painNICE has published a technology appraisal guidance recommending the use of lubiprostone (Amitiza) in the treatment of chronic idiopathic constipation (CIC) and associated symptoms in adults who have failed laxatives.

It recommends lubiprostone as an option for treating CIC for adults in whom treatment with at least two laxatives from different classes, at the highest tolerated recommended doses for at least 6 months, has failed to provide adequate relief and for whom invasive treatment for constipation is being considered.

NICE regulations require that clinical commissioning groups, National Health Service England and local authorities comply with NICE recommendations within three months of the date of publication. Specifically, the NICE guidance for lubiprostone states that “if a patient has chronic idiopathic constipation and the doctor responsible for their care thinks that lubiprostone is the right treatment, it should be available for use, in line with NICE’s recomendations.”

“Constipation places a significant burden on the UK healthcare system, resulting in over 60,000 hospitalisations annually,” said Dr Ramesh Arasaradnam, University Hospitals Coventry and Warwickshire NHS Trust and University of Warwick. “For many of the patients who are refractory to standard laxatives, effectively treating with lubiprostone in primary care could negate the need to progress to a secondary or tertiary care referral.”

Lubiprostone was approved by the Medicines and Healthcare Products Regulatory Agency in September 2012 for the treatment of CIC and associated symptoms in adults, when response to diet and other non-pharmacological measures (eg. educational measures, physical activity) are inappropriate, and was made commercially available in the UK in December 2013.

For the full guidance from NICE on the usage of lubiprostone please visit