# prucalopride



## kc99 (Jun 7, 2007)

I've seen some occasional posts here regarding prucalopride. If I understand correctly, this is not available in the US, but is available in Canada?

If so, has anyone based in the US used a US-based script to get prucalopride from Canada?

I was recently hearing that it was not all that uncommon for this kind of practice to be used for obtaining domperidone (another prokinetic agent that is available in Canada but not the US, albeit one that is more effective for upper GI regions), so, it seemed like maybe this was a possibility with prucalopride.

More generally: Are there other good lower-GI-focused prokinetic agents out there, beyond zelnorm/tegaserod and prucalopride? And I'm specifically thinking here prokinetics, not other anti-constipation meds that work via other mechanisms.


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## annie7 (Aug 16, 2002)

i know people who have had good success getting prucalopride (with their doctor's script of course) from canadadrugs.com and they do say that this is a good, reputable online pharm to use. and there are other canadian online pharmacies that also supply it---as long as you have a doc's script for it.

i have not yet done this myself but according to his nurse, one of the gastros i am seeing does write prucalopride scripts for his patients so they can get it from canadadrugs.i have gone online and read the canada drugs website--it's a very straightforward and helpful site.

i saw this gastro last week and he wanted me to try linzess again because he thought it might work better for me now since my emergency partial colectomy this summer. but unfortunately it didn't--i still got sick on it, no bm's--just like the first time. his nurse is going to call me soon to see how i did with this second linzess trial and i plan to ask her about prucalopride again. fingers crossed i can get a script for it. i'd love to try it.

yes, i do so wish there were more prokinetics out there for us to try! i need a med to push stool out--not one that just adds increases intestinal fluid like amitiza and linzess. i just end up carrying all that fluid around inside me--it needs a peristalic push to get it out--lol..

from my understanding--and i could be wrong here--, domperidone (motillum) and metoclopramide (reglan) are prokonetics but they only speed up transit time through the stomach and they have a mild effect on speeding up transit through the small intestine but they don't have an effect on the colon.

i am totally afraid to try reglan because of the alarming side effects and i think domperidone is only available in canada although i think i read it's getting harder to get???

two non-prokinetcs i've tried are colchicine---which stopped working for me, increased abdominal pain greatly and also can have very very serious side effects on white blood cells, bone marrow, etc and if used long term needs constant blood count monitoring.

i've also tried cytotec--misoprostol--this increases fluid in the colon and it worked at first for me but then, like linzess, the results (bm's) tapered off and the stomach pain and nausea and bloating from all that increased fluid i was carrying around in my colon just got worse and worse. plus it only worked for me if i also used a stimulant laxative with it. that's how they advised using it in one of the clinical trials i read--with a stimulant--in this case, senna.


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## Cogna (Jul 10, 2007)

any idea which of these pro-kinetics was common in the usa ~circa 1994? I had a family physician who prescribed one of these for me and it helped a lot at the time, but once I got better I dropped it and now wish I knew the name. basically it mildly stimulated peristalsic action.

having said that, I will say, as I've said elsewhere here, that "on a good day" Psyllium raw husks accomplish the same thing. Now if you read the clinical info on psyllium [not the hype... read the real medicals] this sounds contradictory, as one of the clinical effects is that psyllium is said to have a slowing effect on [its own] motility. in my case the beneficial effect is to 'jump start' the process, which is why I have found best results to take it not long after waking in the morning before any other solids. Within about 30 minutes [max] I can feel my stomach/upper going "normal" and I get a normal appetite, and whatever I eat [on the safe list] for breakfast then seems to digest properly and move on - no bloating etc. For me, the Psyllium will trigger a movement all the way through the system, and I've found by trial/error that its better for me to keep the dosage small, 'cause otherwise I overproduce BM's. I use about the equivalent of rounded teaspoon and as all the lit says, with a good dose of water. I learnt the hard way to let it soak in the cup of water for awhile so it swells and finishes its 'filling' process before injesting. otherwise it can be harmful - the "unfinished" wet particles are like glue before becoming fully fluffed out, and they will cause their own semi indigestion. you'll note that they stick to everything and anything in the kitchen or whatever.... Not so with the fully engorged husks.


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## annie7 (Aug 16, 2002)

conga--the prokinetic might have been cisapride (propulsid). it was discovered in 1980 and then removed from the us market in 2000 due to serious heart issues. i've read people saying that apparently it is still available to patients but only if their doctors fill out a boatload of paperwork on it...and there is this link:

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a694006.html

one of my cats has constipation problems, poor kitty--like mother, like daughter?. she is currently on both lactulose and also cisapride which thankfully is still available at some compounding pharmacies for veterinary use. it doesn't have the adverse heart effects on animals. these are the only meds that have helped her and i do hope and pray i can still keep getting cisapride for her. last time i was at the vet they told me their compounding pharm had stopped carrying it but i was able to find it online at 800 pet meds. also i read online that the reason why a lot of veterinary pharms quit carrying it was because they had discovered that some of the pets' owners were buying it for their own use and not the pet's. i've been tempted myself to poach some of hers--lol--but she needs it more than i do....i hare to see her suffer so like she does when she is all backed up and miserable...

so glad psyllium works for you. that's terrific! i have tried it over the years in many forms including the way you take it but never had any success with it. we are are so different in the way our bodies react to meds, supplements, foods, fiber etc...

some people say cayenne pepper--either the spice or as a pill--capiscool, etc--helps increase their motility. i've been afraid to try it though since i have reflux/GERD. definitely not for sensitive stomachs.


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## kc99 (Jun 7, 2007)

Thanks for the info. I'm surprised that there would be any hesitation to prescribe the prucalopride, but, I have to admit I don't know much about it -- this is the only place where I've seen it discusssed. Are there serious side effects or risks involved?

That's interesting regarding the cayenne pepper -- it would be interesting to look into any research that has been done on this (presumably the key ingredient involved would be capsaicin).

I have only recently heard of domperidone and Reglan -- all I heard was that their effect weakened along an upper-to-lower GI gradient (which could very well imply no action at all at the level of the colon -- I haven't done any reading on these meds). Likewise, I haven't investigated how readily available domperidone would be. I did hear about the not-all-that-rare incidence of irreversible tardive dyskinesia with the Reglan --- wow.

Based on observations of my own situation, I can now agree with the conclusion that just because one can make the contents of the bowel into slosh, that doesn't mean the slosh is going to be all that efficiently expelled, either because of problems with the colon, the anorectal area, or both. It took me a while to figure this out for myself, but yes, I do now see the very real need for good prokinetics. One would think this would be a very compelling target for the pharmaceutical companies, but at the same time I could see how the risk of repeating the zelnorm story migh cause them to shy away from it.


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## annie7 (Aug 16, 2002)

i imagine many docs in the usa are reluctant to give their patents a script for prucalopride because it's not approved by the fda and also because it involves ordering from a foreign online pharmacy...

here is a good lick with onfo on prucalopride--maybe you've seen it:

http://www.netdoctor.co.uk/digestive-health/medicines/resolor.html

also:

http://www.ncbi.nlm.nih.gov/pubmed/19911858

oh i do so agree with you about the bowel full of slosh. the day mag citrate decided to quit working on me i carried a belly full of slosh inside me for 24 hours--and this involved a five hour road trip as well. miserable. it took 15 mg of dulcolax to finally kick that stuff out.


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## kc99 (Jun 7, 2007)

The links are helpful -- I'm checking them out. Thanks!


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