{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:06:27Z","timestamp":1786125987621,"version":"build-2736575974"},"reference-count":31,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"4","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clozapine-induced constipation may occur in at least 60% of patients, with first-line options typically involving polyethylene glycol or sennosides. However, there may be adherence barriers to an over-the-counter bowel regimen due to the dosage form, lack of insurance coverage, or lack of benefit. One possible solution to address these adherence barriers may include prescribing a secretagogue laxative. However, there is limited literature supporting the use of secretagogue laxatives in clozapine-associated constipation. A case series is presented in which adherence barriers impeded the use of over-the-counter laxatives, and a secretagogue laxative was implemented to manage clozapine-induced constipation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>In 4 cases, lubiprostone or linaclotide was initiated, either as monotherapy or in combination with over-the-counter laxatives. Reasons for secretagogue laxative initiation included: (1) reducing a complex over-the-counter laxative regimen, (2) a lack of insurance coverage of over-the-counter laxatives, (3) dissatisfaction with polyethylene glycol\u2019s palatability, and (4) cognitive impairment leading to decreased adherence to polyethylene glycol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>It is important that clozapine-induced constipation is managed adequately to prevent severe consequences of gastrointestinal hypomotility. In addition to timely initiation and titration of constipation pharmacotherapy, adherence should be assessed. When adherence barriers to the use of over-the-counter laxatives are present, the use of a secretagogue laxative may be an option, recognizing there is limited evidence to guide this decision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In these cases, adherence barriers to over-the-counter laxatives were identified. A secretagogue laxative was implemented, well-tolerated, and able to be continued for the duration of follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.9740\/mhc.2026.08.207","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:39:19Z","timestamp":1786124359000},"page":"207-216","source":"Crossref","is-referenced-by-count":0,"title":["Secretagogue laxatives as a potential strategy to overcome adherence barriers to over-the-counter treatment for clozapine-induced constipation"],"prefix":"10.9740","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3836-9375","authenticated-orcid":true,"given":"Jonathan G.","family":"Leung","sequence":"first","affiliation":[{"name":"(Corresponding author) Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, Leung.jonathan@Mayo.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0437-5497","authenticated-orcid":true,"given":"Matej","family":"Markota","sequence":"additional","affiliation":[{"name":"Consultant, Assistant Professor, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-1161","authenticated-orcid":true,"given":"Xiao Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Consultant, Associate Professor, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","reference":[{"issue":"3","key":"i2168-9709-16-4-207-b01","series-title":"Clin Schizophr Relat Psychoses","first-page":"163","article-title":"A guide to the management of clozapine-related tolerability and safety concerns","volume":"10","author":"Citrome","year":"2016","unstructured":"Citrome L,\nMcEvoy JP,\nSaklad SR. 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Lessons learned: chronic idiopathic constipation patient experiences with over-the-counter medications. PloS One. 2021;16(1):e0243318. DOI: 10.1371\/journal.pone.0243318"},{"issue":"6","key":"i2168-9709-16-4-207-b21","series-title":"Cureus","first-page":"e25576","article-title":"Lubiprostone for the treatment of clozapine-induced constipation: a case series","volume":"14","author":"Torrico","year":"2022","unstructured":"Torrico TJ,\nKaur S,\nDayal M,\nEagala P,\nWeinstein D. Lubiprostone for the treatment of clozapine-induced constipation: a case series. Cureus. 2022;14(6):e25576. DOI: 10.7759\/cureus.25576"},{"issue":"3","key":"i2168-9709-16-4-207-b22","series-title":"Int Clin Psychopharmacol","first-page":"162","article-title":"Prevalence and predictors of laxatives use in clozapine-related constipation: an observational study","volume":"36","author":"Nakamura","year":"2021","unstructured":"Nakamura M,\nNagamine T. 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