Treating IBS With Viberzi

Viberzi (eluxadoline) is a medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of diarrhea-predominant IBS (IBS-D) in adults. Viberzi was designed to act locally on the digestive tract to help control diarrhea and alleviate abdominal pain caused by the disease.

Customers and female pharmacist in a pharmacy
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While doctors still don't fully understand what causes the recurrent symptoms of IBS (including abdominal pain, bloating, gas, diarrhea, or constipation), Viberzi is able to provide relief to sufferers who don't respond to traditional anti-diarrheal agents.

How Viberzi Works

Viberzi is available by prescription and is designed to be taken by mouth, twice daily, with food. It comes in both a 75-milligram and 100-milligram film-coated tablet.

Viberzi works by activating or impeding various opioid receptors in the digestive tract. These are the receptors involved in gut motility, pain sensation, and the secretion of intestinal fluids. Viberzi is unique in that it stimulates two types of receptors and inhibits another, providing relief without constipation.

These receptors each have different and unique functions:

  • Mu receptors are responsible for gut motility (the contraction of gastrointestinal muscles).
  • Kappa receptors inhibit colon contractions.
  • Delta receptors are associated intestinal secretions.

The addition of a delta receptor antagonist is key to avoiding constipation seen with other drugs such as Imodium (loperamide) and Lomotil (atropine/diphenoxylate), which only affect the mu and kappa receptors.

The FDA approved Viberzi based on two Phase III clinical trials which concluded that the drug offered modest improvement in the frequency and urgency of bowel movements and a modest improvement in abdominal pain and stool consistency.

Drug Side Effects

The side effects of Viberzi are typically gastrointestinal in nature but may also affect other systems due to the opioid effects. In some cases, the symptoms of the drug may trigger the very same ones experienced with IBS. Among some of the more common side effects:

  • Nausea
  • Abdominal pain
  • Upper respiratory tract infection
  • Vomiting
  • Runny or stuffy nose
  • Bloating
  • Bronchitis
  • Dizziness
  • Gas
  • Rash
  • Fatigue

The opioid effect can, in rare cases, affect the sphincter of Oddi (the valve while regulates the flow of bile and pancreatic fluid into the intestines). If this happens, pancreatitis can develop.

As such, Viberzi cannot be prescribed to persons who do not have a gallbladder (the organ that produces bile) or who have pancreatitis, liver impairment, a bile duct obstruction, or severe constipation. Hospitalization and death have been reported in persons without a gallbladder who took as few as two doses of Viberzi.

It should also be avoided in persons who drink more than three alcoholic beverages per day.

An opioid drug, Viberzi has the potential for abuse and/or dependence. It should only be used under the supervision of a doctor. While the effects are far less profound than Oxycontin (oxycodone), it can cause euphoria if abused and lead to opioid dependence.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Özdener AE, Rivkin A. Eluxadoline in the treatment of diarrhea-predominant irritable bowel syndrome. Drug Des Devel Ther. 2017;11:2827-2840. doi:10.2147/DDDT.S127405

  3. Davenport JM, Covington P, Bonifacio L, Mcintyre G, Venitz J. Effect of uptake transporters OAT3 and OATP1B1 and efflux transporter MRP2 on the pharmacokinetics of eluxadoline. J Clin Pharmacol. 2015;55(5):534-42. doi:10.1002/jcph.442

  4. Lacy BE, Chey WD, Cash BD, Lembo AJ, Dove LS, Covington PS. Eluxadoline efficacy in IBS-D patients who report prior loperamide use. Am J Gastroenterol. 2017;112(7):1210. doi:10.1038/ajg.2017.72

  5. MedlinePlus. Eluxadoline.

  6. Lacy BE. Review article: an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(8):817-830. doi:10.1111/apt.14948

  7. Dove LS, Lembo A, Randall CW, et al. Eluxadoline benefits patients with irritable bowel syndrome with diarrhea in a phase 2 study. Gastroenterology. 2013;145(2):329-38.e1. doi: 10.1053/j.gastro.2013.04.006

  8. FDA. FDA warns about an increased risk of serious pancreatitis with irritable bowel drug Viberzi (eluxadoline) in patients without a gallbladder.

By Barbara Bolen, PhD
Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.