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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 EnteraGam® had fewer days with:
  • Loose stools
  • Abdominal discomfort (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.

VIBERZI® is a prescription medicine used to treat men and women adults who have irritable bowel syndrome with diarrhea (IBS-D).

Do not take VIBERZI if you:
  • Have or had a blockage in your gallbladder or a sphincter of Oddi problem
  • Have or had problems with alcohol abuse, alcohol addiction, or drink more than 3 alcoholic drinks a day
  • Have had inflammation of your pancreas (pancreatitis) or other pancreas problems, including if you have had or may have had a blockage in your pancreas
  • Have severe liver problems
  • Have had long-lasting (chronic) or severe constipation, or problems caused by constipation
  • Have or may have had a bowel blockage (intestinal obstruction)

XIFAXAN® is a prescription treatment that can help relieve the symptoms of irritable bowel syndrome with diarrhea (IBS-D), including abdominal pain and diarrhea. (Rifaximin the active ingredient, is marketed by the name Zaxine in Canada, Xifaxnta in the UK and Xifapill and Ciboz in India.)

With XIFAXAN, 2 weeks of treatment can provide 6 to 24 weeks of relief from IBS-D symptoms, with an average of 10 weeks of relief seen in clinical studies. Patients may be retreated up to 2 times if symptoms come back.


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. Those interested may contact FDA's Division for Drug Information about the emergency IND process.

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 Xifaxan (rifaximin), have been investigated and approved by the FDA to treat this IBS-D in the United States..


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
Viberzi.com
Xifaxan.com
Mark Pimentel MD, Annals of Internal Medicine vol. 145 no. 8 557-563


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
lubiprostoneindicated 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 antagonistunder investigation in Europe by Solvay Pharmaceutical for chronic diarrhea

Citrucel

methylcellulose
fiber bulking agent - smooth, non-gas forming

Colpermin
enteric coated peppermint oil capsulessymptomatic 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
desipramineantidepressant - 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 bromidespecifically for the treatment of IBS pain and intestinal discomfort (Not available in USA)

Donnatal
belladonna/phenobarbitalantispasmodic

Effexor
venlafaxineantidepressant

Elavil
amitriptylineantidepressant - anticholinergic - lessen gut activity and secretions

EnteraGam
serum-derived bovine immunoglobulin/protein isolatemedical food for chronic loose or frequent stools (IBS-D)

Equalactin
calcium polycarbophilhelps equalize the water balance in the intestines to relieve diarrhea

FiberChoice
fructanchewable fiber supplement

Florastor
saccharomyces boulardiiyeast probiotic which normalizes intestinal flora; relieves diarrhea

Ibsacol
lyproxeapatented fatty acid ester compound specifically formulated to improve the immune systems response to inflammation

Imodium
loperamideanti-diarrhea - mild

Konsyl
psyllium fiberPsyllium fiber is helpful to conditions such as constipation, diarrhea, hemorrhoids, diverticular disease

Kytril
granisetronprimarily used for the management of oncology related nausea and vomiting. Used for abdominal pain and diarrhea similiar to Lotronex.

Lactaid
lactasedairy digestive supplement that works to make dairy foods more digestible

Levbid/Levsin
hyoscyamine sulfateantispasmodic

Librax
clidinium bromidetranquillizer for gut

Linzess
linaclotideIBS-C and chronic constipation (CC) (United States)

Lomotil

diphenoxylate + atropine sulfate
Antidiarrheal, antiperistaltic

Lotronex
alosetronreduces 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 mucilloidhigh fiber bulking agent - smooth

Miralax
polyethylene glycol 3350laxative for occasional constipation

Modulon
trimebutine maleategastrointestinal tract regulator

Motilium
domperidone maleatehelps contractions and co-ordination of stomach and small intestine

Motofen
difenoxin hydrochloride with atropine sulfateAntidiarrheal, antiperistaltic

NuLev
hyoscyamine sulfateantispasmodic

Norpramin
desipramineantidepressant - anticholinergic - lessen gut activity and secretions

Pamine
methscopolamine bromideanticholinergic/antispasmodic

Paxil
paroxetineantidepressant

Pepto-Bismol
bismuth subsalicylaterelief of diarrhea, nausea, indigestion, heartburn and upset stomach

Prilosec
omeprazoleblocks the formation of acid in the stomach

Perdiem/Prodiem
psylliumhigh fiber bulking agent - semi-rough

Prepulsid/Propulsid
cisapridemoves 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
fluoxetineantidepressant

Psyllium

high fiber bulking agent - smooth

Questran
cholestyramineresin which absorbs and combines with the bile acids in the intestine to form an insoluble complex which is excreted in the feces

Remeron
mirtazapineantidepressant

Renzapride
5-HT4 agonist and a 5-HT3 -antagonistunder investigation by Alizyme for mixed IBS-C/D

Resotran
prucalopridetreatment of chronic idiopathic constipation (Available in Canada)

Saccharomyces Boulardii
yeast probioticnormalizes intestinal flora; relieves diarrhea

Sinequan
doxepinantidepressant - anticholinergic - lessen gut activity and secretions

Spasmonal
alverine citrateantispasmodic which relaxes the smooth muscle in the colon

Tagamet
cimetidineulcer, acid suppressor

Tofranil
imipramineantidepressant

Tums

antacid

Tylenol#1
acetaminophen w/codeinepain reliever - codeine is constipating

Viberzi
eluxadolineused to treat men and women adults who have irritable bowel syndrome with diarrhea (IBS-D).

VSL #3
lactic acid bacteriahigh-potency probiotic with 450 billion live bacteria

Xanax
alprazolamused for the management of anxiety disorders or short-term symptomatic relief for excessive anxiety and/or panic attacks

Xifaxan
rifaximinantibiotic used to reduce symptoms of IBS-D. (Rifaximin the active ingredient, is marketed by the name Zaxine in Canada, Xifaxnta in the UK and Xifapill and Ciboz in India.)

Zantac
ranitidineulcer, acid suppressor

Zelnorm (Zelmac)
tegaserodtreatment 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 hydrochlorideprimarily 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
sertalineantidepressant

Source: IBS Self Help and Support Group© - Irritable Bowel Syndrome and Digestive Health Support Forum

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


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

Medication ClassExamplesDosagePrincipal indicationComment
AntispasmodicsHyoscyamine0.125 - 0.25 mg ac&hs
Pain,
post-
prandial urgency
Xerostomia, urinary retention, tachycardia, and other anticholinergic side effects can be seen
Dicyclomine10 - 20 mg ac&hs
AntidiarrhealsLoperamide2 - 4 mg up to qidDiarrhea,
urgency, incontinence
Considerable variation in required dose; prophylactic use may reduce social anxiety; can induce constipation
Fiber supplementsPsyllium1 Tbs up to tidConstipationMay initially induce bloating and flatulence; gradually increase dose
Methylcellulose1 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 discomfortsFewer 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 antidepressantsSSRIs (e.g., fluoxetine, paroxetine)Usual psychiatric dosingTo 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 antagonistAlosetron1/2-1 mg bidPain,
urgency,
diarrhea in diarrhea-
predominant female patients
May induce constipation requiring separate management
5-HT4 antagonistTegaserod6 mg bidPain,
constipation in constipation-
predominant female patients
May initially induce diarrhea
Chloride channel activatorLubiprostone8 mg bidPain,
constipation in constipation-
predominant female patients
May experience nausea or diarrhea

Source: American Digestive Health Foundation©
 
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