Pharmacological management of childhood constipation: Bridging today’s gaps with tomorrow’s therapies

Table 3 Current clinical utility of novel pharmacological agents

Name of drug	Mechanism of action	Adult trials	Pediatric trials
Plecanatide	Selective guanylate cyclase-C receptor agonist, which finally helps to increase secretion of chloride ions and water into the intestine, facilitating the passage of stools. Plecanatide is more active in acidic pH, hence the drug is more active in the upper small intestine	Phase III clinical trial has shown that the drug was able to increase the frequency of complete, spontaneous bowel movement compared to placebo	No pediatric trials
Tenapanor	Selective sodium/hydrogen exchanger isoform 3 inhibitor. The increased luminal sodium leads to retention of the fluid in the intestine, resulting in softening of stools and increased spontaneous bowel motions	Phase III clinical trials have shown a significant increase frequency of spontaneous bowel movements in adults with IBS-C	No pediatric data
Mizagliflozin	Selective sodium glucose co-transporter inhibitor in the small intestinal epithelium. The process helps to increase luminal water content and soften stool, and facilitate its passage	One trial including Japanese adults with IBS-C shows efficacy in improving spontaneous bowel motion compared to a placebo	No pediatric data
Elobixibat	Inhibits the reabsorption of bile acids in the terminal ileum. The non-absorbed bile acids stimulate the secretion of chloride and water into the colon and also enhance smooth muscle activity in the colon. Both activities contribute to the passage of soft stools	Although showing good safety and reducing colonic transit time, the improvement of clinical parameters related to constipation is limited and not convincing	No pediatric data

IBS-C: Irritable bowel syndrome with constipation.