Vegaprat film-coated tablets 1 mg No. 30

Release form, packaging and composition

Film-coated tablets

white or almost white, round, biconvex, in cross section the core of the tablet is white or almost white.

1 tab.
Prucalopride succinate	1.321 mg,
which corresponds to the content of prucalopride	1 mg

Excipients

: microcrystalline cellulose - 96 mg, sodium carboxymethyl starch - 1.419 mg, magnesium stearate - 0.9 mg, colloidal silicon dioxide - 0.36 mg.

Tablet weight without coating

pharmachologic effect

A drug that increases intestinal motility, dihydrobenzofurancarboxamide. The effect on intestinal motility is most likely due to the selectivity and high affinity of prucalopride for serotonin 5-HT4 receptors.

Pharmacokinetics

After a single oral dose, prucalopride is rapidly absorbed from the gastrointestinal tract. After taking a dose of 2 mg, Cmax is achieved within 2-3 hours. Absolute bioavailability after oral administration exceeds 90%. Taking with food does not affect bioavailability. Prucalopride is widely distributed in the body, Vd at steady state is 567 l. Plasma protein binding is approximately 30%.

An equilibrium state is achieved after 3-4 days of administration, and when taking prucalopride at a dose of 2 mg 1 time / day, Cmin and Cmax in blood plasma at steady state are 2.5 and 7 ng/ml, respectively.

The pharmacokinetics of prucalopride is linearly dependent on the dose in the range of up to 20 mg/day. With long-term administration 1 time/day, pharmacokinetics do not depend on the duration of administration.

The metabolism of prucalopride in the human liver in vitro is very slow and only a small number of metabolites are formed. Following oral administration of 14C-labeled prucalopride in humans, 8 metabolites are found in small amounts in urine and feces. The main metabolite (R107504, formed by O-demethylation of prucalopride and oxidation of the resulting alcohol to a carboxylic acid) accounts for less than 4% of the dose. As studies with a radioactive label have shown, about 85% of the active substance remains unchanged; metabolite R107504 is present in plasma in small quantities.

Most of the orally administered dose is excreted unchanged (approximately 60% via the kidneys and at least 6% via the feces). Excretion of unchanged prucalopride by the kidneys involves passive filtration and active secretion. The clearance of prucalopride from blood plasma averages 317 ml/min, the final T1/2 is approximately 1 day.

Practical experience with prucalopride: clinical demonstrations

Professor Drapkina O.M.: – And we already see Novosibirsk. We all see you. Hello, Marina Fedorovna and Marina Igorevna, you and I are together. Firstly, we had a lot of connections for pulmonology, and there are still a lot of connections, and that’s why I’m very happy. We are now connecting Yekaterinburg with Novosibirsk, with Moscow, plus the entire Internet space is also watching us. But I always know how Marina Fedorovna speaks, and I look forward to her message. Dear colleagues, I would like to urge you once again to write questions. You have the opportunity to get answers to these questions live and from experts who don’t even need to be introduced, they are already very well known. So, Professor Marina Fedorovna Osipenko, sitting in Novosibirsk, will now tell Russian doctors - and not only Russian ones, today Alma-Ata, Ukraine, Kazakhstan, Baku, Minsk are with us (I’m afraid I’ll offend someone if I don’t name them) - practical experience with prucalopride, and clinical demonstrations await us. Please, Marina Fedorovna.

(01:26) Screensaver: Practical experience with prucalopride: clinical demonstrations

Professor Osipenko M.F.: – So, dear colleagues, the topic of my message concerns practical experience in the use of prucaloprides. So, a 42-year-old patient sought the help of a gastroenterologist with complaints of infrequent bowel movements with the help of laxatives, lumpy stool, ineffective urge, and manual aid for bowel cleansing. All these symptoms have been bothering the patient for quite a long time and they intensify on business trips, when changing places of stay, and are periodically accompanied by pain in the anus and hemorrhoidal bleeding. Despite the fact that the patient first turned to gastroenterologists for help, she had a tendency to constipation since her student years, and sometimes she used irritating laxatives. Over the past 10 years, my work has involved frequent business trips, and in practice the effect of previously used drugs has decreased significantly.

The patient takes care of herself, she leads an active lifestyle, drinks enough fluids, and includes a sufficient amount of fiber, vegetables and fruits in her diet. She tried other classes of laxatives, such as lactulose or macrogol. Almost all of them cause her excessive bloating, reduce her quality of life, and she does not get the effect from them that she would like to have from the medications she takes. Three years ago she turned to proctologists for help, and here it should be noted that due to the presence of anxiety symptoms, namely blood in her stool, she underwent a full examination by proctologists. They diagnosed the patient with internal and external hemorrhoids, they diagnosed her with a fissure. There was no particular need for surgical treatment, and the patient tried to cope with these situations in a conservative way.

And next, I would like to draw our attention to the fact that today we can use different definitions of constipation. But no matter what definition we turn to, be it the definition of constipation in general, which is described and given in the Roman criteria, where the emphasis is on hard stools, straining during bowel movements, unproductive urges, a decrease in the number of bowel movements and prolongation of gastrointestinal transit time. intestinal tract. Have we turned to the definition given by the American Gastroenterological Association, which also emphasizes that chronic constipation is a set of symptoms, which includes difficulty in evacuating stool, a feeling of incomplete bowel movement, dissatisfaction with bowel movements, and rare bowel movements. Or another definition that relates to the definition given by the World Gastroenterological Organization, which also lists the 5 most characteristic symptoms, any 2 of which, out of these 5, will indicate the presence of constipation.

So, no matter which of these definitions you and I use, based on the totality of the symptoms that were listed by our patient, without a doubt, she is worried about constipation. A modern approach or algorithm for the management of patients with this symptom complex, which is proposed by leading European gastroenterologists. We must clearly understand that the diagnosis of constipation as such is made anamnestiically based on the totality of the above symptoms.

The next question or the next task that we face – it always faces us, and it faces especially acutely for gastroenterologists – is whether or not there are symptoms of anxiety. Because our further tactics depend on the presence or absence of anxiety symptoms. I remind you and I of the well-known symptoms of anxiety and draw our attention to the fact that the examinations that were carried out on the patient 3 years ago were caused precisely by the presence of such an anxiety symptom as intestinal bleeding. At the time of our contact with the patient, the patient had no symptoms of anxiety, and the next question we had to answer was whether the patient was or was taking any medications that could cause constipation. The patient answered this question in the negative; she did not take any medications for any reason that could cause constipation.

I once again emphasize that a detailed examination of the intestines of this patient, carried out three years ago, was caused precisely by the presence of anxiety symptoms, and not by the presence of constipation as such. So, upon objective examination and the results of additional routine testing, complete blood count and biochemical studies, there were no symptoms of alarm, and referring to the algorithm that I am now referring to, the next step is, essentially, making a diagnosis of chronic functional constipation, which This is what we did with our patient.

If we turn to the definition of the Roman criteria, according to the Roman criteria for functional constipation, which Igor Borisovich has already demonstrated, then please pay attention: the presence of at least two of the following criteria, and here we highlight exactly those symptoms that our patient had , namely, prolonged straining, rough or hard stools, a feeling of incomplete evacuation, a feeling of anorectal obstruction, less than 3 evacuation per week, plus sometimes digital evacuation from the rectum - all this, without a doubt, confirms that the patient has functional constipation. In addition, we can discuss with you the issue related to the presence or absence of independent stool.

Indeed, the patient has had episodes, and there are episodes, when there is practically no independent bowel movement without the use of laxatives. And one more important point that I would like to draw your attention to is that there are not enough criteria for irritable bowel syndrome. Here, once again, dear colleagues, I would like to remind you of the criteria for irritable bowel syndrome, one of the variants of which is irritable bowel syndrome, where the dominant factor is indeed the presence of constipation. And while these situations are similar - this applies to both a decrease in stool frequency and a decrease in stool shape - the key to diagnosing irritable bowel syndrome is abdominal pain or discomfort.

It is schematically demonstrated that it is not always easy to distinguish between irritable bowel syndrome and functional constipation. Indeed, in a number of situations, the symptoms of constipation dominate in patients, and abdominal pain is not very distinct or is associated and caused by the medications that the patient is taking. In any case, it should be noted that with long-term observation of patients who have constipation syndrome, in some cases symptoms similar to irritable bowel syndrome arise, and in some cases in the same patients, when observed for decades at a certain At the stage of the disease, functional constipation is dominant.

Thus, in this clinical situation, we settle on the diagnosis of chronic functional constipation and note tolerance to irritating laxatives. The only concomitant condition that we can currently identify in our patient is excess body weight, which we note in the diagnosis.

Our algorithm of actions if we have diagnosed chronic functional constipation. This is a lifestyle correction, a nutritional correction, which the patient did on her own without any advice from us; she already leads a fairly healthy lifestyle, with appropriate corrections. The next step for you and me is an attempt to select laxatives. We essentially also skip this stage in this particular case, because the patient not only tried to use various laxatives for 2-4 weeks or several months, including in combination, we move immediately to the next stage, since the patient applied to us due to the fact that the drugs used did not bring sufficient effect. And the next stage of our intervention in the correction of syndromes in this patient is associated with the prescription of a fundamentally new class of drugs in the treatment of constipation, namely enterokinetics.

These are all the groups of drugs that were used by our patient, these are irritant laxatives or osmotic laxatives, their mechanism of action was associated with the fact that they increased the volume of fluid in the intestine in various ways, thereby increasing the volume of stool, stimulating peristalsis and thereby causing the process defecation. All the new treatments for chronic constipation that have appeared on the world market today, which Igor Borisovich mentioned, lead us to the need to prescribe the drug that we really actually have on the market today, and which has been studied quite well in the world practice.

This is the enterokinetic prucaloprid, or as it is called in our market, resolor. The drug has a fundamentally different effect on bowel movements compared to the drugs that were used by our patient. It directly stimulates the receptor apparatus, stimulates peristalsis and thereby facilitates or improves the process of defecation. The drug has been studied quite well, in almost 2000 patients. And it must be said that almost all of these studies selected patients who had a long history of constipation, who had tried many laxatives without getting the desired effect from them. And based on the totality of all these studies, 73% noted an improvement, first of all, in the number of bowel movements, but in addition, the drug demonstrated not only an increase in the number of bowel movements, but also the relief of other manifestations of constipation - such as a feeling of incomplete evacuation, false urges, hard stools, bloating, discomfort , pain and cramps in the abdomen. That is, essentially, not only increasing the number of bowel movements, but also relieving other manifestations of constipation. In addition, the drug showed a good safety and tolerability profile. Those side effects that occurred mainly concerned the first day of administration, starting almost from the second day of administration, there were practically no differences in the number of side effects between prucalopride, resolor and placebo.

So, we prescribed resolor to the patient at the usual therapeutic dosage of 2 mg per day, with a recommendation to take it at a time convenient for her. The patient did not come to the follow-up appointment; a month later, a conversation took place with her on the phone, a little more than a month later. The patient is very active and busy with professional activities. She reported that she was completely satisfied with the result of the treatment and did not see the need for our further consultation.

The second clinical situation that I would like to share with you. This is a 25-year-old patient who also sought an appointment with a gastroenterologist, and here is a conversation with this patient. When asked about the purpose of coming to the gastroenterologist, the patient said that she was worried about poor bowel function, and she asked for help to improve this function. To the specific question: “Do you have constipation?” (please pay attention to this), the patient answered “no,” saying that she had bowel movements every day. However, when we asked her to explain what she meant by poor bowel function, she said that a feeling of fullness, a feeling that the intestines are not completely cleared, that not everything comes out of it, that she always has lumpy stools, and that she has to strain for a long time to performing bowel movements.

Here a very important point is to once again refer to the existing definitions of constipation. We must understand that decreased bowel movements are one of the symptoms of constipation. In fact, if we look at our patient, we will see that she has other manifestations of constipation, such as hard stools in a large percentage of cases, a feeling of incomplete emptying and prolonged straining. And, despite the fact that she achieves bowel movements every day, the symptoms of constipation bother her, without a doubt. Once again, I draw attention to the modern interpretation or criteria for the diagnosis of constipation. We must understand that this is not the most common symptom of constipation - a decrease in the number of bowel movements per week. Straining, hard stools and a feeling of incomplete emptying are much more common, which is confirmation or proof of the diagnosis of constipation in the patient.

Anamnesis revealed that the problems had been bothering the patient for quite a long time, that she had tried everything that her relatives and the Internet advised, that she took care of herself, went to the gym, consumed a sufficient amount of fluid, took a sufficient amount of fiber, she never sought medical help. didn't apply. She tried a lot of drugs that were recommended to her by relatives, friends, and pharmacists, but after most of them her quality of life significantly decreased, and symptoms associated with pain and bloating appeared, she had to take additional drugs, antispasmodics, espumisan. She believes that she doesn't want to use extra pills, and she wants a faster, more predictable, side-effect-free way to deal with the problem she has.

And if we look at world practice, and here is our domestic practice, which does not differ significantly from the world one, - indeed, only 13% of patients consult a doctor due to constipation. Most patients treat themselves or turn to pharmacists, or consult with neighbors on how to cope with this symptom. And if you and I now look at the algorithm of actions that we are taking to supervise patients whose main pathology is constipation, this is our patient that we are now analyzing, it is very important for us, firstly, to establish that , that the diagnosis is indeed constipation, and we are now confirmed in this.

The next thing is we need to understand whether she has anxiety symptoms or not. Our patient had no symptoms of anxiety. She was not taking medications that could cause constipation, so we settle on a diagnosis of chronic functional constipation. So, having made a diagnosis of chronic functional constipation, we must once again look at world practice and make sure that more than half of the patients are not satisfied with treatment with conventional laxatives. This applies not only to our country, but this applies to the whole world, and here is the data that almost 50% of patients, regardless of whether they take medications or not, are dissatisfied, using the terminology that was used by our patient, dissatisfied with the functioning of the intestines , dissatisfied with defecation.

Indeed, we are faced with a situation where the effectiveness of the diet is clearly limited and does not solve problems. The remedies our patient used only caused her to develop new symptoms. In addition, they do not completely eliminate the problems that the patient had. Plus, she also experiences a lot of inconvenience - just like, in fact, the first patient - due to the inconvenience of taking laxatives. Therefore, we recommend that our patient continue the healthy lifestyle that she led before coming to us, and we recommend a new enterokinetic drug, Resolor, in the usual therapeutic dosage - 2 mg once a day for a long time, focusing the patient’s attention on the fact that this is exactly what a drug that not only increases the number of bowel movements per day or per week, but it, among other things, relieves precisely those symptoms that bother our patient - hard stools, long periods of straining, and a feeling of intestinal obstruction. Two months later, the patient came to us to thank us for receiving and using a reliable, effective remedy for normalizing intestinal function. We recommended that she continue the treatment she had started.

And finally, the next, third situation, where we encountered a 76-year-old patient who turned to us for help and came for help with her son. She came on the recommendation of a cardiologist. This is an elderly woman who has long suffered from chronic heart failure, arterial hypertension, and impaired glucose tolerance. She receives a combination of fairly extensive therapy related to her main pathology. At the same time, constipation has been bothering her for a long time. She fights this situation as best she can, using enemas and various laxatives. Sometimes the effect is better, sometimes it’s worse. But one day, relatively recently, after a five-day delay, that is, the absence of bowel movements, the patient uncontrollably, frightened by the situation, took a whole set of different laxatives, including irritating laxatives. As a result, she developed severe diarrhea, severe weakness, a drop in blood pressure, extrasystole, and with suspicion of acute coronary syndrome, the patient was hospitalized in a medical institution.

I want to draw your attention to the fact that the patient developed classic manifestations of laxative disease, which occur when taking uncontrolled irritating laxatives, when diarrhea, hypokalemia, electrolyte imbalance occurs, which our patient had, and that, of course, in this particular case not only reduced the quality of her life, but also brought with it a threat to her life as such. It was the fear of such a syndrome that forced the patient to seek help from gastroenterologists.

Very interesting studies were conducted on 73 thousand postmenopausal patients (as we understand, this is a fairly adult cohort of patients) and assessed the risks of cardiovascular events in patients with moderate and severe constipation. So here is the risk, despite the fact that constipation is essentially a functional disorder, however, in this category of people it carries with it an increased risk of cardiovascular problems, serious cardiovascular problems. Thus, severe constipation increases these risks by almost a quarter, which we must keep in mind when dealing with this rather difficult category of patients to manage.

So, using the same algorithm, we must answer the symptoms of anxiety in terms of gastrointestinal problems. We conducted an enzyme immunoassay test for occult blood in the patient and received a negative result. Of course, age itself is a risk factor for various serious intestinal diseases. Next, we tried to analyze the medications she was taking, and we realized that a number of them could actually aggravate the constipation, but they were carefully selected by cardiologists, and we did not adjust this therapy. Therefore, we, having excluded the patient’s symptoms of anxiety and essentially excluding or not interfering with the drug therapy that she received, of course, putting chronic heart failure, arterial hypertension, etc. in the first place, made a diagnosis of chronic constipation.

In terms of the treatment that was prescribed to the patient, we prescribed her Resolor 1 mg once a day, using the instructions for use of Resolor. The fact is that in patients of older age groups, the rate or area under the concentration-time curve is increased, possibly due to a weakening of the excretion functions of resolor metabolites. And therefore, patients over 65 years of age are recommended to start therapy with half the dose, with 1 mg 1 time per day.

The next very important point that we must keep in mind when working with this group of patients is that prucalopride is a full type 4 receptor agonist. Because when we work with older groups of patients, we are always concerned about whether they have a negative impact, in particular on provocation and arrhythmias. And it must be said that studies have been conducted and are now being conducted in relation to prucalopride and people in older age groups, and these studies have shown any lack of drug on the QT interval and the presence of any proarrhythmogenic effect of this drug, the only side effects the effects that existed concerned mainly the digestive system and occurred in the first days of administration, regardless of the form of administration of the drug.

Thus, we learned from the patient after three weeks that the effect was good at a dose of 1 mg per day, we left the same dosage and recommended that the patient see her after some time for some treatment adjustments.

To date, we have treated 56 patients with functional constipation of different ages and different duration of the disease. It must be said that most of them, before asking for help, almost all tried to use information from the Internet, newspapers, magazines, neighbors, etc., and turned to them after they were practically faced with the ineffectiveness of the drugs they were using. 71% of patients were completely satisfied with the therapy. 14% of patients were dissatisfied with the therapy (unfortunately, we did not achieve the desired effect in them). In 14% of patients, we encountered an improvement, with a positive effect on relieving constipation, but this effect was not entirely complete.

As a summary, I would like to draw the attention of my dear colleagues to the fact that constipation is a complex of symptoms that is diagnosed on the basis of medical history complaints, and we should examine patients in detail only if there are symptoms of anxiety or if we have not received an effect from all available classes of drugs. And the appearance on our market today of a fundamentally new drug, enterokinetics resolor, allows us to adopt an effective drug with a predictable effect, easy to use, a single dose, which relieves various manifestations of constipation and is well tolerated. We are hopeful and remain optimistic about this drug and our ability to reverse this very common and quite serious problem in our patients. Thank you for your attention.

Side effect

From the digestive system:

very often - nausea, diarrhea, abdominal pain; often - vomiting, dyspepsia, rectal bleeding, flatulence, abnormal bowel sounds; infrequently - anorexia.

From the nervous system:

very often - headache; often - dizziness; infrequently - tremor.

From the cardiovascular system:

infrequently - palpitations.

From the urinary system:

often - pollakiuria.

General reactions:

often - weakness; infrequently - fever, poor health.

Use during pregnancy and breastfeeding

Use during pregnancy and lactation (breastfeeding) is not recommended.

Cases of miscarriage have been reported in clinical studies, although given the presence of other risk factors, the association of these events with the use of prucalopride remains unproven.

Women of childbearing age should use reliable methods of contraception during treatment.

Prucalopride is excreted in breast milk, however, when used in therapeutic doses, the effect on newborns/infants is unlikely. There are no data on use in nursing mothers.

In preclinical studies

in animals, no direct or indirect adverse effects on the course of pregnancy, development of the embryo/fetus, childbirth and postnatal development of the offspring were detected; any effect on the fertility of males and females.

Vegaprat

Prucalopride is rapidly absorbed; after a single oral dose of 2 mg, the maximum concentration (Cmax) is reached after 2-3 hours. Absolute bioavailability after oral administration exceeds 90%. Taking the drug with food does not affect bioavailability.

Prucalopride is distributed throughout the body, the volume of distribution at steady state is 567 l. Plasma protein binding is approximately 30%.

Metabolism of the drug in the human liver in vitro

is very slow and only small amounts of metabolites are formed. After oral administration of 14C-labeled prucalopride by humans, 8 metabolites are found in small amounts in urine and feces. The main metabolite (R107504, formed by O-demethylation of prucalopride and oxidation of the resulting alcohol to carboxylic acid) constitutes less than 4% of the administered dose of the drug. As studies with a radioactive label have shown, about 85% of the drug remains unchanged; metabolite R107504 is present in plasma in small quantities.

An equilibrium state is achieved after 3-4 days of taking the drug, and when taking prucalopride at a dose of 2 mg 1 time per day, the minimum and maximum concentrations in blood plasma at steady state are 2.5 and 7 ng/ml, respectively. When taken once a day, the coefficient k of the drug ranges from 1.9 to 2.3.

The pharmacokinetics of prucalopride is linearly dependent on the dose in the range of up to 20 mg/day. With long-term use of the drug once a day, its pharmacokinetics do not depend on the duration of administration.

Pharmacokinetics in selected patient groups

Population pharmacokinetics

Population pharmacokinetic analysis showed that the total clearance of prucalopride correlates with creatinine clearance (CC) and is independent of the age, body weight, sex or race of patients.

Elderly patients

When the drug was taken by elderly patients at a dose of 1 mg 1 time per day, the maximum plasma concentration of prucalopride (Cmax) and the area under the concentration/time curve (AUC) were 26% and 28%, respectively, higher than in young patients. This difference may be due to decreased renal function in older adults.

Renal dysfunction

In patients with severe renal impairment (creatinine clearance less than 24 ml/min), the plasma concentration of prucalopride was 2.3 times higher than in healthy people.

Liver dysfunction

About 35% of prucalopride is eliminated extrarenally, so impairment of liver function is unlikely to clinically significantly alter the pharmacokinetics of the drug.

Children

After a single oral dose of 0.03 mg/kg prucalopride in children aged 4-12 years, the Cmax of the drug was the same as after taking the drug in adults at a dose of 2 mg, and the AUC of the unbound fraction of the drug was 30-40% less than in adults, and did not depend on the age of children. The average half-life of the drug in the terminal phase is approximately 19 hours in children (range 11.6-26.8 hours).

special instructions

Use with caution in patients with severe and clinically unstable concomitant diseases (liver, lung, cardiovascular, neurological, endocrine diseases, mental disorders, cancer, AIDS) has not been studied; use with extreme caution in patients with cardiac arrhythmias or coronary artery disease in the anamnesis.

Due to the specific mechanism of action of prucalopride (stimulation of intestinal motility), increasing the daily dose to more than 2 mg is unlikely to increase the effect. If taking prucalopride once a day for 4 weeks does not produce an effect, the patient should be re-examined and the advisability of continuing treatment should be determined.

Severe diarrhea may reduce the effectiveness of oral contraceptives, and the use of additional methods of contraception is recommended to prevent a decrease in the effectiveness of oral contraceptives.

Use in pediatrics

Not recommended for use in children and adolescents under 18 years of age.

Impact on the ability to drive vehicles and operate machinery

In some cases, the use of prucalopride has been associated with the development of dizziness and weakness, especially in the first days of treatment, which may affect the ability to drive vehicles and operate machinery.

Vegaprat, 1 mg, film-coated tablets, 30 pcs.

Prucalopride is rapidly absorbed; after a single oral dose of 2 mg, the maximum concentration (Cmax) is achieved after 2-3 hours. Absolute bioavailability after oral administration exceeds 90%. Taking the drug with food does not affect bioavailability.

Prucalopride is distributed throughout the body, the volume of distribution at steady state is 567 l. Plasma protein binding is approximately 30%.

Metabolism of the drug in the human liver in vitro is very slow, and only a small amount of metabolites is formed. After oral administration of 14C-labeled prucalopride by humans, 8 metabolites are found in small amounts in urine and feces. The main metabolite (R 107504, formed by O-demethylation of prucalopride and oxidation of the resulting alcohol to carboxylic acid) constitutes less than 4% of the administered dose of the drug. As studies with a radioactive label have shown, about 85% of the drug remains unchanged; metabolite R 107504 is present in plasma in small quantities.

Most of the orally administered dose of the active ingredient is excreted unchanged (approximately 60% by the kidneys and at least 6% in the feces). Excretion of unchanged prucalopride by the kidneys involves passive filtration and active secretion. Plasma clearance of prucalopride averages 317 ml/min, with a terminal half-life of approximately 24 hours. An equilibrium state is achieved after 3-4 days of taking the drug, and when taking prucalopride at a dose of 2 mg 1 time per day, the minimum and maximum concentrations in blood plasma at steady state are 2.5 and 7 ng/ml, respectively. When taken once a day, the k coefficient of the drug ranges from 1.9 to 2.3. The pharmacokinetics of prucalopride is linearly dependent on the dose in the range of up to 20 mg/day. With long-term use of the drug once a day, its pharmacokinetics do not depend on the duration of administration.

Pharmacokinetics in selected patient groups

Population pharmacokinetics

Population pharmacokinetic analysis showed that the total clearance of prucalopride correlates with creatinine clearance (CC) and does not depend on the age, body weight, gender or race of patients.

Elderly patients

Renal dysfunction

Compared with patients with normal renal function, in patients with mild (creatinine clearance 50-79 ml/min) and moderately severe (creatinine clearance 25-49 ml/min) renal impairment, the plasma concentration of prucalopride after a single dose of 2 mg was increased by 25% and 51%, respectively. In patients with severe renal impairment (creatinine clearance less than 24 ml/min), the plasma concentration of prucalopride was 2.3 times higher than in healthy people.

Liver dysfunction

About 35% of prucalopride is eliminated extrarenally, so impairment of liver function is unlikely to clinically significantly alter the pharmacokinetics of the drug.

Children

Indications for use

Prucalopride is indicated for the symptomatic treatment of chronic constipation in women in whom laxatives have not been sufficiently effective in relieving symptoms.