2015-06-30 17:26:52 UTC

IBS 107: Understanding Drugs to Treat IBS

Learn more about the drugs to treat IBS in this patient companion, based on the AGA Clinical Guideline "Pharmacological Management of Irritable Bowel Syndrome."

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: Pharmacological Management of Irritable Bowel Syndrome

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

Contents:

IBS Overview

IBS Treatment Options

Drug Options for Treating IBS with Constipation (IBS-C)

Drug Options for Treating IBS with Diarrhea (IBS-D)

Drug Options for Treating General IBS

 


IBS Overview

  • Some people with IBS have constipation (hard or infrequent bowel movements), known as IBS-C.
  • Others have diarrhea (frequent loose stools, often with an urgent need to move the bowels), known as IBS-D.
  • Some people have both, known as IBS-M (mixed).
  • IBS affects more than just your health. People with uncontrolled IBS tend to have a lower quality of life, are less productive at work, and spend more time and money going to see the doctor. Learn more about IBS here.
  • Work with your gastroenterologist to find the treatment that’s best for you. To find a GI in your area, use AGA’s GI Locator.

IBS Treatment Options

  • There are many drug treatments for patients with IBS.
  • The drugs work in different ways, and differ in terms of cost and possible side effects.

This tool has been built to help you make informed decisions with your doctor about which treatment options may be best for you.

Key

  Green = Positive effect has been confirmed in literature 
Red = Adverse effect has been confirmed in the literature
Yellow = Effect may exist, but has not been confirmed in the literature
Dash = No effect exists

Drug Options for Treating IBS with Constipation (IBS-C)

Individuals with IBS-C often feel like they are not able to complete a bowel movement, and pass hard, lumpy stools at least 25 percent of the time.

  Linaclotide Lubiprostone Polyethylene Glycol (PEG) Laxatives
Lessens belly pain
Increases number of complete bowel movements
Improves general IBS-C symptoms
Improves quality of life
Cost  Higher cost Higher cost Lower-cost option
May cause diarrhea
Quality of scientic evidence High Moderate Low. More research is needed.
Notes

One of the most effective drugs for IBS-C. It may cause diarrhea, but it is mild to moderate in most patients.

It may take up to 12 weeks for abdominal pain to get better.

Has been shown to effectively treat IBS-C and most patients report very few side effects.

Safe and low cost, but it is uncertain whether they are effective in improving all symptoms tied to IBS.

Patients may get more benefit in using PEG laxatives in combination with another drug.

Drug Options for Treating IBS with Diarrhea (IBS-D)

Individuals with IBS-D have powerful, frequent urges to use the bathroom that disrupt daily life, and they often pass mushy, watery stools at least 25 percent of the time.

  Rifaximin Alosetron Loperamide
Lessens belly pain
Lessens bloating (swelling) and discomfort
Decreases watery stool
Improves general IBS-D symptoms
Improves quality of life
Cost Higher cost Lower-cost option
May cause constipation
May cause dangerous (unsafe) side effects in some patients
Quality of scientific evidence Moderate Moderate Very low. More rearch is needed.
Notes

May work better in women and older adults.

The effectiveness of rifaximin may decrease over time, so multiple rounds of treatment may be necessary.

Only female patients with severe IBS-D should consider taking alosetron. This drug can cause serious side effects in rare cases, so patients must be carefully monitored while taking it. Loperamide is safe and low cost. It may provide the most benefit when used in combination with another drug.

Drug Options for Treating General IBS

  TCAs Anti-spasmodics
Lessens belly pain
Lessens bloating (swelling) and discomfort
Improves general IBS symptoms
Improves quality of life
Cost  Lower-cost option Lower-cost option
May cause constipation
May cause dangerous side effects in some paitents
Quality of scientific evidence Low. More research is needed. Low. More research is needed.
Notes

Tri-cyclic antidepressants (TCAs) are a low-cost way to treat IBS. They may also help improve a patient’s mental well-being.

Patients with certain heart problems should avoid taking TCAs. Ask your doctor if you are at risk of serious side effects.

Anti-spasmodics can help improve some IBS symptoms with few side effects. However, not all of these drugs are available in the U.S.

 

 

Updated March 2016

©AGA, July 2016

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