Patterns of laxative use for chronic functional constipation in Japanese children: A longitudinal descriptive study

To characterize real-world pharmacotherapy patterns among Japanese children with chronic functional constipation (CFC), with particular attention to changes after the market introduction of polyethylene glycol (PEG) 4000 in 2019.

This longitudinal descriptive study was conducted using a Japanese health insurance claims database. We identified children aged 0-14 years who had an outpatient claim with a constipation diagnosis and received an initial prescription for laxatives lasting ≥5 days at the same visit between 2012 and 2022. We described baseline characteristics and laxative treatment trajectories throughout a 12-month follow-up. Subgroup analyses were performed by sex, age, and institution type.

Among 166,808 eligible children, 64.1% entered the cohort after 2019. Mean age was 4.0 years and 56.6% were female. Magnesium oxide was the most commonly used laxative (31.0%), followed by PEG 4000 (19.9%). Introduction of PEG 4000 in 2019 was accompanied by a decline in prescriptions for other conventional agents. Medication choices varied by age: magnesium oxide was predominant across all age groups; PEG 4000, malt extract, and lactulose were more commonly used in younger children; and traditional Japanese Kampo medicine was favored in older children.

Magnesium oxide remains the most frequently prescribed laxative for pediatric CFC in Japan, with PEG 4000 now ranking second. The introduction of PEG 4000 in 2019 reduced reliance on other conventional laxatives. These findings may help clinicians tailor pharmacotherapy for childhood constipation.