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Medications are not the first choice of treatment of irritable bowel syndrome. Many people are able to control their symptoms with home treatment. The goal of drug treatment is relieve your symptoms enough to prevent them from interfering with your daily activities, because it may not be possible to eliminate symptoms. Medications are used to treat moderate-to-severe pain, diarrhea, or constipation that does not respond to home treatment.
Antidepressant medications may improve IBS symptoms even in people who do not have depression, especially the medication class known as tricylic antidepressants. Anti-anxiety medications may help people whose anxiety contributes to their IBS symptoms.
No single medication has been shown to be affective in relieving IBS over the long-term.
In most cases the choice of medication is based on your most troublesome symptom. If constipation is the main symptom, using bulking agents and increasing fiber may be helpful.
Anti-diarrheal medications such as diphenoxylate hydrochloride (Lomotil) and loperamide hydrochloride (Imodium), slow intestinal movements. This allows stool to stay in the intestine longer, allowing more water to be absorbed, which makes the stool formed rather than watery when it is passed. Lomotil may cause dry skin, itching, dizziness, drowsiness, nausea, or vomiting. Psychological dependence may occur in high doses. Imodium may cause abdominal pain, dry mouth, nausea, vomiting, or dizziness. These side effects are usually minor and do not last long. This medication may not help people who have alternating periods of diarrhea and constipation because it may worsen the constipation. These medications may be dangerous if they are used by people who have certain types of intestinal infections or who have inflammatory bowel disease. You should not use these medications if you have fever or blood in your stool.
Bile acid binding agent cholestyramine (Questran) - this medication prevents bile acids from stimulating the colon which slows the passage of stool and relieves diarrhea. They are usually not tried soon after a person is diagnosed, but if symptoms do not improve with usual treatment they may be tried. Bile acid binding agents, such as cholestyramine (Questran) are mixed with water and may be taken several times a day. These medications are usually prescribed to treat high cholesterol. Side effects include nausea, bloating, gas, feeling of fullness, abdominal pain, and constipation. These side effects may be similar to the symptoms that the medication is intended to treat. They must be taken three hours before or after other medications so they do not interfere with the absorption of other medications.
Anticholinergics or Antispasmodics for Irritable Bowel
The following medications may be used to help prevent or relieve painful cramps and spasms of the intestine:
These medications are taken 30 minutes before meals to help prevent cramps that occur after eating. Side effects include drowsiness, dry mouth, blurred vision, or inability to urinate. Medications may make constipation worse.
The following medications may be used if long-term chronic pain occurs with anxiety or depression. Antidepressants are used to treat depression or anxiety or both by correcting balances in brain chemistry. For people who have irritable bowel syndrome the does is much lower than those usually used to treat depression. They can also help relieve intestinal spasms and may relieve sensations of pain, bloating, and feeling like you are unable to pass the stool. They may be used to treat chronic, unremitting abdominal pain that interferes with your daily activities. Examples include Elavil, Wellbutrin, Celexa, Norpramin, Sinequan, Prozac, Tofranil, Serzone, Paxil, Zoloft, Deseryl, Effexor. In people who have irritable bowel syndrome along with depression and anxiety, these medications may be used in doses that are usually used to treat depression or anxiety. Some antidepressants may worsen constipation, others may worsen diarrhea. These medications usually must be taken for at least two weeks to become effective.
Zelnorm - This drug has been taken off the market due to concerns of stroke and cardiovascular disease and therefore is no longer available. For patients still taking Zelnorm they should immediately stop taking it and inform their physician.
Lotronex - it was used in women with diarrhea-predominant irritable bowel but it was pulled off of the market due to problems with constipation and reduced blood flow to the large intestine (ischemic colitis). In a few cases the side effects lead to surgery to correct the problem and seven deaths may have been linked to the medication. Lotronex has returned to the market for limited use. An advisory panel of the USFDA has recommended strictly controlled use of Lotronex in women with the most severe diarrhea from irritable bowel syndrome. Many people who took the medication without side effects say it helped make their condition bearable. Still, some experts say the benefits of the medication do not outweigh the risk of serious side effects.
This drug (Lotronex) is available on a special FDA program for women only less than 55. Only some physicians are permitted to prescribe this drug and there are restrictions on who can get it. Dr Bhandari is involved in the program that prescribes this drug. For more information on this program talk to your physician.
Research - Dr. Bhandari is currently involved in 2 clinical studies in treatment for diarrhea in IBS and 1 study in treatment for constipation in IBS.
You Should Know :Dr. Bhandari specializes in digestive disease disorders. He is triple board certified in Internal Medicine, Medical Nutrition & Gastroenterology. He is a highly trained and skilled Endoscopist. |
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