Irritable Bowel Syndrome Self Help and Support Group
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Irritable Bowel Syndrome (IBS) Medications and Drugs

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. FDA Drug Safety Information for Patients and Health Care Professionals.

Diarrhea

EnteraGam™ is a medical food prescribed to help people manage their IBS-D. Medical foods provide specific nutrients needed to manage ongoing problems with loose or frequent stools (diarrhea). In a study, patients with IBS who had loose or frequent stools were given EnteraGam™ and asked to keep a diary of their symptoms. The study showed that patients who took EnteraGamhad fewer days with: 

  • Loose stools
  • Abdominal pain (pain in the bowel or belly)
  • Bloating (a feeling of fullness in the belly)
  • Flatulence (gas)
  • Urgency (sudden need to have a bowel movement)

LOTRONEX® is a medicine only for some women with severe chronic IBS whose main problem is diarrhea and IBS symptoms have not been helped enough by other treatments. Some patients have developed serious bowel side effects while taking LOTRONEX.

LOTRONEX may be right for you if all of these things are true about you:

  • Your doctor has told you that your symptoms are due to IBS.
  • Your IBS bowel problem is diarrhea.
  • Your IBS has lasted for 6 months or longer.
  • You tried other IBS treatments and they didn't give you the relief you need.
  • Your IBS is severe.

You MUST do 3 things if you are going to take LOTRONEX (From the FDA Medication Guide):

1) Understand that LOTRONEX has serious risks.
2) Sign a Patient-Physician Agreement with your doctor.
3) Follow the directions in the FDA Medication Guide.

If you cannot follow ALL of these, you should not take LOTRONEX. A Co-pay Assistance Savings Program for LOTRONEX® exists from the pharmaceutical.

Constipation

LINZESS® (linaclotide), CONSTELLA® in Canada and Europe, is a new prescription medicine approved by the FDA to treat adults with IBS-C and Chronic Idiopathic Constipation in men and women 18 years of age and older.  “Idiopathic” simply means the cause of the constipation is not known and not due to an underlying illness or medication.

LINZESS or CONSTELLA is not for everyone.  If you know you have a bowel obstruction, do not take LINZESS or CONSTELLA.

AMITIZA® is a prescription medicine approved by the FDA to treat adults with IBS-C and Chronic Idiopathic Constipation in women 18 years of age and older.

AMITIZA is not for everyone. If you know you have a bowel obstruction, do not take AMITIZA.

ZELNORM is no longer approved for IBS-C or chronic constipation. In the U.S. access may be available under a special FDA emergency program. More information on this protocol can be found here.

Resotran was approved for Chronic Idiopathic Constipation in women in Canada.

Antidepressants, Antispasmodics and Antidiarrheals

Although antidepressants were developed to treat depression, research studies have shown that they can also be effective in reducing pain. Antidepressants are, therefore, effective in treating symptoms of IBS and other functional GI disorders. Patients who have taken antidepressants for their IBS symptoms have reported significant improvement in their abdominal pain and reduction in other IBS symptoms, such as diarrhea, constipation, bloating, nausea or urgency. Patients who have been taking antidepressants should be aware of the possibility of developing Antidepressant Discontinuation Syndrome, or SSRI Discontinuation Syndrome, upon rapid stopping or tapering the use of antidepressants.

Antispasmodics and Antidiarrheals are helpful in reducing periodic painful episodes of spasms and diarrhea respectively.

Antibiotics

While the cause of irritable bowel syndrome is uncertain, there is some research evidence suggesting that IBS symptoms may be caused in part by an abnormal growth of bacteria in the small intestine, referred to as Small Intestinal Bacterial Overgrowth (SIBO). A specific regiment of antibiotics, namely Rifaximin, have been investigated to treat this condition.

Medical Foods

Medical foods are regulated by the FDA under the Orphan Drug Act, specially formulated to be consumed or administered orally or enterally; to be used under physician supervision (e.g. by prescription) as part of ongoing care to endure proper, safe use; specifically for management of distinctive nutrient needs, resulting from a specific chronic condition or disease; and specially formulated and processed, as results are not achievable by normal dietary intake.

Probiotics

Probiotics are dietary supplements which contain beneficial or friendly bacteria or yeasts which may strengthen or exert health benefits to the body’s natural digestive system. Probiotics offer a way to restore the natural balance of your digestive system especially if you suffer from anyone of constipation, diarrhea, abdominal discomfort, urgency or gas and bloating. Numerous research studies have shown benefits for sufferers of Irritable Bowel Syndrome and Inflammatory Bowel Disease (Crohn’s and Ulcerative Colitis). Probiotics which contain the strain bifidobacterium infantis 35624 have been shown to relieve abdominal pain, bloating, urgency, constipation or diarrhea.

 

Source:
Lotronex.com
Amitiza.com
Aligngi.com
Mark Pimentel MD, Annals of Internal Medicine vol. 145 no. 8 557-563

 

Medication class, dosage and principal indication adapted from American Digestive Health Foundation:

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
Dicyclomine 10 - 20 mg ac&hs
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
Tertiary
amines
(e.g., amitriptyline,
imipramine)
25 - 125 mg daily (usually at hs)
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
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
Chloride channel activator Lubiprostone 8 mg bid Pain,
constipation in constipation-
predominant female patients
May experience nausea or diarrhea

Source: American Digestive Health Foundation©

Brand medications, active ingredient and indication compiled by IBS Self Help and Support Group:

Brand Name Active Ingredient Indication
Alflorex bifidobacterium infantis 35624 probiotic that delivers "good" bacteria to your digestive system to relieve abdominal pain, bloating, urgency, constipation or diarrhea.
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)
Constella linaclotide IBS-C and chronic constipation (CC) (Canada & Europe)
Culturelle   Lactobacillus GG probiotics
Desipramine desipramine antidepressant - anticholinergic - lessen gut activity and secretions
Digestive Advantage IBS BC30 (Bacillus coagulans GBI-30, 6086) probitotic probiotic which helps to provide relief of IBS symptoms.
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
EnteraGam serum-derived bovine immunoglobulin/protein isolate medical food for chronic loose or frequent stools (IBS-D)
Equalactin calcium polycarbophil helps equalize the water balance in the intestines to relieve diarrhea
FiberChoice fructan chewable fiber supplement
Florastor saccharomyces boulardii yeast probiotic which normalizes intestinal flora; relieves diarrhea
Ibsacol   patented fatty acid ester compound specifically formulated for IBS and associated symptoms
Imodium loperamide anti-diarrhea - mild
Konsyl psyllium fiber Psyllium fiber is helpful to conditions such as constipation, diarrhea, hemorrhoids, diverticular disease
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
Linzess linaclotide IBS-C and chronic constipation (CC) (United States)
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
Resotran prucalopride treatment of chronic idiopathic constipation (Available in Canada)
Rifaximin xifaxan nonabsorbed oral antibiotic for travellers diarrhea
Saccharomyces Boulardii yeast probiotic normalizes intestinal flora; relieves diarrhea
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

Source: 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