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Pharmacologic treatment of chronic idiopathic constipation

The 2023 AGA/ACG medicine recommendations for adults already diagnosed with chronic idiopathic constipation.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adults already diagnosed with chronic idiopathic constipation who are choosing pharmacologic treatment. The 2023 joint AGA/ACG guideline evaluates fiber, over-the-counter laxatives and prescription medicines. It does not establish how to diagnose constipation, investigate alarm features, evaluate a defecatory disorder, manage opioid-induced constipation or select a procedure.
sources for this section:aga-acg-cic-2023

The Bottom Line

  • The panel suggests fiber supplementation and strongly recommends polyethylene glycol for adults with chronic idiopathic constipation.
  • Magnesium oxide, lactulose and senna have conditional recommendations, with lactulose considered after failure of or intolerance to over-the-counter therapies.
  • Bisacodyl or sodium picosulfate is strongly recommended for short-term use or rescue therapy rather than presented as a complete diagnostic or long-term care pathway.
  • After unsuccessful over-the-counter treatment, the panel strongly recommends linaclotide, plecanatide and prucalopride.
  • Lubiprostone has a conditional recommendation after unsuccessful over-the-counter treatment; choices should reflect preference, cost, availability and current product information.
sources for this section:aga-acg-cic-2023

Practical clinical workflow

1
First confirm that the clinical question is pharmacologic treatment of established chronic idiopathic constipation in an adult.
2
Discuss the guideline-supported over-the-counter options and distinguish strong recommendations from conditional suggestions.
3
Use polyethylene glycol as the strongly recommended chronic over-the-counter option and reserve bisacodyl or sodium picosulfate for the source-defined short-term or rescue role.
4
When over-the-counter agents have not worked, discuss the recommended or suggested prescription options without treating them as interchangeable.
5
Use shared decision-making around expected benefit, adverse effects, medication cost and availability, then assess response under current product labeling.
sources for this section:aga-acg-cic-2023

Safety boundaries and escalation

  • This pharmacologic guideline does not supply a diagnostic, alarm-feature, cancer-evaluation or acute-abdominal pathway.
  • It does not establish digital rectal examination, anorectal manometry, balloon-expulsion testing, pelvic-floor biofeedback or surgery recommendations.
  • It does not apply automatically to children, pregnancy, opioid-induced constipation, bowel obstruction or constipation caused by another disease or medicine.
  • Agent-specific contraindications, interactions, renal considerations and adverse-effect monitoring must come from current FDA labeling and the patient鈥檚 clinical context.
sources for this section:aga-acg-cic-2023

Localization

The 2023 joint AGA/ACG guideline is a US pharmacologic framework for diagnosed adult chronic idiopathic constipation. It does not determine insurer step therapy or establish a diagnostic and procedural pathway. Use current FDA labels.
sources for this section:aga-acg-cic-2023

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. American Gastroenterological Association and American College of GastroenterologyClinical Practice Guideline: Pharmacological Management of Chronic Idiopathic ConstipationDOI 10.14309/ajg.0000000000002227 路 published 2023-06-01 路 accessed 2026-08-20
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