Antidiarrheals for IBS

For people living with irritable bowel syndrome with diarrhea (IBS-D), antidiarrheal drugs are an important treatment option that can help improve quality of life. These drugs can decrease the number of episodes of diarrhea and help the body absorb water so that stools are firmer.^1,2

Examples

There are several types of antidiarrheals for IBS. Each drug works differently.

Imodium and Lomotil

Two common over-the-counter antidiarrheals are Imodium (loperamide) and Lomotil (diphenoxylate/atropine). They work by reducing the movement the intestines make to move food down the gastrointestinal (GI) tract. This movement is called peristalsis.^1,2

These drugs are not recommended as a long-term solution for people living with IBS-D. They can reduce the amount and severity of diarrhea per day. But they do not help with abdominal pain or other IBS symptoms.^1,2

Xifaxan

Xifaxan® (rifaximin), is a non-systemic antibiotic. That means it does not affect the entire body. It works only in the intestines.³

The community of bacteria that live in your intestines is called your gut microbiome. When the levels of certain bacteria in your microbiome change, IBS symptoms like bloating, constipation, or diarrhea can result. Rifaximin helps change the gut microbiome to improve IBS-D symptoms.³

Viberzi

Viberzi® (eluxadoline) is from a drug class called opioids. However, it is not an addictive pain-killer like oxycodone or morphine. Eluxadoline is a safer opioid that slows how quickly food moves through the GI tract. This allows the intestines to absorb more water to solidify stool. The drug also has some mild pain-relieving qualities.⁴

Lotronex

Lotronex® (alosetron hydrochloride) is from a drug class called selective 5-HT3 antagonists. It has been shown to improve abdominal pain along with other IBS symptoms.²

However, early studies on alosetron found that it can have complications such as ischemic colitis. In this condition, too little blood flows to the colon. Because of this, alosetron is only used in women with severe IBS-D for whom other treatments did not work and who are being watched by their doctor.²

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Common side effects include:^5-7

• Xifaxan can cause nausea or loss of appetite in people with IBS-D.
• Viberzi can cause constipation, nausea, or abdominal pain. It is also not recommended for people who have more than 3 alcoholic drinks per day or have had inflammation of the pancreas (pancreatitis).
• Lotronex can cause constipation, abdominal pain, or nausea along with severe GI reactions such as ischemic colitis.

These are not all of the possible side effects of antidiarrheals. Talk to your doctor about what to expect when you are taking antidiarrheals. You should also call your doctor if you experience any changes to your health while taking these drugs.

Other things to know

The first step in treating IBS-D is lifestyle change. Your doctor may discuss ways that you can improve your symptoms through changing your diet. For example:²

• An elimination diet focuses on removing foods that can worsen your symptoms.
• Adding more fiber to your diet will bulk up your stools.
• Probiotic supplements can help improve your gut microbiome.
• Peppermint oil may improve stomach cramps.

It may take time to figure out what treatment is best for you. You may need to try combining lifestyle changes with drugs. You also might need to try a few drugs to find what works for you.

Before beginning treatment for IBS-D, tell your doctor about all of your health conditions and any other drugs, vitamins, or supplements you take. This includes over the counter drugs.