Medications

The goal of treating irritable bowel syndrome (IBS) is management of symptoms and, in so doing, improving the patient’s quality of life. Treatment is generally a combination of therapies, and there are several medications that may be used to alleviate symptoms. There are different kinds of medications that may be prescribed for IBS symptoms:

• Drugs that relieve constipation
• Antidiarrheals
• Antispasmodics
• Antibiotics
• Antidepressants
• Anti-anxiety drugs¹

Therapeutic approaches to IBS treatment can also be classified as peripherally acting – that is, specific therapies that affect the intestinal symptoms of IBS – or centrally acting, which describes those therapies that provide global or systemic benefit.²

Peripherally acting therapies

Peripherally acting strategies target the dominant symptom of IBS. Patients who have IBS with constipation (IBS-C) may try adding fiber to their diet or using medications that treat IBS-C such as Amitiza (lubiprostone), Tenapanor (Ibsrela), Trulance (plecanatide), Zelnorm (tegaserod), and Linzess (linoclotide). Patients with IBS with diarrhea (IBS-D) may try probiotics, antidiarrheals, antispasmodics, or other medications such as Lotronex (alosetron) or Viberzi (eluxadoline). There are also gut-specific antibiotics, such as Xifaxan (rifaximin), that may help patients with IBS who complain of gas and bloating symptoms.²

Centrally acting therapies

Centrally acting agents affect the entire body, providing a global approach and benefit. They may be added as a complement to peripherally acting therapies. Centrally acting therapies include antidepressants and anti-anxiety medications.²

Studies have shown an association between IBS and mood disorders such as anxiety and depression, as well as posttraumatic stress disorder (PTSD).¹ A patient with anxiety or depression may experience IBS symptoms due to the colon in part being controlled by the nervous system. Or, a patient with IBS may feel more anxious or depressed with the stress and frustration of dealing with IBS symptoms.³ Antidepressants and anti-anxiety medications promote global well-being and may also provide relief from IBS symptoms, such as abdominal pain, intestinal transit, or motility.⁴

Potential side effects

All medications may have unwanted side effects, and patients should discuss with their doctor the possible risks and benefits of each medication. In addition, patients should talk to their doctor about all medications and nutritional supplements they are currently taking, as some may not interact well with new medications. Patients who are pregnant, who plan to become pregnant, or who are breastfeeding should discuss with their doctor the best course of treatment that is also safe for their baby.

Additional treatment options for IBS

Medication can be helpful in treating some of the symptoms from IBS. Many patients with IBS find they need to try several different treatment options before finding the approach or combination of approaches that work best to manage their symptoms. This trial-and-error process can be frustrating. It may be comforting to know there are several options available. It is important to note that some medications are no longer approved for IBS. In addition to medication, patients can try a variety of lifestyle approaches, such as making dietary changes, adding exercise, managing stress, or getting counseling. Some patients have also gotten relief from using complementary or alternative therapies.