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Medications for Irritable Bowel Syndrome

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Since there is no known cause of IBS , medicines are used to treat specific symptoms. There are several types of medicines that are thought by some doctors to be helpful. But, not all of the medicines listed below are of proven value in treating symptoms of IBS. In some cases, your doctor may recommend that you take a combination of medicines.

Prescription Medications

  • Hyoscyamine (such as Anaspaz, HyoMax)
  • Cimetropium
  • Dicyclomine (Bentyl)
  • Loperamide (such as Imodium A-D)
  • Amitriptyline (Elavil, Endep)
  • Paroxetine (Paxil)
  • Domperidone (Motilium)
  • Cisapride (Propulsid)
  • Metoclopramide (Reglan)
  • Alosetron (Lotronex)
  • Diazepam (Valium)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Rifaximin
  • Lubiprostone

Prescription Medications

Antispasmodics
Common names include:
  • Hyoscyamine (such as Anaspaz, HyoMax)
  • Cimetropium
  • Dicyclomine (Bentyl)
These medicines may quiet the digestive system and reduce painful bowel spasms. When taken in reasonable doses, side effects are generally mild.
Possible side effects include:
  • Dry mouth
  • Nausea
  • Dizziness
  • Vomiting
  • Changes in heart rate
  • Urinary retention
  • Visual problems
  • Sexual problems
  • Sleepiness
  • Confusion
  • Itching
  • Rash
Antidiarrheals
Common names include: loperamide (such as Imodium A-D)
These medicines are relatives of morphine but much less addicting.
Possible side effects include:
  • Dry mouth
  • Nausea and vomiting
  • Allergic reactions
  • Sleepiness
  • Confusion
  • Lightheadedness
  • Dizziness
  • Euphoria
  • Drowsiness
Antidepressants
Common names include:
  • Amitriptyline (Elavil, Endep)
  • Paroxetine (Paxil)
Depression is a common symptom in people with IBS. Some of these drugs may have antispasmodic effects.
Possible side effects include:
  • Dry mouth
  • Nausea
  • Dizziness
  • Sleep disruption
  • Diarrhea
  • Drowsiness
  • Anxiety
  • Weight loss or weight gain
  • Impaired sexual function
Prokinetic Agents
Common names include:
  • Domperidone (Motilium)
  • Cisapride (Propulsid)
  • Metoclopramide (Reglan)
Cisapride, a drug used to increase bowel motility, has been removed from the US market. But, it may still be prescribed in special cases.
Possible side effects of domperidone and metoclopramide include:
  • Headache
  • Dry mouth
  • Stomach ache
  • Diarrhea
  • Restlessness
  • Sleep disruption
5-hydroxytryptamine (5-HT) Antagonists and Agonist
Common name includes: alosetron (Lotronex)
Alosetron may be prescribed to treat diarrhea, as well as general IBS symptoms, such as abdominal pain.
Possible side effects include:
  • Severe constipation
  • Nausea and vomiting
  • Stomach pain
Anti-Anxiety Medications
Common names include:
  • Diazepam (Valium)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
These medicines may be prescribed to reduce anxiety associated with IBS.
Possible side effects include:
  • Drowsiness
  • Confusion
  • Impaired memory
  • Heart rate changes
  • Sleepiness
  • Constipation
  • Diarrhea
  • Rashes
  • Dry mouth
Antibiotics
Common names include: rifaximin
In some cases, antibiotics are recommended to treat IBS symptoms, such as bloating and diarrhea.
  • Lubiprostone
Lubiprostone may be useful in managing IBS when constipation is the primary symptom and fiber is unsuccessful.
Possible side effects include:
  • Nausea and vomiting
  • Headache
  • Stomach ache
  • Heartburn
  • Diarrhea

Over-the-Counter Medications

Fiber Supplements
Common names include:
  • Psyllium
  • Bran
  • Polycarbophil
  • Methylcellulose
Dietary fiber is the undigestible part of plants considered important in the optimal functioning of the digestive tract. Initially, fiber supplements may cause bloating and gas, which usually subside within a few weeks. Increase your fiber intake gradually. Drink plenty of water as you increase your fiber to promote regularity. Bran may be less effective than psyllium or other “soluble” fibers.
Possible side effects include:
  • Bloating
  • Flatulence
Antidiarrheals
Common names include:
  • Loperamide
  • Lomotil
  • Bismuth subsalicylate (Pepto-Bismol)
Loperamide can cause constipation. Bismuth subsalicylate soothes the digestive tract without producing constipation.
Antiflatulents
Common name includes: simethicone
This drug breaks up bubbles in the stomach to make it easier for gas to exit upward, before it gets into the intestines.
Probiotics
Probiotics are "friendly" bacteria such as acidophilus, which is found in yogurt. Probiotics may help improve abdominal pain and other symptoms of IBS. These bacteria can also be bought as a supplement. Talk to your doctor if you are interested in adding probiotics to your diet.
Pain Relievers
Common names include: acetaminophen (Tylenol)
Acetaminophen may relieve abdominal pain.

When to Contact Your Doctor

  • If the medicine is not working
  • If you are getting worse
  • If you are having new symptoms

Special Considerations

If you are taking medicines, follow these general guidelines:
  • Take your medicine as directed. Do not change the amount or schedule.
  • Know what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking the medicine.
  • Plan ahead for refills if you need them.
  • Do not share your medicine with anyone.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

References

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Drug Facts and Comparisons . 56th ed. St. Louis, MO: Facts and Comparisons; 2001.

Fauci AS, Braunwald E, et al. Harrison's Principles of Internal Medicine . 14th ed. New York, NY: The McGraw-Hill Companies; 2000.

FDA's MedWatch safety alerts: March 2009. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm142815.htm . Published March 23, 2009. Accessed August 4, 2009.

International Foundation for Functional Gastrointestinal Disorders, Inc. website. Available at: http://www.iffgd.org . Accessed March 3, 2006.

Irritable Bowel Syndrome Self-help and Support Group website. Available at: http://www.ibsgroup.org . Accessed March 3, 2006.

Lexi-PALS. Alosetron. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary . Updated June 28, 2010. Accessed September 12, 2011.

Lexi-PALS. Cisapride. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary . Updated May 25, 2010. Accessed September 12, 2011.

Lexi-PALS. Domperidone. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary . Updated October 10, 2010. Accessed September 12, 2011.

Lexi-PALS. Lubiprostone. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary . Updated June 28, 2010. Accessed September 12, 2011.

Moeser A, Nighot PK, et al. Recovery of mucosal barrier function in ischemic porcine ileum and colon is stimulated by a novel agonist of the ClC-2 chloride channel, lubiprostone. Am J Physiol Gastrointest Liver Physiol . 2007;292(2):G647-656.

Pimentel M, Park S, et al. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 2006;145(8):557-563.

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