From the Guidelines
The drug of choice for treating Irritable Bowel Syndrome (IBS) depends on the predominant symptom pattern, with eluxadoline (75-100 mg twice daily) being a recommended option for IBS with diarrhea (IBS-D) based on recent guidelines 1. For IBS-D, eluxadoline has been shown to be effective in improving symptoms, including abdominal pain and stool consistency, with a relatively good safety profile compared to other options like alosetron and ramosetron, which have more limited availability and specific contraindications 1.
- Key considerations for the treatment of IBS include:
- Symptom severity and predominant pattern (constipation, diarrhea, or mixed)
- Presence of abdominal pain or other complicating factors
- Potential side effects and contraindications of medications
- Need for lifestyle modifications, including dietary changes and stress management
- Other treatment options for IBS may include:
- Linaclotide (145-290 mcg once daily) or lubiprostone (8 mcg twice daily) for IBS with constipation (IBS-C) 1
- Antispasmodics like dicyclomine (10-20 mg three to four times daily) or peppermint oil capsules (0.2-0.4 mL three times daily) for abdominal pain
- Low-dose tricyclic antidepressants such as amitriptyline (10-25 mg at bedtime) for pain and sleep disturbances, although the evidence for their use is of lower certainty 1
- The choice of medication should be individualized, considering the patient's specific symptoms, medical history, and potential interactions with other medications, with the goal of improving morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
LINZESS is a guanylate cyclase-C agonist indicated for treatment of: Irritable bowel syndrome with constipation (IBS-C) in adults. Lubiprostone is indicated for the treatment of irritable bowel syndrome with constipation (IBS-C) in women at least 18 years old.
The drug of choice for treatment of Irritable Bowel Syndrome (IBS) with constipation is either linaclotide (PO) or lubiprostone (PO), depending on the patient's specific condition and demographics.
- Linaclotide (PO) is indicated for treatment of IBS-C in adults 2.
- Lubiprostone (PO) is indicated for treatment of IBS-C in women at least 18 years old 3 and 3.
From the Research
Treatment Options for Irritable Bowel Syndrome (IBS)
The treatment of IBS can be challenging due to its complex and diverse presentation. Several medications have been found to improve various IBS symptoms, including:
- Loperamide, which is effective in managing diarrhea-predominant IBS 4
- Fibre supplements, such as psyllium, which can help with constipation-predominant IBS 4
- Lubiprostone, which is used to treat constipation-predominant IBS 4
- Tricyclic antidepressants (TCAs), which can help with pain modulation in severe cases of IBS 4, 5, 6
- Selective serotonin receptor inhibitors (SSRIs), which may be beneficial for patients with constipation-predominant IBS 4, 5
- Antispasmotics, such as dicyclomine and hyoscyamine, which can help with abdominal pain and cramps 5
- Rifaximin, which is a nonsystemic antibiotic used to treat IBS with diarrhea (IBS-D) 7, 8
- Eluxadoline, which is a mixed µ- and κ-opioid receptor agonist/δ-opioid antagonist used to treat IBS-D 8
- Alosetron, which is a selective serotonin 5-HT3 antagonist used to treat severe IBS-D in women 8
Pharmacologic Therapies for IBS
The US Food and Drug Administration has approved several pharmacologic therapies for the treatment of IBS, including:
- Rifaximin, eluxadoline, and alosetron for IBS-D 8
- Lubiprostone for constipation-predominant IBS 4
- Linaclotide for constipation-predominant IBS (not mentioned in the provided studies)
Non-Pharmacologic Therapies for IBS
Non-pharmacologic therapies, such as dietary modifications, psychotherapy, and behavioral strategies, can also be effective in managing IBS symptoms 7, 5. A comprehensive treatment plan may involve a combination of pharmacologic and non-pharmacologic therapies tailored to the individual patient's needs.