[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [5-HT4 receptor agonist prokinetics](https://durgical.com/en/pharmacology/classes/5-ht4-receptor-agonist-prokinetics/) › Prucalopride

# Prucalopride

## 5-HT4 receptor agonist prokinetics?

5-HT4 receptor agonist prokinetics

A selective 5-HT4 agonist that stimulates colonic peristalsis. Used for chronic idiopathic constipation in adults.

Updated Nov 1, 2026

## Quick facts

**Group**
[5-HT4 receptor agonist prokinetics](https://durgical.com/en/pharmacology/classes/5-ht4-receptor-agonist-prokinetics/)

**Target**
Serotonin 5-HT4 receptor on enteric neurons

**Used for**
Chronic idiopathic constipation

**Key effects**
Headache · Abdominal pain · Nausea

**Monitor**
Mood and suicidal thoughts · Renal function

**ATC**
A06AX05

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Serotonin 5-HT4 receptor on enteric neurons**Prucalopride

ⓘ The figure shows serotonin in the human 5-HT4 receptor; prucalopride activates the same receptor.

**Target in 3D:** Serotonin 5-HT4 receptor on enteric neurons. PDB structure 7XT8 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7XT8) · Drag to rotate · pinch to zoom

Prucalopride is a selective serotonin 5-HT4 receptor agonist with little action on other serotonin receptors such as 5-HT2B or 5-HT3. On enteric neurons it increases acetylcholine release, strengthening contractions and triggering high-amplitude propagating contractions of the colon, so bowel motility increases.

- Prucalopride activates enteric 5-HT4 receptors
- Acetylcholine release increases
- Colonic peristalsis strengthens; stools become more frequent

## Indications

- Chronic idiopathic constipation in adults

## Adverse effects

### Common

- Headache
- Abdominal pain, bloating, flatulence
- Nausea, vomiting, diarrhoea
- Dizziness, fatigue

### Serious (rare, important)

- Suicidal thoughts and behaviour, new or worse depression

## Contraindications

- Hypersensitivity to prucalopride
- Intestinal perforation or obstruction, obstructive ileus
- Severe inflammatory conditions of the gut: Crohn's disease, ulcerative colitis, toxic megacolon or megarectum

## Key interactions

**Other laxatives**
More diarrhoea and cramping

**Ketoconazole (strong CYP3A and P-glycoprotein inhibitor)**
Modestly higher prucalopride levels

## What is monitored

- Mood and suicidal thoughts
- Bowel frequency and diarrhoea
- Renal function (dose depends on it)

## Administration and safety

- Oral tablet, with or without food.
- A lower dose is used in severe renal impairment.
- Stopped at once if mood changes or suicidal thoughts appear.

## Pregnancy and breastfeeding

Human data from case reports are insufficient to define a risk; animal studies showed no developmental harm.

## Nursing care

- Ask about depression or suicidal thoughts before starting.
- Teach the patient and family to watch for mood changes and report them at once.
- Warn that headache and abdominal pain are common in the first days.
- Check that there is no bowel obstruction or active severe IBD.

## Pharmacokinetics

**Absorption**
High oral bioavailability; food has no effect

**Elimination**
Mainly renal, largely unchanged; dose is lowered in severe renal impairment

**Half-life**
About one day

## Memory aid

«PRU-moves the colon»: 5-HT4 on, acetylcholine up, stool out; watch the mood.

## Test yourself

Think of the answer, then tap the question to see it.

## Which receptor does prucalopride stimulate?

The serotonin 5-HT4 receptor on enteric neurons.

## Which psychiatric warning applies?

Suicidal thoughts and behaviour, and new or worsening depression.

## Why is the dose lowered in severe kidney disease?

It is excreted mainly unchanged by the kidneys.

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[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 4

- [Plecanatide](https://durgical.com/en/pharmacology/plecanatide/)
- [Linaclotide](https://durgical.com/en/pharmacology/linaclotide/)
- [Lubiprostone](https://durgical.com/en/pharmacology/lubiprostone/)
- [Metoclopramide](https://durgical.com/en/pharmacology/metoclopramide/)

[← Back to the class: 5-HT4 receptor agonist prokinetics](https://durgical.com/en/pharmacology/classes/5-ht4-receptor-agonist-prokinetics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - PRUCALOPRIDE tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e1e9e36c-ce5a-4323-9d20-395bb5e80e64) (DailyMed (U.S. National Library of Medicine), 2024); [Prucalopride: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a619011.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=A06AX05) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [RCSB PDB - 7XT8: Serotonin 4 (5-HT4) receptor-Gs-Nb35 complex](https://www.rcsb.org/structure/7XT8) (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/prucalopride/