Prucalopride
MOTEGRITY
What it isSelective 5-HT4 agonist; chronic idiopathic constipation.
Why this oneIts receptor selectivity avoids the off-target cardiac liability that undermined older 5-HT4 prokinetics.
What limits itHeadache, nausea, and diarrhea cluster early. Renal impairment requires adjustment.
FDA-approved for
- chronic constipation (2018)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Chronic idiopathic constipation | Adults | 2 mg QD | ||
| Chronic idiopathic constipation | Severe renal impairment (CrCl <30 mL/min) | 1 mg QD |
Renal Severe impairment (CrCl <30 mL/min): 1 mg QD; no adjustment for mild–moderate; avoid in ESRD requiring dialysis
Hepatic Undefined
Instructions
- Take with or without food
Contraindications
- Intestinal perforation or obstruction from structural/functional gut-wall disorder, obstructive ileus, or severe inflammatory intestinal conditions (Crohn's disease, ulcerative colitis, toxic megacolon/megarectum)
Cautions
- Suicidal ideation and behavior, self-injurious ideation, and new-onset/worsening depression — monitor; discontinue and contact provider if mood changes
Adverse reactions
- Headache
- Abdominal pain
- Nausea
- Diarrhea
- Abdominal distension
- Dizziness
- Vomiting
- Flatulence
- Fatigue
Pregnancy Insufficient human data to identify drug-associated risk; no adverse developmental effects in animal studies.
Lactation Present in breast milk (milk:plasma AUC ~2.65:1); weigh benefits against clinical need.
NO BOXED WARNINGS
Principal riskHeadache and diarrhea early
Cost, est. cash$300–$2,500/month
Generic entry2032 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.
Mechanism of action: Prucalopride ballicule
Open Prucalopride in the interactive console ↗
Memory aids: mascots and interaction avatars
blue theme → serotonergic mechanism
