Irritable Bowel Syndrome Self Help and Support Group

Overview of Medications for Irritable Bowel Syndrome:

The IBS Self Help and Support Group cannot provide direct medical advice. If you have a digestive disorder then you should consult a healthcare professional. We are not able to offer medical, pharmaceutical or nutritional advice. Our highest priority is to raise awareness and to provide support for this illness.

Medication Class	Examples	Dosage	Principal indication	Comment
Antispasmodics	Hyoscyamine	0.125 - 0.25 mg ac & hs	Pain, post- prandial urgency	Xerostomia, urinary retention, tachycardia, and other anticholinergic side effects can be seen
Antispasmodics	Dicyclomine	10 - 20 mg ac & hs	Pain, post- prandial urgency
Antidiarrheals	Loperamide	2 - 4 mg up to qid	Diarrhea, urgency, incontinence	Considerable variation in required dose; prophylactic use may reduce social anxiety; can induce constipation
Fiber supplements	Psyllium	1 Tbs up to tid	Constipation	May initially induce bloating and flatulence; gradually increase dose
	Methylcellulose	1 Tbs. up to tid
	Calcium Polycarbophil	2 caplets (1250 mg) up to qid
Tricyclic antidepressants	Secondary amines (e.g., nortriptyline, desipramine)	25 - 125 mg daily (usually at hs)	Pain, other discomforts	Fewer CNS and anticholinergic side effects and less sedation, orthostatic hypotension & weight gain with secondary amines; start low and work up to target dosage
Tricyclic antidepressants	Tertiary amines (e.g., amitriptyline, imipramine)	25 - 125 mg daily (usually at hs)	Pain, other discomforts
Newer antidepressants	SSRIs (e.g., fluoxetine, paroxetine)	Usual psychiatric dosing	To treat co-morbid anxiety or depression; can be used for pain management in patients who fail or are intolerant to TCAs	Transient exacerbation of nausea; diarrhea can occur with SSRIs; sleep disruption occurs with some agents
Newer antidepressants	Others (e.g., buproprion, venlafaxine)	Usual psychiatric dosing
5-HT3 antagonist	Alosetron	1/2-1 mg bid	Pain, urgency, diarrhea in diarrhea- predominant female patients	May induce constipation requiring separate management
5-HT4 antagonist	Tegaserod	6 mg bid	Pain, constipation in constipation- predominant female patients	May initially induce diarrhea

© American Digestive Health Foundation

Brand Name	Active Ingredient	Indication
Align	bifidobacterium infantis 35624	probiotic that delivers "good" bacteria to your digestive system to relieve abdominal pain, bloating, urgency, constipation or diarrhea.
Amitriptyline	amitriptyline	antidepressant - anticholinergic - lessen gut activity and secretions
Amitiza	lubiprostone	indicated for IBS-C or chronic idiopathic constipation
Benefiber	partially hydrolyzed guar gum (PHGG)	fiber bulking agent - grit-free, water soluble
Bentyl	dicyclomine	antispasmodic
Bentylol	dicyclomine	antispasmodic
Buscopan	hyoscine (N-butylscopolamine)	antispasmodic; abdominal discomfort and pain
Cilansetron	5-HT3 antagonist	under investigation in Europe by Solvay Pharmaceutical for chronic diarrhea
Citrucel	methylcellulose	fiber bulking agent - smooth, non-gas forming
Colpermin	enteric coated peppermint oil capsules	symptomatic relief of abdominal pain and bloating associated with an irritable bowel. (Not Available In USA or Canada)
Culturelle		Lactobacillus GG probiotics
Desipramine	desipramine	antidepressant - anticholinergic - lessen gut activity and secretions
Digestive Advantage IBS	Ganeden Lactobacillus Cultures and amino acid	probiotic enzymes which help aid normal digestion
Dicetel	pinaverium bromide	specifically for the treatment of IBS pain and intestinal discomfort (Not available in USA)
Donnatal	belladonna/phenobarbital	antispasmodic
Effexor	venlafaxine	antidepressant
Elavil	amitriptyline	antidepressant - anticholinergic - lessen gut activity and secretions
Equalactin	calcium polycarbophil	helps equalize the water balance in the intestines to relieve diarrhea
FiberChoice	fructan	chewable fiber supplement
Ibsacol		patented fatty acid ester compound specifically formulated for IBS and associated symptoms
Imodium	loperamide	anti-diarrhea - mild
Kytril	granisetron	primarily used for the management of oncology related nausea and vomiting. Used for abdominal pain and diarrhea similiar to Lotronex.
Lactaid	lactase	dairy digestive supplement that works to make dairy foods more digestible
Levbid/Levsin	hyoscyamine sulfate	antispasmodic
Librax	clidinium bromide	tranquillizer for gut
Lomotil	diphenoxylate + atropine sulfate	Antidiarrheal, antiperistaltic
Lotronex	alosetron	reduces multiple symptoms of IBS-D, including cramping abdominal pain, abdominal discomfort, urgency and diarrhea. (Restricted marketing in U.S. ONLY)
Maalox		antacid - also helps to break down gas
Maxeran	metoclopramide	upper gut regulator
Metamucil	psyllium hydrophilic mucilloid	high fiber bulking agent - smooth
Miralax	polyethylene glycol 3350	laxative for occasional constipation
Modulon	trimebutine maleate	gastrointestinal tract regulator
Motilium	domperidone maleate	helps contractions and co-ordination of stomach and small intestine
Motofen	difenoxin hydrochloride with atropine sulfate	Antidiarrheal, antiperistaltic
NuLev	hyoscyamine sulfate	antispasmodic
Norpramin	desipramine	antidepressant - anticholinergic - lessen gut activity and secretions
Pamine	methscopolamine bromide	anticholinergic/antispasmodic
Paxil	paroxetine	antidepressant
Pepto-Bismol	bismuth subsalicylate	relief of diarrhea, nausea, indigestion, heartburn and upset stomach
Prilosec	omeprazole	blocks the formation of acid in the stomach
Perdiem/Prodiem	psyllium	high fiber bulking agent - semi-rough
Prepulsid/Propulsid	cisapride	moves food and fluid along in the upper GI. Used for GERD.(Withdrawn in U.S. on March 23, 2000, Canada on May 31, 2000)
Prozac	fluoxetine	antidepressant
Psyllium		high fiber bulking agent - smooth
Questran	cholestyramine	resin which absorbs and combines with the bile acids in the intestine to form an insoluble complex which is excreted in the feces
Remeron	mirtazapine	antidepressant
Renzapride	5-HT4 agonist and a 5-HT3 -antagonist	under investigation by Alizyme for mixed IBS-C/D
Sinequan	doxepin	antidepressant - anticholinergic - lessen gut activity and secretions
Spasmonal	alverine citrate	antispasmodic which relaxes the smooth muscle in the colon
Tagamet	cimetidine	ulcer, acid suppressor
Tofranil	imipramine	antidepressant
Tums		antacid
Tylenol#1	acetaminophen w/codeine	pain reliever - codeine is constipating
VSL #3	lactic acid bacteria	high-potency probiotic with 450 billion live bacteria
Xanax	alprazolam	used for the management of anxiety disorders or short-term symptomatic relief for excessive anxiety and/or panic attacks
Zantac	ranitidine	ulcer, acid suppressor
Xifaxan	rifaximin	antibiotic being studied to reduce symptoms of IBS.
Zelnorm (Zelmac)	tegaserod	treatment of IBS-C abdominal pain, bloating, discomfort and constipation and/or chronic idiopathic constipation. (Effective April 2, 2008 Zelnorm is only available to patients in the U.S. under emergency situations.)
Zofran	ondansetron hydrochloride	primarily used for the management of oncology related nausea and vomiting. Not effective in preventing motion-induced nausea and vomiting. Used for abdominal pain and diarrhea similiar to Lotronex.
Zoloft	sertaline	antidepressant

© IBS Self Help and Support Group - http://www.ibsgroup.org

Legend:
Requires a physician's prescription
Requires a physician's prescription in some locations
Withdrawn from market
Investigational drug

Last updated April 29, 2008