From the Guidelines
Loperamide and alosetron are recommended for managing Irritable Bowel Syndrome (IBS) with diarrhea.
Medications for IBS-D
- Loperamide: may be an effective treatment for diarrhea in IBS, with a recommended dose of 4-12 mg daily 1, and is suggested for use in patients with IBS-D by the AGA 1.
- Alosetron: is a selective 5-HT3 antagonist that improves symptoms of IBS compared with placebo, with a recommended starting dosage of 0.5 mg twice per day, and is suggested for use in patients with severe IBS-D, particularly women, under a risk-management program 1.
Important Considerations
- Loperamide has minimal adverse effects and is a useful adjunct to other IBS-D therapies 1.
- Alosetron requires careful selection of patients and education about the risks and benefits, due to potential serious adverse events such as ischemic colitis and complications of constipation 1.
- The quality of evidence for loperamide is very low, while the quality of evidence for alosetron is moderate to high 1.
From the Research
Medications for Managing IBS with Diarrhea
The following medications are recommended for managing Irritable Bowel Syndrome (IBS) with diarrhea:
- Loperamide, an over-the-counter medication that may improve stool frequency and rectal urgency 2, 3, 4, 5, 6
- Eluxadoline, a prescription medication that has been shown to improve abdominal pain and stool consistency in patients with IBS-D 2, 3, 5, 6
- Rifaximin, a prescription medication that has been shown to improve abdominal pain and stool consistency in patients with IBS-D 3, 4, 5, 6
- Alosetron, a prescription medication that is approved for women with severe IBS-D 2, 3, 6
- Tricyclic antidepressants, which may be useful in managing IBS-D symptoms 2, 3, 4
- Bile acid sequestrants, which may be useful in managing IBS-D symptoms 2, 3, 6
- Antispasmodics, which may be useful in managing IBS-D symptoms 2, 3, 6
Non-Pharmacological Interventions
In addition to medications, non-pharmacological interventions such as dietary and lifestyle modifications, probiotics, and psychological therapies may also be useful in managing IBS-D symptoms 3.
Considerations for Treatment Selection
When selecting a treatment for IBS-D, it is essential to weigh the benefits and risks of pharmacologic interventions and consider the individual patient's symptoms, quality of life, and preferences 2, 3, 5.