A pilot study on the efficacy of Picolax given as a four-week course for the treatment of refractory constipation

OBJECTIVES. Although Picolax (sodium picosulphate and magnesium citrate) has been widely documented for use in bowel preparation, there is limited literature on its efficacy in the treatment of constipation. Refractory constipation is a more difficult situation with limited treatment options available. The primary objective of this study was to investigate the efficacy of Picolax in the treatment of refractory constipation. DESIGN. Prospective single-centre cohort study. SETTING. The Gastroenterology and Hepatology Centre of a major private hospital in Hong Kong. PATIENTS. Patients aged 18 years or more with chronic constipation refractory to tegaserod or polyethylene glycol and attending the centre in the period of July 2009 to June 2010. RESULTS. A total of 20 patients completed this 6-week single-centre study, with a 2-week baseline assessment and 4-week treatment period. Complete data sets were available for analysis from 17 of these patients. The mean (standard deviation) age of the cohort was 50 (9) years, of which 94% were female. Treatment consisted of half-a-sachet of Picolax taken orally on alternate days, 3 times a week. Patients were required to fill in daily and weekly diary entries of their bowel habit. The mean (standard deviation) number of weekly complete spontaneous bowel movements increased from 0.5 (0.9) to 2.4 (2.6) times per week (P=0.02) after initiation of the treatment, which was a clinically and statistically significant difference; with a mean change of +1.9 (95% confidence interval, 0.3 to 3.4) per week. As a secondary endpoint, 11 patients recorded the use of rescue medication before and after the 4-week treatment. The ratio of patients who took rescue medication decreased significantly from 73% (n=8) to 0% (n=0) [P=0.008]. The mean reduction in the frequency of resorting to rescue medication was 2.6 times (95% confidence interval, -4.2 to -1.1) per week. CONCLUSIONS. Picolax improved the number of complete spontaneous bowel movements and significantly reduced resorting to rescue medication. This formulation could therefore be considered as a treatment option in patients with chronic constipation who are refractory to conventional treatment regimens.