Medicine for Diarrhea Predominant Inflammatory Bowel Disease (IBS-D)

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Diarrhea-predominant irritable bowel syndrome (IBS-D) causes frequent, urgent bouts of loose, watery diarrhea, abdominal pain, and cramping. While irritable bowel syndrome (IBS) can also cause diarrhea, it is the central symptom of IBS-D.

There are several medication options that can relieve the symptoms of diarrhea in IBS-D. A few are approved specifically for IBS-D, several are used for the treatment of diarrhea of a variety of causes, and others are used off-label for IBS-D.

Over-the-Counter Medication

If you have IBS-D, over-the-counter anti-diarrhea medications may be effective in relieving your symptoms. However, they can cause serious side effects, so, even though you can get them without a prescription, if you have IBS-D, you should only use over-the-counter anti-diarrhea medication at the direction of your doctor.

  • Imodium (loperamide), an over-the-counter anti-diarrhea medication is taken orally and is usually well-tolerated when used as directed. It works against diarrhea by decreasing the speed of intestinal contractions and the amount of fluid in the large intestine. This results in less urgency and firmer stool. Overuse may cause constipation or a serious side effect called toxic megacolon, which is severe distension (widening) of the colon.
  • Pepto-Bismol, Kaopectate (bismuth subsalicylate) can relieve diarrhea, stomach upset, and indigestion. It prevents diarrhea by reducing the amount of fluid and inflammation in the intestines. It may not be practical if you have prolonged bouts of diarrhea with your IBS-D because is not recommended that you take it for longer than two consecutive days.

Prescription Medications

There are a number of prescription treatments that you can use to relieve your diarrhea in IBS-D, some of which are specifically indicated for the condition, and others which can be effective for a variety of problems, including diarrhea of IBS-D.

FDA approved medications for the treatment of IBS-D:

  • Xifaxan: Xifaxan (rifaximin) can reduce abdominal pain, episodes of diarrhea, and bloating with IBS-D. it is an antibiotic that is not absorbed in the stomach, and its actions are thought to occur locally in the small intestine. It is typically well-tolerated and does not have a harmful impact on bacteria within the large intestine, a concern with some other antibiotics.
  • Viberzi: Viberzi (eluxadoline) can reduce episodes of diarrhea and abdominal pain in IBS-D. It works on opioid receptors within your digestive system to regulate the speed of intestinal contractions, fluid secretion, and pain sensations, and it is labeled a controlled substance because there is a risk that it could become habit-forming.

Antispasmodics/Anticholinergics

Antispasmodic anticholinergic medications are frequently prescribed for the relief of abdominal pain and cramping caused by a number of conditions. These medications target and reduce acetylcholine, a neurotransmitter that stimulates the digestive system. The resulting reduction in secretion of mucus and slowing of the intestines reduces symptoms of diarrhea in IBS-D.

Antispasmodics prescribed for IBS include:

Antidepressants

Although commonly prescribed for the treatment of depression and anxiety, antidepressants can have beneficial effects on IBS-D symptoms. Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may work to reduce symptoms of IBS-D through their action on neurotransmitters in the intestines. Prescribing an antidepressant for IBS is considered off-label for treatment of IBS-D symptoms, but it is commonly used because it can be effective and is generally well tolerated.

Bile Acid Binders

Emerging​ research has indicated that approximately one-third of all cases of IBS-D might be attributable to a condition known as bile acid diarrhea (BAD). For some people episodes of diarrhea occur immediately after eating. Bile acid binders can be used off-label for this condition.

Bile acid binders used to treat IBS-D include:

A Word From Verywell

It may take years for you and your doctors to recognize that you have IBS-D, even if you have already been diagnosed with IBS. The medication treatment strategies can be a little different than for IBS, as you may need little or no medication for constipation, and you may need to take anti-diarrhea medications more frequently. Be sure to take medications only as recommended to avoid side the effects and adverse events that can occur with overuse of anti-diarrhea medicine.

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