From the Guidelines
Treatment for Irritable Bowel Syndrome (IBS) should commence with dietary therapies, such as a low-FODMAP diet, and first-line drugs, as recommended by the British Society of Gastroenterology guidelines 1. When managing IBS, it is essential to identify the specific subtype (constipation-dominant, diarrhea-dominant, or mixed) to guide treatment.
- For dietary management, a low-FODMAP diet for 4-6 weeks can help alleviate symptoms, followed by systematic reintroduction to identify triggers 1.
- Increasing soluble fiber intake gradually through foods like oats or supplements such as psyllium (Metamucil) at 3-4g daily can also be beneficial 1.
- Medications such as laxatives like polyethylene glycol (MiraLAX, 17g daily) or prescription medications like linaclotide (Linzess, 145-290mcg daily) or lubiprostone (Amitiza, 8-24mcg twice daily) can be used to treat IBS-C (constipation) 1.
- For IBS-D (diarrhea), loperamide (Imodium, 2-4mg as needed) can help acutely, while prescription options include eluxadoline (Viberzi, 75-100mg twice daily) or rifaximin (Xifaxan, 550mg three times daily for 14 days) 1.
- Antispasmodics like dicyclomine (Bentyl, 10-20mg up to four times daily) can relieve abdominal pain, and low-dose antidepressants such as amitriptyline (10-50mg at bedtime) may help with pain and gut motility 1.
- Stress management through regular exercise, adequate sleep, and relaxation techniques like meditation or cognitive behavioral therapy is also crucial, as stress often triggers or worsens IBS symptoms 1.
From the FDA Drug Label
1.3 Irritable Bowel Syndrome with Constipation Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
Lubiprostone is used for the treatment of Irritable Bowel Syndrome with Constipation (IBS-C) in women at least 18 years old 2. The recommended oral dosage for IBS-C is 8 mcg twice daily.
- Key points:
- Indicated for IBS-C in women at least 18 years old
- Recommended dosage: 8 mcg twice daily
- Administration instructions: take with food and water, swallow capsules whole 2.
From the Research
Treatment Options for IBS
- Lifestyle and dietary changes, including the low-FODMAP or gluten-free diet, are the first-in-line treatment for all patients 3
- Medications such as laxatives, prokinetics, antidiarrheals, antispasmodics, and neuromodulators can be used to treat specific symptoms 3, 4
- Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists, or alternative therapy, including psychotherapy, hypnotherapy, acupuncture, or phytomedicines 3
Medication Management
- There is evidence to support improvements in specific IBS symptoms following treatment with loperamide, psyllium, bran, lubiprostone, linaclotide, amitriptyline, and other medications 4
- Rifaximin, lubiprostone, linaclotide, fiber supplementation, and peppermint oil have the most reliable evidence supporting their use for the treatment of IBS 4
- The efficacy of medications for IBS symptoms can vary depending on the individual patient and the specific symptoms being treated 4, 5, 6
Guidelines for Treatment
- Traditional symptom-based therapies are often of limited efficacy in addressing the entire symptom complex of IBS 5
- Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment 5
- Exclusion diets, dietary fiber, bulking agents, laxatives, antispasmodics, and other medications can be effective in improving individual symptoms 5, 6
- Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients 5
Current Therapies
- Current therapies are directed at relieving symptoms of abdominal pain or discomfort, bloating, constipation, and diarrhea 7
- Pharmacologic agents used to treat IBS-associated pain include myorelaxants, peppermint oil, and peripherally acting opiates 7
- Fiber supplementation, polyethylene glycol, and tegaserod are current treatment options for constipation-predominant symptoms 7
- Loperamide, alosetron, and clonidine are available therapies for diarrhea-predominant symptoms 7