Table 5.

Management of constipation in PSP/CBS.

1. Non-pharmacologic therapy

a. Increased physical activity

b. Adequate hydration until suppertime to minimize nocturnal trips to void

c. Fiber supplementation

d. Minimize

i. Anticholinergics

ii. Amantadine

iii. Opiates

2. Pharmacologic therapy

a. Stool softener, docusate starting at 100 mg daily titrated weekly to 100 mg TID

b. Osmotic laxatives

i. Polyethylene glycol

ii. Magnesium citrate

iii. Lactulose

iv. OTC enema preparations of saline or other hyperosmolar salts

c. Stimulants for very short-term use

i. Bisacodyl

ii. Senna

d. Prescription medications for refractory cases

i. Linaclotide (guanylate cyclase C agonist)

ii. Prucalopride (selective 5-HT4 receptor agonist)