Indications: chronic constipation in women when other laxatives fail to provide an adequate response

Cautions: history of arrhythmias or ischemic heart disease; concomitant use with drugs that prolong QT interval; severe, unstable chronic illness.

Contra-indications: intestinal perforation or obstruction; severe inflammatory conditions of the intestinal tract (such as Crohn's disease, ulcerative colitis, and toxic megacolon)

Hepatic impairment: in severe impairment, initially 1 mg once daily, increased if necessary to 2 mg once daily Renal impairment: max. 1 mg daily if eGFR less than 30 ml/ minute/1.73 m2

Pregnancy: manufacturer advises avoid and recommends effective contraception during treatment

Breast-feeding: manufacturer advises avoid—present in milk

Side Effects: nausea, vomiting, abdominal pain, dyspepsia, flatulence, diarrhoea, rectal bleeding; headache, dizziness, fatigue; polyuria; less commonly anorexia, palpitation, tremor, and fever

Dose: ADULT over 18 years, 2 mg once daily; ELDERLY over 65 years, initially 1 mg once daily, increased if necessary to 2 mg once daily

Note: Review treatment if no response after 4 weeks