Treatment Options Involving Medication

, Jan Gunnar Hatlebakk1 and Trygve Hausken1



(1)
Clinical Medicine, University of Bergen, Bergen, Norway

 




Summary






  • Medications for irritable bowel syndrome (IBS) are symptoms-based, focusing on the main (i.e., most troubling) symptom for the patient.


  • Loperamide, which is an opiate-like medication, is effective against diarrhea.


  • Tricyclic antidepressants alter pain perception, but have strong side effects.


  • Selective serotonin-reuptake inhibitor antidepressants have global benefits without affecting bowel symptoms.


  • Bulking agents, and osmotic and emollient laxatives are effective against constipation.


  • Prucalopride, linaclotide, and lubiprostone are three new medications that are effective against constipation and reduce abdominal pain and distention.

Since the cause of IBS is not firmly established, treatment with medications is symptom-based, and focuses on the symptom that troubles the patient the most. Thus, medications designed to ameliorate abdominal pain and/or bloating, diarrhea, and constipation are the most commonly prescribed (Table 6.1).


Table 6.1
Medications available for the treatment of IBS































































Name
Dose
Effect
Type

Loperamide
2 mg with each loose stool, to a maximum of 16 mg/day
Reduces diarrhea
Opiate-like

Desipramide
10–150 mg at night
Reduces diarrhea, abdominal distension, and pain
Tricyclic antidepressants

Amitriptyline
10–150 mg at night
Improves well-being without benefit to bowel symptoms
Selective serotonin-reuptake inhibitors

Nortriptyline
10–150 mg at night
    

Paroxetine
20–50 mg daily
    

Fluoxetine
10–40 mg daily
    

Rifaximin
400–550 mg three times daily for 7–10 days
Total improvement of symptoms, especially bloating and distension
Antibiotics

Neomycin
1 g daily for 10 days
    

Metronidazole
400 mg twice daily for 15 days
    

Psyllium
2.5–30 g daily in divided doses
Improves constipation

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Oct 6, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on Treatment Options Involving Medication

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