Use of the chloride channel activator lubiprostone for constipation in adults with cystic fibrosis: a case series.
OBJECTIVE
To describe the use of lubiprostone for constipation in 3 adults with cystic fibrosis (CF).


METHODS
This case series describes the use of lubiprostone for the treatment of constipation in 3 adults with CF (mean +/- SD length of therapy 17.3 +/- 1.5 mo). All 3 patients were prescribed lubiprostone 24 microg twice daily after hospitalization for treatment of intestinal obstruction. Patient 1 continues on chronic polyethylene glycol (PEG) 3350 and lubiprostone and has not had a recurrence of obstruction. Patient 2 requires aggressive chronic therapy with PEG 3350, lubiprostone, and methylnaltrexone. She has had 1 recurrence of obstruction. Patient 3 continues with lubiprostone taken several times per week with good control of constipation and no recurrence of obstruction to date. The adverse effect profile has been tolerable in all 3 patients.


CONCLUSIONS
CF is caused by a genetic mutation resulting in a dysfunctional or absent CF transmembrane conductance regulator that normally functions as a chloride channel. This results in viscous secretions in multiple organ systems including the lungs and intestinal tract. Accumulation of viscous intestinal contents contributes to constipation, which is common among adults with CF and can sometimes lead to intestinal obstruction. Lubiprostone is indicated for chronic constipation and works by activating type 2 chloride channels (ClC-2) in the intestinal tract. Because it utilizes an alternate chloride channel, lubiprostone may be especially effective for constipation in patients with CF.


CONCLUSIONS
Lubiprostone provides an additional option for the treatment of constipation in adults with CF. Its use in the CF population deserves further study.
O'Brien
Catherine E
CE
College of Pharmacy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. obriencatherinee@uams.edu
Anderson
Paula J
PJ
Stowe
Cindy D
CD
D000328:Adult; D000527:Alprostadil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D018118:Chloride Channels / Q000187:drug effects / Q000378:metabolism; D003248:Constipation / Q000188:drug therapy* / Q000209:etiology; D003550:Cystic Fibrosis / Q000150:complications* / Q000235:genetics / Q000503:physiopathology; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics / Q000378:metabolism; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy / Q000209:etiology; D000068238:Lubiprostone; D008297:Male; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
D018118:Chloride Channels; D019005:Cystic Fibrosis Transmembrane Conductance Regulator; D000068238:Lubiprostone; D000527:Alprostadil