From the Guidelines
For IBS pain, tricyclic antidepressants such as amitriptyline (starting at 10mg at bedtime) are a recommended treatment option, as they have been shown to be effective in reducing abdominal pain and global symptoms in IBS patients 1. When considering treatment options for IBS pain, it's essential to evaluate the efficacy and safety of various medications.
- Antispasmodics like dicyclomine and hyoscyamine can be used to relax intestinal muscles and reduce cramping, but their effectiveness may vary depending on the individual patient 1.
- Peppermint oil capsules can also be effective in reducing abdominal pain and are a reasonable alternative to antispasmodics 1.
- For patients with IBS with diarrhea, medications like Eluxadoline (Viberzi, 75-100mg twice daily) and rifaximin may be considered, but their use should be carefully evaluated due to potential contraindications and side effects 1.
- Secretagogues like linaclotide and lubiprostone can be effective in treating abdominal pain in patients with IBS with constipation, but their relative efficacy may vary depending on the individual patient 1. It's crucial to work with a healthcare provider to determine the best course of treatment for IBS pain, as treatment often requires personalization and may involve a combination of medications, dietary modifications, stress management, and regular exercise.
- The goal of treatment should be to minimize side effects while maximizing symptom relief, and patients should be carefully monitored to adjust treatment as needed 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE Dicyclomine hydrochloride tablets, USP are indicated for the treatment of patients with functional bowel/irritable bowel syndrome.
The medication dicyclomine is used to treat irritable bowel syndrome (IBS), which includes symptoms of IBS pain.
- Dicyclomine is an option for managing IBS pain.
- The FDA label for dicyclomine 2 directly supports its use for IBS treatment.
From the Research
Medication for IBS Pain
- The current approach to treating IBS is symptomatic and consists of a regimen of first-line pharmacological treatment options, including the use of anti-depressant drugs 3.
- Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment, such as antispasmodics for abdominal pain and discomfort, and laxatives for constipation 4.
- Certain medications, including loperamide, fibre supplements, lubiprostone, tricyclic antidepressants (TCAs), selective serotonin receptor inhibitors (SSRIs), antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide, and probiotic treatments, have been shown to improve various IBS symptoms, including abdominal pain 5.
- The use of chloride channel activators and guanylate cyclase activators is recommended to treat global IBS with constipation symptoms, while rifaximin is recommended to treat global IBS with diarrhea symptoms 6.
- Gut-directed psychotherapy is also suggested as a treatment option for global IBS symptoms 6.
Treatment Approaches
- A multidisciplinary approach, including medicinal care, Chinese medicine, reflexology, and naturopathy, has been shown to result in significant improvement in symptoms and quality of life for IBS patients 3.
- Physician-dietitian collaboration is invaluable for IBS patients to achieve a successful outcome, particularly when using the FODMAP elimination diet as a first-line therapy 7.
- A positive diagnostic strategy, rather than a diagnostic strategy of exclusion, is suggested to improve time to initiating appropriate therapy 6.