Medications for Bloating and Stomach Gas
For simple bloating and gas symptoms, start with simethicone as a first-line over-the-counter option, as it is FDA-approved specifically for relief of gas-related pressure and bloating. 1
First-Line Approach: Over-the-Counter Options
Simethicone is the primary FDA-approved antigas medication for bloating and gas relief. 1 It works by reducing surface tension of gas bubbles, allowing them to coalesce and be expelled more easily. While some research suggests it may be less effective than alternatives for functional bloating, it remains the safest and most accessible initial option. 2
When Simple Gas Relief Fails: Context-Dependent Treatment
The optimal medication depends critically on whether bloating occurs with constipation or diarrhea, as this fundamentally changes the treatment approach:
For Bloating with Constipation (IBS-C Pattern)
Linaclotide 290 mcg once daily is the most efficacious medication for bloating associated with constipation, demonstrating superior improvement in abdominal bloating across 4 trials with 3,061 patients. 3 This guanylate cyclase-C agonist has strong evidence (high quality) for treating both bloating and abdominal pain in IBS-C. 3
Key caveat: Diarrhea is a common side effect of linaclotide. 3
Alternative for constipation-related bloating:
- Lubiprostone 8 mcg twice daily is superior to placebo for abdominal bloating and has the distinct advantage of being significantly less likely to cause diarrhea compared to other secretagogues. 3, 4 However, nausea is a frequent side effect that requires patient counseling; taking it with food can mitigate this. 4
For Bloating with Diarrhea (IBS-D Pattern)
Rifaximin is the most effective antibiotic for reducing gas production and bloating in patients with diarrhea-predominant symptoms, significantly reducing hydrogen excretion and the number of flatus episodes. 5 The British Society of Gastroenterology recognizes rifaximin as an efficacious second-line drug for IBS-D, though its effect on abdominal pain is limited. 3
Important limitation: Rifaximin is not FDA-approved for bloating specifically and is expensive. 3
For Bloating Without Clear Bowel Pattern Changes
Antispasmodics may be effective for global symptoms and abdominal pain when bloating occurs without predominant constipation or diarrhea, though dry mouth, visual disturbance, and dizziness are common side effects. 3
Tricyclic antidepressants (starting at 10 mg amitriptyline once daily, titrating to 30-50 mg) work through gut-brain neuromodulation and can address bloating without causing diarrhea, making them useful second-line options. 3, 4
Additional Considerations
Probiotics may be effective for bloating as part of IBS treatment, though no specific species or strain can be recommended. A reasonable trial is up to 12 weeks, discontinuing if no improvement occurs. 3
Dietary modification should be considered first, particularly a 2-week trial eliminating lactose, fructose, or artificial sweeteners, as food intolerances are extremely common causes of bloating (60% fructose intolerance, 51% lactose intolerance in DGBI patients). 3
Common Pitfalls to Avoid
- Do not use simethicone alone for functional bloating in refractory cases—research shows it is inferior to combination products or alternative treatments. 2
- Do not prescribe secretagogues (linaclotide, plecanatide, tenapanor) to patients with diarrhea-predominant symptoms—they will worsen loose stools. 3, 4
- Do not forget to counsel about nausea with lubiprostone—this is the most common side effect and can be mitigated by taking with food. 3, 4
- Do not use loperamide for bloating alone—while loperamide-simethicone combinations show efficacy for diarrhea with gas-related discomfort, loperamide can cause abdominal pain, bloating, nausea, and constipation as side effects. 3, 6