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.
There is only a single medication that has been approved for diarrhea predominant IBS. 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:
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.
LINZESS® (linaclotide) 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 is not for everyone. If you know you have a bowel obstruction, do not take LINZESS.
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.
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.
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.
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.
|Medication Class||Examples||Dosage||Principal indication||Comment|
|Antispasmodics||Hyoscyamine||0.125 - 0.25 mg ac&hs||
|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||
|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|
|2 caplets (1250 mg) up to qid|
amines (e.g., nortriptyline,
|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|
|25 - 125 mg daily (usually at hs)|
|Newer antidepressants||SSRIs (e.g., fluoxetine, paroxetine)||Usual psychiatric dosing||
anxiety or depression;
can be used
management in patients who
fail or are
|Transient exacerbation of nausea; diarrhea can occur with SSRIs; sleep disruption occurs with some agents|
(e.g., buproprion, venlafaxine)
|Usual psychiatric dosing|
|5-HT3 antagonist||Alosetron||1/2-1 mg bid||
diarrhea in diarrhea-
predominant female patients
|May induce constipation requiring separate management|
|5-HT4 antagonist||Tegaserod||6 mg bid||
constipation in constipation-
predominant female patients
|May initially induce diarrhea|
|Chloride channel activator||Lubiprostone||8 mg bid||
constipation in constipation-
predominant female patients
|May experience nausea or diarrhea|
Source: 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|
|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 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)|
|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|
|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|
|Librax||clidinium bromide||tranquillizer for gut|
|Linzess||linaclotide||IBS-C and chronic constipation (CC)|
|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|
|Norpramin||desipramine||antidepressant - anticholinergic - lessen gut activity and secretions|
|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)|
|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|
|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|
|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.|
Source: IBS Self Help and Support Group© - http://www.ibsgroup.org
Requires a physician's prescription
Requires a physician's prescription in some locations
Withdrawn from market