From the Guidelines
Treatment for mixed Irritable Bowel Syndrome (IBS) should commence with dietary therapies, including a low-FODMAP diet and increased soluble fiber intake, alongside regular exercise and stress management techniques, as these approaches have been shown to be beneficial in managing symptoms 1. The treatment of mixed IBS is generally directed towards the predominant symptom, or symptoms, experienced by the patient.
- Dietary adjustments, such as a low-FODMAP diet, can help identify trigger foods and reduce symptoms 1.
- Increasing soluble fiber intake gradually (25-30g daily) can also be beneficial, but insoluble fiber should be avoided as it may exacerbate symptoms 1.
- Medications, such as antispasmodics (e.g., dicyclomine or hyoscyamine) for pain and cramping, loperamide for diarrhea, and osmotic laxatives (e.g., polyethylene glycol) for constipation, may be used to manage symptoms 1.
- For more severe symptoms, prescription medications, such as linaclotide for constipation or eluxadoline for diarrhea, may be considered 1.
- Psychological therapies, including cognitive behavioral therapy and gut-directed hypnotherapy, can help manage stress-related symptoms and should be considered when symptoms have not improved after 12 months of drug treatment 1.
- Regular exercise (30 minutes most days), stress management techniques, and adequate sleep are also important components of treatment, as they can help address both the gut motility issues and hypersensitivity that characterize mixed IBS 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
VIBERZI is indicated in adults for the treatment of irritable bowel syndrome with diarrhea (IBS-D).
1 INDICATIONS AND USAGE
XIFAXAN is indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.
The treatment for mixed Irritable Bowel Syndrome (IBS) is not directly addressed in the provided drug labels.
- The labels only mention treatment for Irritable Bowel Syndrome with Diarrhea (IBS-D).
- There is no information about the treatment of mixed IBS. 2 3
From the Research
Treatment Options for Mixed IBS
The treatment for mixed Irritable Bowel Syndrome (IBS) involves a combination of non-pharmacological and pharmacological interventions. Some of the treatment options include:
- Dietary modification, which is often the first line of therapy 4
- Lifestyle treatments, such as complementary alternative medications (CAM), probiotics, and peppermint oil, which can be useful adjuncts 4
- Psychotherapy, which has strong evidence to support its use in the treatment of IBS 4
- Pharmacological treatments, such as:
- Rifaximin, a nonabsorbable antibiotic, which has been shown to provide mild to moderate efficacy in managing IBS-D 5
- Eluxadoline, a gut-targeting μ and κ opioid receptor agonist and a δ opioid receptor antagonist, which has been shown to provide relief to patients with IBS-D 5
- Alosetron, a 5-HT(3) antagonist, which is superior to placebo for reducing bowel frequency, improving stool consistency, and relieving abdominal pain in women with D-IBS 6
- Loperamide, which is ineffective for relief of abdominal pain, but can be used to treat diarrhea-predominant symptoms 6
Non-Pharmacological Interventions
Non-pharmacological interventions, such as dietary and lifestyle modification, are generally used as first-line therapy for mixed IBS. These interventions can include:
- A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which is the most commonly recommended diet for IBS patients 7
- Probiotics, which have demonstrated efficacy and safety in patients with IBS, but studies are inconsistent in strains examined, dosing, and treatment duration 8
- Psychological therapies, such as cognitive behavioral therapy and hypnotherapy, which can improve IBS symptoms 8, 7
Pharmacological Interventions
Pharmacological interventions for mixed IBS can include:
- FDA-approved agents, such as eluxadoline, rifaximin, and alosetron, which have been shown to improve abdominal pain and stool consistency in patients with IBS-D 8, 5
- Loperamide, which can be used to treat diarrhea-predominant symptoms, but is ineffective for relief of abdominal pain 6
- Smooth muscle antispasmodics, bile acid sequestrants, and antidepressants, which can be used to treat various symptoms of IBS 8