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Food and Nutrition

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

Antispasmodics

Hyoscyamine (such as Anaspaz, HyoMax)
Cimetropium
Dicyclomine (Bentyl)

Antidiarrheals

Loperamide (such as Imodium A-D)

Antidepressants

Amitriptyline (Elavil, Endep)
Paroxetine (Paxil)

Prokinetic Agents

Domperidone (Motilium)
Cisapride (Propulsid)
Metoclopramide (Reglan)

5-hydroxytryptamine (5-HT) Antagonists and Agonists

Alosetron (Lotronex)

Anti-anxiety Medication

Diazepam (Valium)
Alprazolam (Xanax)
Lorazepam (Ativan)

Antibiotics

Rifaximin

Miscellaneous Medications

Lubiprostone

Over-the-Counter Medications

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.

Miscellaneous Medications

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:

Chang HY, Kelly EC, et al. Current gut-directed therapies for irritable bowel syndrome. Curr Treat Options Gastroenterol. 2006;9(4):314-323.

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: . Published March 23, 2009. Accessed August 4, 2009.

International Foundation for Functional Gastrointestinal Disorders, Inc. website. Available at: . Accessed March 3, 2006.

Irritable Bowel Syndrome Self-help and Support Group website. Available at: . Accessed March 3, 2006.

Lexi-PALS. Alosetron. EBSCO Health Library, Lexi-PALS website. Available at: . Updated June 28, 2010. Accessed September 12, 2011.

Lexi-PALS. Cisapride. EBSCO Health Library, Lexi-PALS website. Available at: . Updated May 25, 2010. Accessed September 12, 2011.

Lexi-PALS. Domperidone. EBSCO Health Library, Lexi-PALS website. Available at: . Updated October 10, 2010. Accessed September 12, 2011.

Lexi-PALS. Lubiprostone. EBSCO Health Library, Lexi-PALS website. Available at: . 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.

Spasmonal. EPG Online website. Available at: . Updated June 2010. Accessed January 11, 2010.

9/26/2006 DynaMed's Systematic Literature Surveillance : Mueller-Lissner S, Tytgat GN, Paulo LG, Quigley EM, Bubeck J, Peil H, et al. Placebo- and paracetamol-controlled study on the efficacy and tolerability of hyoscine butylbromide in the treatment of patients with recurrent crampy abdominal pain. Aliment Pharmacol Ther. 2006;23(12):1741-1748.

4/10/2007 DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. FDA announces discontinued marketing of GI drug, Zelnorm, for safety reasons [press release]. March 30, 2007. US Food and Drug Administration website. Available at:

9/18/2009 DynaMed's Systematic Literature Surveillance : Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154.

11/4/2009 DynaMed Systematic Literature Surveillance : Ford AC, Brandt LJ, Young C, Chey WD, Foxx-Orenstein AE, Moayyedi P. Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2009;104(7):1831-1843.

1/11/2010 DynaMed's Systematic Literature Surveillance : Wittmann T, Paradowski L, Ducrotté P, Bueno L, Andro Delestrain MC. Clinical trial: efficacy of alverine citrate/simethicone combination on abdominal pain/discomfort in irritable bowel syndrome: results of a randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2009 Dec 10. [Epub ahead of print]

4/30/2010 DynaMed's Systematic Literature Surveillance : Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3):325-332.

2/18/2011 DynaMed's Systematic Literature Surveillance : Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry 2010;71(10):1259-1272.

Last reviewed October 2012 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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