Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
SynopsisH

Tegaserod (Zelnorm) for irritable bowel syndrome: reports of serious diarrhea and intestinal ischemia

Eric Wooltorton
CMAJ June 22, 2004 170 (13) 1908; DOI: https://doi.org/10.1503/cmaj.1040882
Eric Wooltorton
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading
  • © 2004 Canadian Medical Association or its licensors

Reason for posting: The serotonin 5-HT4 receptor partial tegaserod (Zelnorm) is sometimes prescribed for patients who have irritable bowel syndrome with constipation.1 However, a recent letter to health care professionals from the drug's manufacturer warns of serious adverse events in some cases.2 Although 1 in 10 patients taking the drug will experience mild diarrhea, about 1 in 250 will have very serious diarrhea complicated by hypovolemia, hypotension and syncope that sometimes necessitates admission to hospital and intravenous therapy.2 As well, ischemic colitis and other forms of intestinal ischemia have occurred in some patients taking the drug; although the exact incidence of this adverse event is unknown, it probably occurs in fewer than 1 in 11 000 patients.2

The drug: The pathophysiology of irritable bowel syndrome is not well understood, but serotonin 5-HT4 receptors appear to mediate peristalsis in the enteric nervous system.3 Tegaserod is a serotonin 5-HT4 receptor antagonist that reduces symptoms of abdominal pain, discomfort, bloating and constipation. A recent Cochrane review concluded that the number needed to treat to reduce these gastrointestinal symptoms (relative to placebo) is 17.1

What to do: Irritable bowel syndrome is a common, chronic, painful and frustrating condition for many patients4 but is itself not life-threatening. Most patients do not require drug treatment but instead benefit from “listening, validating, educating, and identifying and reinforcing coping strategies in a long-term therapeutic alliance.”4 For affected patients with constipation, fibre supplementation or periodic use of osmotic laxatives is often the best treatment.3 Tegaserod therapy should be reserved for specific patients (women with irritable bowel syndrome and constipation) who have more moderate to severe symptoms.3 The duration of treatment should not exceed 12 weeks, and therapy should be stopped after 4 weeks if there has been no response.2 Patients should be warned that they may experience potentially serious diarrhea or, rarely, intestinal ischemia. They should be advised to seek prompt medical attention if serious diarrhea, lightheadedness or postural symptoms develop during treatment. The drug should be immediately stopped if rectal bleeding or new or worsening abdominal pain develops.

Eric Wooltorton CMAJ

References

  1. 1.↵
    Evans BW, Clark WK, Moore DJ, Whorwell PJ. Tegaserod for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2004; (1):CD003960.
  2. 2.↵
    Health Canada. Important safety update. Diarrhea and ischemic colitis in patients using Zelnorm (tegaserod hydrogen maleate). [Dear Health Care Professional Letter]. Dorval (QC): Novartis Pharmaceutical Canada Inc.; 2004. Available: www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/zelnorm_hpc_e.html (accessed 2004 May 31).
  3. 3.↵
    Mertz HR. Irritable bowel syndrome. N Engl J Med 2003;349:2136-46.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Paterson WG, Thompson WG, Vanner SJ, Faloon TR, Rosser WW, Birtwhistle RW et al. Recommendations for the treatment of irritable bowel syndrome in family practice. CMAJ 1999;161(2):154-60.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 170 (13)
CMAJ
Vol. 170, Issue 13
22 Jun 2004
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Tegaserod (Zelnorm) for irritable bowel syndrome: reports of serious diarrhea and intestinal ischemia
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Tegaserod (Zelnorm) for irritable bowel syndrome: reports of serious diarrhea and intestinal ischemia
Eric Wooltorton
CMAJ Jun 2004, 170 (13) 1908; DOI: 10.1503/cmaj.1040882

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Tegaserod (Zelnorm) for irritable bowel syndrome: reports of serious diarrhea and intestinal ischemia
Eric Wooltorton
CMAJ Jun 2004, 170 (13) 1908; DOI: 10.1503/cmaj.1040882
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Applying the 2005 Canadian Hypertension Education Program recommendations: 4. Managing uncomplicated hypertension
  • A newborn requiring selective bronchial intubation
  • Does β-blocker prophylaxis improve survival after major noncardiac surgery?
Show more Synopsis

Similar Articles

Collections

  • Topics
    • Gastroenterology
    • Drugs: adverse reactions

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire