Day 6 - Living

Trying Prescription Drugs for Irritable Bowel Syndrome

Remember that while there are a number of different prescription medications available for IBS, their effectiveness does vary greatly from one person to another.

What particular drug (if any) will work best for you is something you'll most likely have to determine through trial and error. If the first medication you try doesn't help much, keep in mind that there are other options available.

You should work in partnership with your doctor to determine which medication best fits your needs.

Medications for IBS

Medication Class	Examples	Principal indication	Side Effects and Comments
Antispasmodics	Donnatol (belladonna/phenobarbital) Bentyl (Dicyclomine hydrochloride), Levsin/Levbid (Hyoscyamine sulfate)	Pain and diarrhea	Dry mouth and eyes, urinary retention, tachycardia, drowsiness. Can be mildly constipating.
Antidiarrheals	Immodium, Kaopectate, and Maalox (all Loperamide); diphenoxylate/atropine (and diphenoxylate/atropine sulfate), Pepto Bismol (bismuth subsalicylate)	Diarrhea, urgency, incontinence	Considerable variation in required dose; can induce constipation, drowsiness and/or dizziness.
Tranquilizer/anti-spasmodic	Librax (Chlordiazepoxide hydrochloride, Clidinium bromide)	Pain, diarrhea	Blurred vision, drowsiness, can be habit-forming.
Tricyclic antidepressants	Secondary amines (e.g., nortriptyline, desipramine)	Pain, diarrhea, other discomforts	Fewer CNS and anticholinergic side effects and less sedation, orthostatic hypotension & weight gain with secondary amines; start low and work up to target dosage. Constipation can worsen.
Tricyclic antidepressants	Tertiary amines (e.g., amitriptyline, imipramine)	Pain, diarrhea, other discomforts
Narcotic Analgesics	Vicodin (Hydrocodone), Percodan and Percocet (Oxycodone), Demerol (Meperidine), Codeine, Morphine.	Pain, diarrhea	Drowsiness, dizziness, constipation, nausea. Can be habit-forming. Possible dangerous interactions with other prescription and over-the-counter drugs, and alcohol.
Newer antidepressants	SSRIs (e.g., fluoxetine, paroxetine)	Can be used for pain management and constipation in patients who are intolerant to TCAs	Transient exacerbation of nausea; diarrhea can occur with SSRIs; sleep disruption occurs with some agents
Newer antidepressants	Others (e.g., buproprion, venlafaxine)
5-HT3 antagonist	Alosetron (LOTRONEX)	Affects multiple symptoms in diarrhea-predominant female patients only, including pain, urgency, and diarrhea.	May cause severe constipation and ischemic colitis. Effectiveness has not been shown in men. Lotronex was withdrawn from the U.S. market November 2000 then reintroduced under stringent prescribing guidelines.
5-HT4 antagonist	Tegaserod (ZELNORM)	Pain and constipation in constipation- predominant female patients	Approved for short-term use only. Approved for women only. May cause diarrhea, bloating, pain.
Under Investigation	Cilansetron	5-HT3 antagonist	Under investigation by Solvay Pharmaceutical for chronic diarrhea
	Prucalopride	5-HT4 receptor	Under investigation by Janssen Research Foundation for chronic constipation

Continue reading First Year: IBS.

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