Prucalopride
MOTEGRITY
Pronunciation: proo-KAL-oe-pride (moe-TE-gri-tee)
“Poo cattle prod, & Mo’ Tegrity”
blue theme → serotonergic mechanism
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.
Prucalopride prescription history
Animated chart of estimated U.S. prescriptions per year, Constipation meds (1900–2026). Prucalopride enters in 2019 (estimated).
FDA-approved for
- chronic constipation (2018)
Principal riskHeadache and diarrhea early
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityDiarrhea, dehydration and electrolyte disturbance, especially with excessive or prolonged use.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- tab 1, 2 mg
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.
Cost
Generic entry2032 est.
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Self-check
- Prucalopride: What avoids older prokinetics' off-target cardiac liability?
Receptor selectivity. - Prucalopride: Which organ impairment requires adjustment?
Renal impairment.