IBS is irritable bowel syndrome characterized by abdominal discomfort and pain, altered bowel habits, resulting in constipation, diarrhea, or both. While there are various therapies used to manage IBS, there are some medicines too, that can help.
IBS or irritable bowel syndrome is one of the commonest gastrointestinal disorders. Knowing the list of medications that can help treat IBS can help to manage the condition better, with medical advice.
Almost 12 percent of patients visit primary health care for IBS related symptoms.1 Studies show that IBS is the most prevalent in South America at about 21 percent and least at 7 percent in Southeast Asia.1 It is reported that almost 76.6% of people suffering from IBS in the US are undiagnosed.2 However, as IBS greatly affects a person’s health and wellness, it is important to get diagnosed for the condition and begin with the right treatment. There are various treatment options, hence a list of medication that can treat IBS can improve your understanding and help you seek timely medical advice,
List of Medications That Can Help Treat IBS
Some studies show that visceral pain is a leading symptom in patients with IBS and the conventional drug treatments for IBS are not satisfactory.3 Studies based on the pharmacotherapy for IBS report that there is an unmet need for an effective treatment for IBS, particularly the pain part of the IBS symptoms.4 However, the present list of medications, including those newly approved can help treat IBS as they are directed at secretion, motility, and non-absorbable antibiotics offer promising results.
IBS is a symptom-based disorder, hence the treatment goals are mainly aimed at resolving the symptoms like diarrhea, constipation, pain, bloating, cramping.1 Based on the predominance of symptoms, IBS can be classified into three subtypes
- IBS diarrhea-predominant (IBS-D) – abdominal discomfort, pain, loose stool, frequent and urgent bowel movement
- IBS constipation-predominant (IBS-C) – stomach pain and discomfort, bloating, hard, lumpy stool and delayed or infrequent bowel movement
- IBS mixed-symptoms (IBS-M) – This being a mixed type, shows constipation-predominant symptoms for some period, followed by diarrhea-predominant symptoms
In the USA, IBS-M is the most prevalent subtype (44%), followed by IBS-C (28%), and IBS-D (26%).5 The medications that can help treat IBS are also listed based on these types. Some of the commonly used medicines include anti-diarrheal, laxatives, probiotics, antispasmodics, antidepressants, and newer drugs that act on opioid receptors.
Let us look at the complete list of medications that can help treat IBS, based on the types.
Medications That Help Treat IBS–D6 or IBS With Diarrhea
The symptoms of IBS-D may be related to an imbalance of gut flora, excessive stress, certain food items, or other factors. The treatment aims to reduce these symptoms and considering the possible underlying causative factors.
Some of the common medications that can help treat IBS-D include the following,
- Rifaximin (xifaxan) – This is an antibiotic to fight bacterial infection in the intestines. It directly acts on the gut and does not affect the other parts. It can help to decrease bacterial overgrowth in the gut and relieves loose stool.
- Eluxadoline (viberzi) – This prescription drug is useful to treat IBS-D, as it directly acts on the gut. It helps reduce the increased sensitivity of the gut, reduces muscle contraction and fluid intestine, also increasing the muscle tone of the rectum.7 It helps to relieve the symptoms of diarrhea and abdominal pain.
- Alosetron (Lotronex) – This drug is used to manage severe IBS, particularly in women, only if found necessary by the physician. It helps relax the colon and slow the bowel movements.
- Loperamide (Imodium/gastro-stop) – This is an antidiarrheal used to reduce the frequency of loose motions. It helps to slow down the digestion process and promotes better absorption of nutrients and fluid, thus also relieving symptoms of diarrhea.
- Atropine (Lomotil) – This too is an antidiarrheal drug for short term use. It slows down the colon motility and improves absorption, thus making the stool firmer and relieves diarrhea.
- Bismuth Subsalicylate (Kaopectate, Pepto-Bismol) – It is a known medicine to reduce bowel movements and ease loose motions, but it does not relieve any other symptoms of IBS.
- Calcium Supplements – As calcium is involved in several bodily processes, like muscle movement, nerve cell coordination, and fluid secretion, calcium supplements are considered helping in treating IBS.
Medications That Help Treat IBS–C6 or IBS with Constipation
For IBS with predominant constipation, diet and lifestyle measures are advised in addition to medications. Here is the list of medications that can help treat IBS of predominant constipation type.
- Lubiprostone (amitiza) – These are chloride channel activators that increase the secretion of fluid in the gut, to make it easy for the stool to pass.
- Linaclotide (linzess) – This medicine increases chloride and water secretion, thus stimulating bowel movements and relieves constipation in IBS-C.
- Ispaghula Husk (Fybogel, Ispagel) – This is a bulk-forming laxative used to treat constipation in IBS-C.
- Psyllium Husk (Equate, Konsyl, Metamucil) – This is a kind of fiber made out of the husk of Plantago ovata seeds. It swells in water and makes bowel movements easy by increasing the roughage.
- Laxatives – If fiber does not help, laxatives may be given. These substances are used as medicines to loosen stool and improve bowel movements. Some commonly used laxatives are magnesium hydroxide oral or Milk of Magnesia or polyethylene glycol (Miralax).
Other Medications That Can Help Treat IBS
Apart from these, some medications can help treat IBS of all types. These include antidepressants like
- Tricyclic Antidepressants – These include amitriptyline (Elavil), Nortriptyline, imipramine These medicines help reduce stomach pain by inhibiting the activity of nerves. This is particularly useful in people having depression, while those without it may be given this medicine in smaller doses.
- SSRIs (Selective Serotonin Reuptake Inhibitors) – These include citalopram, fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft). These medicines are useful to reduce symptoms of pain and constipation in IBS, mostly used in moderate to severe depression
- SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) – The medicines fluoxetine (Prozac, Sarafem), or paroxetine (Paxil). These medicines help to treat depression associated with IBS, as they help to improve communication between the brain cells. These may be used only if needed, more for treating IBS-D.
- Pain Medications ¬– In some cases, medications like Pregabalin (Lyrica) or gabapentin (Neurontin) may be prescribed to ease severe pain and bloating.
Some studies have confirmed that some conventional pain managing drugs are not very effective to treat IBS NSAIDs, acetaminophen, aspirin, and narcotics.3
We have discussed the list of medications that can help to treat IBS. These include,
- Anxiolytic and antidepressant drugs like Benzodiazepines, TCAs, SSRI, and SNRI can help reduce pain.
- Clonidine, gabapentin, and pregabalin can moderately improve IBS symptoms.
- Lubiprostone helps relieve constipation, hence useful in treating IBS-C
- Loperamide helps improve diarrhea, so useful in treating IBS-D.
- Alosetron (used with caution as it shows cardiovascular toxicity), granisetron and ondansetron can be used to treat pain in IBS-D.
- Eluxadoline can be used to minimize symptoms and pain in IBS-D and linaclotide for IBS-C type, as they both target the peripheral GI tract.
To decide the most appropriate treatment plan for IBS, it is important to consult your physician. For some, the best approach is planned by a gastroenterologist and a nutritionist, working with a combination of medications and diet. Depending on the type of IBS and the relevant symptoms, your doctor can tailor the treatment plan with the use of the most appropriate medications that can help treat IBS. Also, as many patients associate their symptoms with food intake, it is essential to have a proper dietary recommendation for the patients, from a nutritionist.
The list of medications that can help treat IBS is exhaustive and there are a variety of options, depending on the type of IBS. In addition to medical treatment, dietary changes, lifestyle modifications, and alternative therapies may also be advised. But the right choice of medications varies from person to person, which is best planned by your physician. So talk to your physician and plan.
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