Intestinal Pseudo-Obstruction Medication

Updated: Jul 23, 2018
  • Author: Burt Cagir, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Medication

Medication Summary

One therapeutic option for intestinal pseudo-obstruction (also referred to as acute colonic pseudo-obstruction [ACPO] or Ogilvie syndrome) is the use of pharmacologic agents (eg, erythromycin, cisapride, and metoclopramide) to increase colonic motility. Acetylcholinesterase inhibitors, such as neostigmine, have also been employed, alone or as part of combination regimens.

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Acetylcholinesterase Inhibitors

Class Summary

Acetylcholinesterase inhibitors, such as neostigmine, have been evaluated for the treatment of ACPO. The combined use of a sympathetic blocker followed by a cholinesterase inhibitor (neostigmine) has also been employed to treat motility disorders. The utility of neostigmine in colonic pseudo-obstruction has been demonstrated. A small study examining the effects of pyridostigmine on colonic motility disorders found some symptomatic improvement, though not in patients with slow-transit constipation.

Neostigmine (Prostigmin)

Neostigmine inhibits destruction of acetylcholine by acetylcholinesterase, thereby facilitating transmission of impulses across the myoneural junction.

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Laxatives, Osmotic

Class Summary

Osmotic laxatives can be helpful in some cases of intestinal pseudo-obstruction. Osmotic laxative therapy may cleanse the colon and gently enhance colonic motility, thereby correcting the underlying problem. The cleansing effect may also make subsequent attempts at colonoscopic decompression easier.

Polyethylene glycol (GoLYTELY, NuLYTELY, Colyte, TriLyte)

Polyethylene glycol is a laxative with strong electrolyte and osmotic effects that has cathartic actions in the gastrointestinal tract.

Sodium Phosphates (Fleet Enema, OsmoPrep, Fleet Pedia-Lax Enema)

Sodium phosphates enema lubricates the bowel and softens the stool. It can be used as a retention enema. It draws water into the lumen of the gut, which, in turn, produces distention and promotes peristalsis and evacuation of the bowel.

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