Irritable Bowel Syndrome (cont.)

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Antispasmodic medicines, such as dicyclomine (Bemote, Bentyl, Di-Spaz) and hyoscyamine (Levsin, Levbid, NuLev), are sometimes used to treat symptoms of irritable bowel syndrome. Antispasmodic medicines help slow the movements of the digestive tract and reduce the chance of spasms. They may have side effects and are not for everyone. Other treatment plans are available, depending on the symptoms and condition.

Antidiarrheal medicines, such as loperamide (Imodium), a kaolin/pectin preparation (Kaopectate), and diphenoxylate/atropine (Lomotil), are sometimes used when diarrhea is a major feature of IBS. Do not take these on a long-term basis without first consulting a doctor.

Antidepressants may be very effective in smaller doses than those typically used to treat depression. Imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are some commonly used medicines that may alleviate irritable bowel syndrome symptoms. Some other antidepressants are more commonly prescribed when depression and IBS coexist.

The following medications are typically reserved for patients with symptoms that do not improve with the previously mentioned treatments:

• Alosetron (Lotronex) is a restricted drug approved only for short-term treatment of women with severe, chronic, diarrhea-predominant IBS (IBS-D) who have failed to respond to conventional IBS therapy. Fewer than 5% of people with irritable bowel syndrome have the severe form, and only a fraction of people with severe IBS have the diarrhea-predominant type. Alosetron was removed from the United States market but was reintroduced with new restrictions approved by the FDA in 2002. Physicians must be registered with the pharmaceutical manufacturer in order to prescribe the medication. Serious and unpredictable gastrointestinal side effects (including some that resulted in death) were reported in association with its use following its original approval. The safety and efficacy of alosetron has not been sufficiently studied in men; therefore, the FDA has not approved the drug for treatment of IBS in men.
• Rifaximin (Xifaxan) is an antibiotic medication for IBS-D that works by reducing or altering gut bacteria, and it can improve symptoms of bloating and diarrhea after a 10 to 14 day course of treatment. Some patients require retreatment at higher doses for symptom relief.
• Eluxadoline (Viberzi) is another newer medication for IBS-D that helps reduce abdominal pain and improves stool consistency in adults.
• Linaclotide (Linzess) is a kind of drug that relieves constipation and pain for some adults with irritable bowel syndrome (IBS). In drug trials, people with IBS with constipation (a subtype of IBS called IBS-C) had more frequent and better bowel movements and less abdominal pain after taking daily doses of Linzess. The drug often began working within the first few days of treatment.
• Lubiprostone (Amitiza) is a type of laxative used to treat severe irritable bowel syndrome with constipation (IBS-C) in women who are at least 18 years of age. It is a capsule taken orally, twice a day with food. It is used to relieve stomach pain, bloating, and straining; and produce softer and more frequent bowel movements in people who have chronic idiopathic constipation.
• Tegaserod (Zelnorm) was a medication used to treat IBS but was removed from the market in 2008 due to increased risk of heart attack, stroke, and ischemic colitis.

New medications for IBS-D are also being developed or are in clinical trials. Those that are most promising include:

• Serotonin synthesis inhibitors may help reduce pain and improve stool consistency
• Ramosetron, similar to alosetron (Lotronex). This is reported to relieve symptoms with less constipation.
• Spherical carbon adsorbent offers short-term relief from pain and bloating, but no improvement in stool consistency.
• Benzodiazepine receptor modulator (dextofisopam) has the potential to reduce colonic motility and gut sensitivity reactions in response to stress.
• Peripheral k-agonist (asimadoline, a kappa-opioid agonist) is in clinical trials and it shows reduced pain, urgency and stool frequency.

Irritable bowel syndrome may initially be diagnosed by your primary care provider such as your family doctor, internist, or family medicine specialist. A gastroenterologist (a doctor who specializes in disorders of the digestive system) usually will provide further treatment. An emergency medicine specialist may be seen if you have an acute flare-up of IBS symptoms and go to a hospital emergency room.

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