From the Guidelines
Treatment for IBS-C should start with lifestyle modifications and dietary changes, and for medication, linaclotide (Linzess) at 290mg once daily is recommended as the first-line treatment due to its strong recommendation and high certainty in the evidence of effects. When managing IBS-C, it's essential to consider a multi-faceted approach that includes:
- Lifestyle modifications: increased fiber intake (25-30g daily), adequate hydration (at least 8 glasses of water daily), and regular physical activity.
- Dietary changes: reducing gas-producing foods like beans and certain vegetables, and following a low-FODMAP diet to identify trigger foods, as supported by the AGA clinical practice update on the role of diet in irritable bowel syndrome 1. For patients who do not respond to lifestyle and dietary changes, medication is the next step.
- Over-the-counter fiber supplements like psyllium (Metamucil) at 1 teaspoon 1-3 times daily mixed with water can be tried first.
- If constipation persists, osmotic laxatives such as polyethylene glycol (MiraLAX) at 17g daily dissolved in water can be used. However, linaclotide (Linzess) at 290mg once daily is the preferred prescription medication for IBS-C due to its strong recommendation and high certainty in the evidence of effects 1. Other prescription medications like lubiprostone (Amitiza) at 8mcg twice daily may also be considered, although with a conditional recommendation and moderate certainty in the evidence of effects 1. Stress management techniques like meditation, yoga, or cognitive behavioral therapy are also beneficial as stress can worsen IBS symptoms through the gut-brain connection. If symptoms don't improve within 2-4 weeks of treatment, it's crucial to consult a healthcare provider for reevaluation.
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.
Treatment for IBS-C
- Linaclotide (PO) is indicated for the treatment of IBS-C in adults 2.
- Lubiprostone (PO) is indicated for the treatment of IBS-C in women at least 18 years old 3.
From the Research
Treatment Options for IBS-C
- The treatment of Irritable Bowel Syndrome with Constipation (IBS-C) typically involves a combination of lifestyle modifications, over-the-counter agents, and prescription medications 4, 5, 6, 7, 8.
- Current therapeutic options for IBS-C include:
- Lifestyle modifications, such as dietary changes and stress reduction
- Over-the-counter agents, such as fiber supplements and laxatives
- Antispasmodics, which may provide short-term relief for abdominal pain and discomfort
- Prosecretory agents, such as lubiprostone and linaclotide, which have been shown to be effective in improving stool frequency, perceived constipation severity, and abdominal pain and discomfort 4, 6, 8
- Emerging treatment options for IBS-C include:
- Prucalopride, a selective 5-hydroxytryptamine receptor agonist
- Plecanatide, a guanylate cyclase-C agonist
- Elobixibat, a ileal bile acid transporter inhibitor
- Tenapanor, a sodium/hydrogen exchanger 3 inhibitor 8
Pharmacological Treatment
- The choice of pharmacological treatment for IBS-C depends on the individual patient's symptoms and response to treatment 5, 6, 7.
- Lubiprostone and linaclotide are two prosecretory prescription drugs approved for the treatment of IBS-C and chronic idiopathic constipation (CIC) 4, 8.
- These medications have been shown to be effective in improving stool frequency, perceived constipation severity, and abdominal pain and discomfort, but may have limited response rates and higher costs 8.