, I can tell you that "just drawing water"is a pretty big deal id you wish to avoid hardhurtful stools.Miralax actually acts on the stool and not really the colon in the drawing capacity.It draws water to the STOOL.Any way, I don't particularly wish to repeat the impaction that sent me running for emergency surgery so I stick with what my doctrs prescribe and hope for the best.Cyndie, I don't know why your docotr has not suggested some different medications for you.Have you asked why?If so then maybe a second opinion is in order just so you can have another professional perspective.Oh, by the way, Hyoscyamine does not give me the "urge" to have a BM.It just takes away my pain and makes it easier to breathe.The Miralax contributes to my "urge" when I drink lots of water.Kamie


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## flux (Dec 13, 1998)

> quote:I wasnt aware that there were any motility drugs


Here is a *partial* listAnticholinergics includedicyclomine hyoscyaminecimetropiumalverineCalcium channel blockers includepinaveriumpeppermint oilotiloniumdiltiazemverapamilnifidepineGut muscle relaxants includemebeverinerociverinetiropramideOpiate agonists includeloperimide(lomotil)trimebutineOpiate antagonists includenaloxonenaltrexoneProkinetic agents includecisapridemetoproclamidedomperidone5HT-3 antagonists includealosetroncilanestron5Ht4 agonnists includerenzaprideprucalopridetegaserodCholinergic agonists includeneostigminebethanecholCCK antagonists includeloxiglumideAlpha agonists includeclonidineMiscellanous motility agents includesomatostatinoxytocinglucagonleuprolidecolchicinemisoprostol


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## thomasw839 (Aug 21, 2002)

Hanginin,The list I happened across and have printed out to ask my doctor about is as follows:"Pro-Motility MedicinesCisaprideColpraMetoclopramideOctamideOctamide PFSPropulsidReclomideReglan."I am IBS-C, currently taking Zelnorm (3 mg in the morning), Miralax (each evening), and 1000 mg magnesium with 500 mg. vitamin C. I also have two tablespoons of ground flax seed mixed into a cup of yogurt for breakfast each morning. The miralax/zelnorm combination does soften the stool, almost too much; however, there is still no motility. I am getting imcomplete, pencil-thin movements. Also have bloating, and a lot of gas with the pains that come along with it. (EEEGADS! I can't believe I'm putting this in the Web!)My doc. really doesn't give a hoot and has not made recommendations. He tried me on two laxatives and said there was nothing more he could do. Now, if I take time to research all those meds Flux listed I'll be 110 befoe I'm done. Doesn't anybody have a quick fix for motility? Bless you all!


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## kamie (Sep 14, 2002)

Propulsid/CisaprideWarning: Serious cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, torsades de pointes, and QT prolongation have been reported in patients taking PROPULSID. Many of these patients also took drugs expected to increase cisapride blood levels by inhibiting the cytochrome P450 3A4 enzymes that metabolize cisapride. These drugs include clarithromycin, erythromycin, troleandomycin, nefazodone, fluconazole, itraconazole, ketoconazole, indinavir and ritonavir. Some of these events have been fatal. PROPULSID is contraindicated in patients taking any of these drugs. (See CONTRAINDICATIONS, WARNINGS, PRECAUTIONS, and DRUG INTERACTIONS).QT prolongation, torsades de pointes (sometimes with syncope), cardiac arrest and sudden death have been reported in patients taking PROPULSID without the above-mentioned contraindicated drugs. Most patients had disorders that may have predisposed them to arrhythmias with cisapride. PROPULSID is contraindicated for those patients with: history of prolonged electrocardiographic QT intervals; renal failure; history of ventricular arrhythmias, ischemic heart disease, and congestive heart failure; uncorrected electrolyte disorders (hypokalemia, hypomagnesemia); respiratory failure; and concomitant medications known to prolong the QT interval and increase the risk of arrhythmia, such as certain antiarrhythmics, including those of Class 1A (such as quinidine and procainamide) and Class III (such as sotalol); tricyclic antidepressants (such as amitriptyline); certain tetracyclic antidepressants (such as maprotiline); certain antipsychotic medications (such as certain phenothiazines and sertindole), astemizole, bepridil, sparfloxacin and terodiline. (The preceding lists of drugs are not comprehensive.)Propulsid/cisapride was pretty much taken off the market in 2000 but I believe it is still available in a limited capacity for certain kinds of medical reasons.I don't have the latest up date on this. maybe some one here knows.There was a big lawsuite on this.It might be prudent to mark Propulsic/cisapride off the list.Kamie


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## AD (Jan 23, 2000)

Cyndie,The reason Flux's list is so long is that he included some investigational drugs not yet available along with some drugs that are not available in the United States. In addition, a doctor may not prescribe certain medications for an IBS patient if they are primarily for other conditions. Many of the medications listed were developed and aprooved to treat other (non-digestive) problems.


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## kamie (Sep 14, 2002)

Cyndie, I have been thinking about your post:____________________________________I am IBS-C, currently taking Zelnorm (3 mg in the morning), Miralax (each evening), and 1000 mg magnesium with 500 mg. vitamin C. I also have two tablespoons of ground flax seed mixed into a cup of yogurt for breakfast each morning. The miralax/zelnorm combination does soften the stool, almost too much; however, there is still no motility. I am getting incomplete, pencil-thin movements. _______________________________Are you sure you are not passing those incomplete pencil thin movements because you are actually backed up with constipation and your stools are becoming smaller and softer to move past the constipation?I dunno, Just my observation from messing around with my own bowels and working to bring some normalcy to my gut.Sounds like you need a new doctor.I've had to make more than one change in the whole medical journery back to health my self.No all Doctors were created equal in the brain department let alone the bedside manner department.If you Doctor is blowing you off get down the road and don't let his door hit you from behind.I mean......RUUUUUUUUUUUUUUUUUUN! don'twalk to another practitioner who has some sense and compassion.I don't know anything about zelnorm but I know that magnesium with miralax will make the stools megga megga soft and you might need a little bulk to help the gut muscle work better.To help it push out.However, it sounds like you have actually reached the point where you might benefit from some imagaing diagnostics and a new doctor instead of trying to trouble shoot at home.I you are having pain, or your pulse gets going over 100 or your blood pressure raises into the hypertensive zone, see a doctor immediately or go to the ER.Let us know how you are doing, take care and start Doctor shopping.KamieP.S. I take my miralax in the morning with my hot black coffee just like the gastroenterologists's office suggested.I take min in the morning so I can create a schedule for my bowels and use the activity during the day to get my bowels active.Walking or some other kind of exercise that requires streteching and movement is part of what each individual needs to do to assure a proper and functional gut.Even my mother gets told by her gastroenterologist that she needs to walk to keep her system functioning and she does not have bowel problems. She's as regular as clockwork.She has a fatty liver from too many years on insulen but bowel dysfunction is not her problem and even she gets told to walk.Just a few more troubleshooting thoughts.


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## Joan Gregg (Jun 6, 2000)

Just had to stick my two cents in.Zelnorm (3 separate tries) gave me massive diahrea but still one soft stool was left up there and fell down at lunch! On another try, I had massive diahrea in p.m. and pencil thin stools taking it in a.m. I tried both 6 and 2 mg.I too, BELIEVE, I have a motility prob (kamie knows my story), but no one on this board would ever give me a list of drugs when I asked.I go to all the right doctors, but not to a motiliy center yet. I can't see swallowing 5 rings, missing 7 days of work and life, waiting for stool to come out that sits there. I have a little kid that needs minding, too. Yes, I have a husband, but he works til 6.No help, Cyndie, but a little info,Joankamie, see my post on the pain/gas/bloating board, please or I'll pmail you.


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## flux (Dec 13, 1998)

> quote:In addition, a doctor may not prescribe certain medications for an IBS patient if they are primarily for other conditions.


*This is false*. Prescriptions apply to medications, not to conditions. The FDA applies exceptions to this rule in only very special cases.


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## kamie (Sep 14, 2002)

Yeh pretty much Frosty is right. Doctors do prescribe stuff that is technically meant for one thing but useful for another.I myself get an SSRI/tricyclic antidepressant for PAIN of a neruological nature.A lot of doctors don't even know that the combo works great on certain types of pain.A lot of doctors also don't know that this same combo can and will stop hot flashes from surgically induced menopause.I also get the combo for that problem since I had an almost total hysterectomy back in April. I have only one ovary remaining and it does not even work half the time so for me hot flashes were such an issue I was becoming dehydrated.I don't take HRT due to heavy breast cancer in the family so they use the tricyclic antidepressant/SSRI combo to help regulate my body.As for medicines that would be restricted, I would think those might fall in the category of majorly controled substances.Kamie


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## DonnaDB (Jan 13, 2001)

Be careful with the motility drugs. I had a bad reaction with domperidone which started me having esophageal spasms--Even after discontinuing the drug. They are VERY PAINFUL!! Although I realize that we are all different and it may work great for you, I just wanted to add my two cents and possibly inform you of any adverse reactions that you may have from a motility drug. Also, they are notorious for causing heart irregularities. Be carefule with them!


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## thomasw839 (Aug 21, 2002)

Thank you all for your input. Much appreciated!


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## kamie (Sep 14, 2002)

Joan, I'll go take a look at your post, but PM anyway if you just need to vent.I know how frustrating things can be sometimes. Sometimes, all you can do IS VENT but then I gues shouting at the wind has it's benefits too...at least we get it all out.Take care and write if you need to chat.Hugs and Hope,Kamie


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