Pharmacologic, or drug, therapy is best used in irritable bowel syndrome (IBS) patients with moderate to severe symptoms which do not respond to physician counseling and dietary manipulations.
What's a medication?
Anything you take for a therapeutic effect counts as a medicine. It can be readily available over-the-counter, in a pharmacy or grocery store, or limited by prescription only. It might be a drug or a supplement; manufactured or "natural." It might come in a pill, a liquid, or a food product. When you take something for a long-term therapeutic effect, tell your doctor about it. He or she can help you monitor quality, effectiveness, possible interactions with other medicines you may be taking, or possible side effects.
Remember, all medicines have potential side effects. Before taking any medication, whether over the counter or prescription, talk to your healthcare provider or pharmacist about dosage, other medicines you are taking, or any other questions you might have about the treatment. Otherwise, carefully follow the directions on the drug package or on your prescription label.
Medications for IBS
First line treatment has traditionally been aimed at treating the most bothersome symptom because of the lack of effective treatment for the overall improvement of multiple symptoms in IBS patients. However, new therapies for IBS have been recently introduced and have been shown to effectively treat multiple symptoms of IBS.
Laxatives – can help treat symptoms of constipation. Laxatives should be used under the supervision of a physician.
Bulking agents – provided they relieve and don’t worsen symptoms, can ease stool passage. Examples include bran or psyllium.
Anticholinergics/Antispasmodics – have limited benefit for treating IBS. In some persons they relieve abdominal pain or discomfort, usually if the symptoms occur soon after eating. Examples include dicyclomine (Bentyl), and hyoscyamine (Levsin).
Anti-diarrheal agents – can be effective in preventing and relieving symptoms of diarrhea. Examples include Loperamide (Imodium), and diphenoxylate and atropine (Lomotil)
Anti-anxiety medications – can be helpful for some people with IBS, mainly those with emotional distress.
There are also effective medications available that relieve the pain and improve the changes in bowel habit. They may need to be taken on a more long-term basis. These include low dose antidepressant agents or the relatively newer medications.
Antidepressants – The use of the antidepressant drug class in low doses for treatment of IBS symptoms is not linked to depression, but rather likely to effects on the brain and the gut. Antidepressant medications can reduce the intensity of pain signals going from gut to brain.
Newer IBS-Targeted Medications Available – There are other medications that are either under study, or have been shown to be effective in treating IBS in multi-center, high quality clinical trials. These are prescription medications intended for specific use under a doctor’s supervision.
The effectiveness of various agents differs between individuals. A medication regimen must be carefully chosen by the patient and his or her physician.
Individuals who have not responded to lifestyle changes and careful use of medications should consider being evaluated by a physician who specializes in motility or stress-related gastrointestinal disorders. More complex medication regimens, and specialized motility and/or psychological screening can reveal specific conditions which may respond to treatment.
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Adapted from IFFGD Publication #168 by Anthony J. Lembo, MD, Instructor of Medicine, Harvard Medical School; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA.
Last modified on February 23, 2015 at 12:18:55 PM