title: Constipation is reduced by beta-blockers and increased by dopaminergic medications in Parkinson's disease.
abstract: BACKGROUND
  Constipation is one of most frequent non-motor symptoms of Parkinson's disease (PD) and it may precede the clinical diagnosis of PD by years, with negative effects on quality of life. In contrast to motor features, levodopa is ineffective and possibly detrimental on constipation. Treatment of constipation in PD is non-specific and frequently unsuccessful. Stemming from a clinical observation of unexpected relief of bothersome constipation, abdominal bloating and pain after treatment with the beta-blocker carvedilol in one patient, we have evaluated the association between the use of beta-blockers and the presence of constipation in a large, unselected PD cohort.
  
  
  METHODS
  Retrospective review of the medical records of every patient with a diagnosis of PD seen in the Movement Disorders clinic at Cedars-Sinai Medical Center from October 2010 to April 2014.
  
  
  RESULTS
  341 medical records with a primary diagnosis of PD were reviewed, 336 of which contained information about constipation. Overall, 205/336 patients (61%) reported constipation. Among the 66 subjects treated with beta-blockers at the time of the encounter of record, only 28 (42.4%) reported constipation. By comparison, among the 270 subjects not treated with beta-blockers, 177 (65.5%) had constipation (χ(2) test p value = 0.001). Multivariate logistic analysis showed an odds ratio (OR) of 0.293 for beta-blockers (95% C.I. 0.161-0.535, p = 0.0001), 2.287 for levodopa (95% C.I. 1.271-4.117, p = 0.006) and 1.805 for dopamine agonists (95% C.I. 1.039-3.136, p = 0.036).
  
  
  CONCLUSIONS
  Beta-blockers are associated with a lower risk of constipation, while dopaminergic treatments appear to increase risk of constipation.
authors.affiliation: Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy; Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy; Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Pagano
authors.affiliation: Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Echo E
authors.initials: EE
authors.lastname: Tan
authors.affiliation: Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Haider
authors.affiliation: Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Bautista
authors.affiliation: Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: michele.tagliati@cshs.org.
authors.forename: Michele
authors.initials: M
authors.lastname: Tagliati
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects*; D015331:Cohort Studies; D003248:Constipation / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D015259:Dopamine Agents / Q000009:adverse effects*; D018491:Dopamine Agonists / Q000009:adverse effects; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000978:Antiparkinson Agents; D015259:Dopamine Agents; D018491:Dopamine Agonists; D007980:Levodopa
keywords: Beta-blockers; Constipation; Dopamine agonists; Levodopa; Parkinson; Parkinson's disease