Which particular drug will work best for you is something you'll most likely have to determine through trial and error. Irritable Bowel Syndrome drugs are symptom-specific (aimed at painful abdominal spasms, diarrhea, or constipation), which means they do not work on the underlying brain-gut dysfunction of IBS (only IBS hypnotherapy can do that). They are meant simply to relieve your Irritable Bowel Syndrome symptoms. If the first IBS medication you try doesn't help much (or at all), don't be discouraged there are other options available.
Remember that there's no one particular treatment of choice for Irritable Bowel Syndrome (and no single drug is approved for all IBS symptoms) but many different medications to try. You should work in partnership with your doctor to determine which medication best fits your needs. This might take a trial period of a few months and several follow-up visits or phone calls. With any new medication, always make sure you receive the clinical insert about health risks, side effects, and possible drug interactions. You may have to specifically ask the pharmacist for this insert (it will be produced by the drug manufacturer) if you don't receive it with your prescription.
Currently, most IBS patients cite great frustration with the lack of safe, reliable and effective Irritable Bowl Syndrome therapies, and would like to see new options made available to them that would have a greater impact on their problem - especially the ability to prevent symptoms. Unfortunately for now, it's mostly a case of better something than nothing at all. So keep your fingers crossed for new treatments on the horizon.
For Irritable Bowel Syndrome Pain
The most frequently prescribed drugs for Irritable Bowel Syndrome IBS pain are Anti-Spasmodics. These drugs affect gut motor activity and reduce the colon's response to both eating and stress. Anti-spasmodics (also known as anticholinergics) are meant to be taken 30 minutes before eating, but they can also be taken whenever needed . Sublingual (dissolve under your tongue) and oral (swallow whole) varieties are available. Typically, antispasmodics are prescribed for use four times per day (before each meal and bedtime). Since they have no cumulative effect, however, many patients prefer to take them only as necessary. I have had the best luck with Donnatol. For many years previously I used Pro-Banthine, which is actually a children's drug, though I was not a child at the time and had no idea the drug was not likely to be as effective for adults. Discovering this fact did explain why I was always having to take the maximum dose to see any results. In general, I find soluble fiber supplements, peppermint (both of which are dealt with in detail in Month 2), and the IBS diet more beneficial than anti-spasmodics most of the time. As a result I take the drugs quite infrequently, a few pills a month at most. However, if I'm under a great deal of stress I may take them with each meal for a few days straight as I find they work half-decently as a preventative measure, though not at all as a means of stopping an attack once it starts.
Low doses of IBS-effective Antidepressants can raise the pain threshold for the painful abdominal cramps of Irritable Bowel Syndrome, and they can also either increase or decrease (depending upon the class of drug) the rate of gastrointestinal contractions as well, thus altering bowel function in either direction (and helping diarrhea or constipation). Why would antidepressants help Irritable Bowel Syndrome? These drugs are meant to affect the uptake of serotonin - a neurotransmitter directly involved in the development of clinical depression - in the brain. However, the enteric nervous system of the gut is also rich with nerves that contain large amounts of serotonin. In fact, 95% of all serotonin in the body is found in the gut, not the brain. So the effect of antidepressants on the brain is felt as a peripheral result in the gut as well.
It's important to note that the dosage of anti-depressants used for Irritable Bowel Syndrome is typically far lower than that of the drug when used for depression. It is also crucial that the doctor prescribing this type of drug be very familiar with its use for IBS, as different classes of anti-depressants have varying side effects. Some can greatly worsen, instead of help, Irritable Bowel Syndrome symptoms such as diarrhea, constipation, and pain, depending on the patient.
In particular, SSRI anti-depressants (Prozac, Celexa, Zoloft and Paxil) stimulate serotonin production and can trigger severe IBS attacks in diarrhea-predominant patients, but they may be helpful for constipation. Conversely, tricyclic anti-depressants (such as Elavil) have the best track record of success for reducing diarrhea-predominant IBS symptoms, but patients with constipation are usually not treated with these drugs because of the possibility of exacerbating this symptom. Tricyclic anti-depressants tend to be anticholinergic that is, they block the activity of the nerves responsible for gut motion. The long-term consequences of taking low-dose anti-depressants for Irritable Bowel Syndrome are unknown, and this is a matter that should be discussed with your physician.
Narcotic Analgesics for IBS are opioid drugs and can be highly effective painkillers. One of their chief side effects, constipation, is actually of benefit to some Irritable Bowel Syndrome sufferers. Narcotics also induce a feeling of tranquility and promote drowsiness, both of which can be helpful for relieving stress-related attacks. The chief problem with narcotic drugs is that it's next to impossible to get a doctor to prescribe them for you. Although there is mounting evidence that these painkillers are not nearly as habit-forming as previously thought, from your doctor's point of view the risks of addiction are still likely to take precedence over your pain. You'll have to decide for yourself, based on the severity of your symptoms, what your own priorities are in the matter and, if appropriate, try to find an understanding physician. Narcotic painkillers work best on an empty stomach and may take up to an hour to halt an attack. They should only be used in the advent of severe pain that occurs despite dietary and stress management precautions, and should not be used as a preventative measure or on a regular ongoing basis as they can be addictive. In addition, the less frequently this medication is used the more effective it tends to be. On a personal note, when I am struck by a severe attack out of the blue, something that happens several times a year, a prescription narcotic painkiller (typically Vicodin) is the only avenue of help that works for me. I don't have as much luck as I'd like with the drug quickly stopping an attack outright (though I would give anything for this), but it does work beautifully to prevent recurring attacks and allow me to stabilize. It somehow seems to push a "reset button" for my body that breaks the cycle of pain, lets me rest and recover, and from that point on take charge of my health once again through diet and stress management. I only use a handful of these painkillers each year, but when I do need them it's hard to convey the sheer gratitude I feel for their availability.
Drugs For Irritable Bowel Syndrome Diarrhea
Imodium and Lomotil are the most common anti-diarrheal medications for Irritable Bowel Syndrome. They enhance intestinal water absorption, strengthen anal sphincter tone, and decrease intestinal transit, thereby increasing stool consistency and reducing frequency. Both are meant to be used for prevention of diarrhea by taking them prior to events (meals or stress) which typically trigger symptoms. They should be taken with plenty of fresh water. Imodium can be used as a daily maintenance drug, but Lomotil is chemically related to narcotics, and as such is not an innocuous drug, so dosage recommendations should be strictly adhered to (especially in children). Lomotil can be habit-forming, and an overdose could be fatal. Lotronex, a potent and selective 5-HT3 antagonist that was meant to be prescribed just for women with diarrhea, is dealt with extensively later in this chapter. Lotronex was pulled off the US market after killing several women, and then was re-introduced. If you're considering taking this drug for Irritable Bowel Syndrome diarrhea, you'll probably find it helpful to get feedback from other Lotronex users on the IBS Message Boards.
Drugs For Irritable Bowel Syndrome Constipation
There are no well-established prescription drugs for constipation-predominant IBS. The use of chemical laxatives (such as Milk of Magnesia or ExLax), which tend to stimulate the bowel by causing an irritated lining, is not recommended as they can easily lead to dependency and they're harmful to the colon. The most typical treatment for constipation is a non-prescription soluble fiber supplement such as Metamucil, Citracel, or Fibercon (discussed in depth in Month 2), lots of fresh water, and exercise. Unfortunately, this is simply not enough for many people with IBS, but there are currently several research studies underway for a prescription medication that can address the problem safely and effectively. Zelnorm is a newly released drug just for Irritable Bowel Syndrome constipation in women, but it hasn't been on the market long enough to determine how effective (or safe) it is, and it's currently only supposed to be prescribed for short term use. If you're considering taking this drug for Irritable Bowel Syndrome constipation, you'll probably find it helpful to get feedback from other Zelnorm users on the IBS Message Boards
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 The only critical examination of the efficacy of medical treatments for IBS was conducted in 1988. Measures of efficacy, placebo response, trial length, maintaining blindedness, study designs, and statistical considerations were examined. Of the 93 controlled pharmacologic studies reviewed at the time, not a single study offered convincing evidence that any pharmacologic therapy was effective in treating IBS symptoms. Studies looked at a wide range of pharmacologic interventions including antispasmodics, anticholinergic/barbiturate combinations, antidepressants, bulking agents, dopamine antagonists, carminatives, opioids, tranquilizers, phenytoin, timolol, and diltiazem. This does not mean that pharmacologic interventions do not work, only that no intervention has been proven to be effective. (Klein KB: Controlled treatment trials in the irritable bowel syndrome: a critique. Gastroenterol 1988;95:232-41).
 Results from DrugVoice's IBSVoice survey of over 2,000 patients, one of the largest and most far-reaching studies of IBS patients ever conducted. Melissa Krauth, President, DrugVoice LLC, Update on IBSVoice Panel, February 23, 2001.
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