From the Guidelines
Diltiazem is not recommended as a PRN medication for irritable bowel syndrome (IBS) due to limited evidence supporting its use in this condition. The British Society of Gastroenterology guidelines on the management of IBS, published in 2021 1, do not mention diltiazem as a treatment option for IBS. Instead, the guidelines recommend the use of antispasmodics, loperamide, peppermint oil, and polyethylene glycol for the management of IBS symptoms.
For IBS management, more appropriate options include:
- Antispasmodics like dicyclomine (10-20mg three to four times daily) or hyoscyamine (0.125-0.25mg every 4 hours as needed) for cramping and pain
- Loperamide (2mg as needed, up to 8mg daily) for diarrhea-predominant IBS
- Fiber supplements or osmotic laxatives like polyethylene glycol (17g daily) for constipation-predominant IBS
These medications work by targeting the gut-specific symptoms of IBS, such as reducing intestinal smooth muscle contractions, slowing intestinal transit, and softening stool or increasing motility. The guidelines also recommend the use of neuromodulators, such as tricyclic antidepressants, as second-line treatment for IBS, particularly for abdominal pain 1.
It's essential to consult with a healthcare provider to determine the most appropriate treatment option based on the patient's predominant symptoms and overall health status. A multidisciplinary approach to IBS management, including dietary counseling, psychological therapies, and self-management strategies, may also be beneficial 1.
From the Research
Prn Diltiazem for Irritable Bowel Syndrome
- There is limited evidence to support the use of diltiazem for irritable bowel syndrome (IBS) 2.
- A short-term double-blind study found no significant difference between diltiazem and placebo in improving IBS symptoms, although there was a trend towards improvement in diarrhea and abdominal pain 2.
- Other studies have investigated various medications for IBS, including loperamide, psyllium, lubiprostone, linaclotide, and rifaximin, which have shown promise in improving specific IBS symptoms 3, 4, 5.
- The management of IBS often involves a combination of medical and dietary therapies, including the use of antispasmodics, antidepressants, and probiotics, as well as dietary changes such as the FODMAP elimination diet 4, 5, 6.
- Physician-dietitian collaboration is recommended for IBS patients to achieve a successful outcome, particularly when using dietary therapies such as the FODMAP elimination diet 6.