Digestive Disorders > IBS

IBS medications: The complete guide

Dr. Sarah Toler, CNM, DNP

Dr. Sarah Toler, CNM, DNP

So far, medications can only play a supporting role in the treatment of irritable bowel syndrome (IBS). Medications for IBS can alleviate irritable bowel symptoms, but do not address the root causes of the syndrome. IBS medications include:

  • Prescription medicine
  • Over-the-counter medicine
  • Herbal medicine
  • Dietary supplements

In order to avoid possible interactions and side effects, selection of medications should always be made with a doctor or pharmacist. Drugs used in the treatment of IBS are classified according to the following four main symptoms:

  1. Pain
  2. Diarrhea
  3. Constipation
  4. Bloating and gas (flatulence)

Which IBS medications help with pain?

Many people with irritable bowel syndrome experience severe abdominal pain. Several studies show that pain perception with IBS might change over time. In people with IBS, even small amounts of air in the abdomen can be associated with pain that a person without IBS would not perceive as painful.

Excessive gas formation from intestinal bacterial overgrowth can also occur and lead to pain. Spasms and cramps of the muscles in the intestinal walls are also perceived as very painful.

Recommended medications for IBS pain

Degree of recommendation Medications
Highly recommended Antispasmodics (e.g. hyoscine butylbromide, otilonium bromide, pinaverium, mebeverine)
Recommended

Tricyclic antidepressants (TCAs, e.g. amitriptyline)
Selective serotonin reuptake inhibitors (SSRIs, e.g. citalopram)
Antibiotics

Probiotics (e.g. Bifidobacterium infantis, Lactobacillus plantarum)

Are pain relievers like acetaminophen, aspirin, or ibuprofen recommended for IBS?

No matter how much pain people with IBS experience, the use of classic pain relievers like aspirin (acetylsalicylic acid or ASA), acetaminophen, or ibuprofen is not recommended for IBS. Since the sensation of pain changes with the disease, these substances have no positive effect with prolonged use. They may actually intensify the disturbance of the pain perception.

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Which IBS medications help with diarrhea?

Acute diarrhea, as is common with gastrointestinal infections, mostly differs from the long-term or chronic diarrhea that is experienced by people with irritable bowel syndrome. Identifying the root cause or triggers of IBS are usually the most successful ways to reduce diarrhea. There are some medications that can help people with IBS acute diarrhea episodes.

Recommended medications for IBS with diarrhea

Degree of recommendation Medications
Highly recommended

Loperamide
Eluxadolone

Bile acid sequestrants like cholestyramine, colestipol, and colesevelam

5-hydroxytryptamine (serotonin) 3 receptor antagonists like Alosetron

How does loperamide work?

Loperamide is a medication that acts almost exclusively on receptors in the intestine and decreases the tone of the smooth muscles. This reduces the motility of the intestine, and leads food and gut content to stay longer in the intestine.

As a result, more liquid and electrolytes are absorbed from the food and the watery stool can solidify again. Loperamide should not be taken for more than two days without consulting a healthcare provider.

It shouldn’t be used if you have bloody diarrhea, an ulcerative colitis flare-up, or a bacterial infection of the small and large intestines (bacterial enterocolitis). Adequate hydration should be ensured while taking this medication.

What you should know about loperamide for IBS
Administration and dosage Initially 2 tablets or capsules and then one tablet after each loose stool. Maximum approved total dose per day is 8 mg for over-the-counter use and 16 mg for prescription use
Side effects Headache, dizziness
Constipation, nausea, flatulence, abdominal pain, bloating and feeling of bloated abdomen
Vomiting, heartburn, dry mouth
Rash
Do not take if you have: Known allergy to loperamide

Diarrhea with fever and / or bloody stool

Diarrhea related to taking antibiotics

Bacterial inflammation of the intestine due to enteroinvasive pathogens (Such as Salmonella, Shigella Campylobacter, or E. coli)

Acute flare-up of an inflammatory bowel disease like ulcerative colitis or Crohn’s disease

Phenylketonuria (error of metabolism characterized by an inability to break down phenylalanine, which is contained in aspartame)

Not for use by children > 12 years unless it has been prescribed by their healthcare provider

Drug interactions P-glycoprotein inhibitors likeritonavir, quinidine, ketoconazole, gemfibrozil, and desmopression

Other medicines for stomach and bowel problems

Some other conditions might also require special safety precautions: always check with your healthcare provider before taking loperamide. Consult your provider if symptoms get worse, change, or don’t improve.

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Which IBS medications help with constipation?

A person is considered to be constipated when they experience bowel movements fewer than three times a week. Constipation can cause stool to be very hard and to form individual lumps. A high-fiber diet containing raw fruits and vegetables may help some people relieve constipation symptoms.

IBS with constipation may not be improved with a change in diet because it could be caused by impaired mobility and activity (motility) of the intestine. The following medications can help with constipation in IBS.

Recommended medications for IBS with constipation

Degree of recommendation Medications
Highly recommended Soluble dietary fiber (e.g. psyllium)
Recommended

Osmotic laxatives like lactulose or milk of magnesia
Polyethylene glycol (PEG) like lubiprostone, linaclotide, or plecanatide

Lubiprostone

5-hydroxytryptamine (serotonin) 4 receptor agonists
Selective serotonin reuptake inhibitors (SSRIs)

Which IBS medications help with bloating?

For some people with IBS, the main symptoms they experience are flatulence and gas. The abdomen might feel swollen or full. People with average gastrointestinal function experience flatulence up to 20 times a day. Food intolerance is often the cause when people experience flatulence more often.

A bloated abdomen is also often a painful symptom of IBS. Applying heat is often a comforting first measure for painful gas. The medications presented below can also alleviate the symptoms.

Recommended medications for IBS with flatulence and bloating

Degree of recommendation Medications
Recommended

Antispasmodic agents like dicyclomine and hyoscyamine

Tricyclic antidepressants (TCAs)

Rifaximin (antibiotic)

When do antidepressants help with IBS?

Most people associate antidepressants with depression, and therefore don’t immediately understand why it might be appropriate to take them with IBS. The intestinal nervous system, like the brain, communicates via chemical messengers called transmitters. Changes in transmitters in the intestine could have an impact on pain perception.

The tricyclic antidepressant (TCA) amitriptyline has shown effectiveness in some adults with IBS, especially in those experiencing pain as a major symptom. It should not be taken by people with constipation, as amitriptyline itself can cause constipation as a side effect. For people with constipation, another group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) is suitable.

Both antidepressant categories may have a direct effect on bowel function. TCAs slow down the passage of intestinal content and therefore improve diarrhea. SSRIs reduce constipation by accelerating the GI transit.

Are there alternative treatments for IBS?

Some alternative therapies for IBS aren’t recommended for as a part of every person’s treatment plan, although some people have luck with them.

If some people find success with these remedies, why aren’t they recommended? They haven’t been studied enough for healthcare providers to say with confidence that they can work for all people with IBS. However, the risk in trying these natural remedies is low and the benefit may be great if they work for an individual with IBS.

Probiotics for IBS

In some cases, probiotics can alleviate IBS symptoms like diarrhea, constipation, pain, bloating, and flatulence. Strains like Lactobacillus plantarum DSM 9843, Escherichia coli DSM1752, Bifidobacterium Bifidum MIMBb75, and Streptococcus faecium have shown to be effectively managing some IBS symptoms in studies. The preparations are available in pharmacies and can be taken once to twice per day as instructed. Some probiotics may cause flatulence; it can help to start with one dose or capsule.

Probiotics work by promoting a healthy intestinal flora, defined as the total of microorganisms living in the gut. The intestinal flora is important for a good working digestive tract.

In many people who live with irritable bowel syndrome, there is an imbalance in the normal intestinal flora. For example, there are often too many “harmful” bacteria, whereas there are fewer bifidobacteria, known to exert positive health benefits on gut health. The exact mechanisms remain unclear but bifidobacteria may have a protective effect on the intestinal inner lining (mucosa) and act as a barrier.

Simethicone for IBS

Painful gases in the intestine often collect in the form of bubbles and foam. Gases cannot be absorbed by the intestinal wall in this form. Defoamers or anti-foaming agents are used in the treatment of flatulence by both preventing gas formation in the digestive tract or making the expulsion of the gas easier. Simethicone, also known as simeticone, is a drug that works physically in the intestine to prevent gas formation. It lowers the surface tension of gas bubbles so that they burst or combine to bigger bubbles and the gas can be absorbed by the intestinal wall. However, it does not lead to a reduction or prevention of gas formation.

  • Administration and dosage: Doses vary depending on the brand and the amount of simethicone in it. The amount stated on the packaging should be taken after meals or at bedtime. Simeticone is available in tablets, capsules, drops and liquids
  • Simethicone can be combined with other ingredients:for example, with medication used to treat heartburn or diarrhea
  • Simethicone is also available as chewable tablets with glucose, sucrose, fennel, dill, caraway, and peppermint oil

Peppermint and caraway oil for IBS

Peppermint oil and caraway oil are two herbal substances called phytotherapeutics that have proven to be antispasmodic and pain-relieving when used for IBS. The oils are available in capsule form and are taken half an hour before a main meal. There are no known serious side effects. However, the smell and taste of the oils can sometimes be perceived as unpleasant. Heartburn, dizziness, headache, mouth dryness, and an increased appetite have also been reported. The use of specific coated pills can help prevent symptoms like heartburn.

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Dr. Sarah Toler, CNM, DNP

Dr. Sarah Toler, CNM, DNP

Sarah Toler is a Certified Nurse Midwife, Doctor of Nursing Practice, and science writer. She focuses on improving women's health and access to health care by working with digital health platforms. Her area of expertise is mental health, particularly the physical manifestations of stress and anxiety.

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