Medications

• 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 action of the digestive tract and reduce the chance of spasms. However, they may have some side effects and thus are not for everyone. Other treatment plans are available, depending on 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 newer medications are typically reserved for patients with symptoms that do not improve with the above treatments:

• Tegaserod (Zelnorm) is used for the short-term treatment of women with irritable bowel syndrome when constipation is the main symptom. Tegaserod stimulates the digestive tract to maintain movement, decreasing the risk of developing constipation. The drug is taken twice daily 30 minutes before the morning and evening meal for 4-6 weeks. In individuals who respond, an additional 4-6 weeks of therapy may be considered. A doctor should be contacted immediately if new or sudden worsening of abdominal pain or diarrhea occurs. The safety and efficacy of tegaserod has not been sufficiently studied in men; therefore, the US Food and Drug Administration (FDA) has not approved the drug for treatment of IBS in men.
  
  
• Alosetron (Lotronex) is approved only for short-term treatment of women with severe, chronic, diarrhea-predominant IBS 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 on June 7, 2002. The drug is being restricted because serious and unpredictable gastrointestinal side effects (including some that resulted in death) were reported in association with its use following its original approval in February 2000. As with tegaserod, 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.

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