The medical treatment of Irritable Bowel Syndrome (IBS) has three main goals:
- Achieving remission (the absence of symptoms)
- Maintaining remission (ease of symptoms or life impacting flare-ups)
- Improving your quality of life
To accomplish these goals, treatment is aimed at controlling the ongoing IBS symptoms. There is no standard approach to managing all people with IBS. The symptoms, severity of disease, and how the disease might impact vary considerably.
Your healthcare provider will work with you to help decide the right treatment for you. It may take some time for medications to take effect, or sometimes a medication may stop working. The management of IBS involves dedication to taking your medications as prescribed, and maintaining open communication with your healthcare team so you can work together towards achieving a better quality of life.
There are many medications available to help control your disease symptoms. IBS medications generally fall into the following categories. View the categories below to learn more about your treatment options.
Medications for IBS
These prescription medications have been FDA approved for marketing for the indication of IBS-D (diarrhea) and/or IBS-C (constipation) and/or Chronic Idiopathic Constipation (CIC).| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Amitiza® | lubiprostone | IBS-C | Prescription | indicated for IBS-C or chronic idiopathic constipation | Link |
| Dicetel® | pinaverium bromide | All IBS types | Prescription | For the treatment and relief of symptoms associated with irritable bowel syndrome (IBS): abdominal pain, bowel disturbances and intestinal discomfort. | Link |
| Ibsrela® / Tenapanor® | NHE3 | IBS-C | Prescription | Non-systemic small molecule inhibitor of NHE3, a sodium transporter present on the epithelia surface of the GI tract. Reduces the absorption of dietary sodium and phosphorus thereby relieving IBS-C. | Link |
| Linzess® / Constella® | linaclotide | IBS-C | Prescription | To treat irritable bowel syndrome with constipation (IBS‑C) and chronic idiopathic constipation (CIC). | Link |
| Lotronex® | alosetron | IBS-D | Prescription | For some women with severe irritable bowel syndrome (IBS) whose main problem is diarrhea; whose IBS symptoms have lasted 6 months or longer and have not been helped enough by other treatments. | Link |
| Motegrity® / Resolor® / Resotran® / Prudac® / DuphaPro® | prucalopride | CIC | Prescription | Prokinetic agent that works by targeting the serotonin (5-HT4) receptors in the intestines. Used for the treatment of chronic idiopathic constipation in women for whom laxative treatment has failed to provide relief by stimulating the muscle movement. Motegrity™ and Resotran™ are only approved in the US and the Canada respectively for chronic idiopathic constipation (CIC). | Link |
| Pizensy® | lactitol | CIC | Prescription | Osmotic laxative. recommended dosage of 20 grams orally daily. Reduce the dosage to 10 grams daily for persistent loose stools. | |
| Trulance® / Plecanatide® | guanylate cyclase-C agonist | IBS-C | Prescription | Stimulate digestive fluid movement and support regular bowel function. Trulance (plecanatide) is approved for the treatment of IBS-C and Chronic Idiopathic Constipation (CIC) in adult patients in the United States. | Link |
| Viberzi® / Truberzi® | eluxadoline | IBS-D | Prescription | Used to treat men and women adults who have irritable bowel syndrome with diarrhea (IBS-D). Truberzi® was recently approved for use in the European Union. | Link |
| Xifaxan® / Zaxine® / Xifaxnta® / Xifapil® / Ciboz® | rifaximin | IBS-D | Prescription | Antibiotic indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. | Link |
| Zelnorm® | tegaserod | IBS-C | Prescription | Indicated for IBS-C for women under 65. Prokinetic agent that works by targeting the serotonin (5-HT4) receptors in the intestines. | Link |
Antidepressants / Central Neuromodulators
Physicians may prescribe an antidepressant, also known as a central neuromodulator, to an IBS patient as an "off-label" use, as no antidepressant has received FDA approval as an IBS treatment. There is research which supports two classes of antidepressants TCAs and SSRIs, in treating symptoms associated with IBS. Antidepressants have been found to have a positive effect on gut motility and visceral hypersensitivity.| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Celexa® | citalopram | IBS-C | Prescription | Selective Serotonin Reuptake Inhibitor (SSRI). May alleviate the abdominal pain and associated symptoms of IBS. Side effect of diarrhea may be helpful for IBS-C. | Link |
| Cymbalta® | duloxetine | IBS-A | Prescription | Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Helpful for managing pain and maybe for constipation or diarrhea. Effective in treating pain like the TCA's but without the side effects of TCA's. | Link |
| Desyrel® | trazodone | IBS-D | Prescription | Serotonin antagonist and reuptake inhibitor (SARI). | Link |
| Effexor® | venlafaxine | IBS-A | Prescription | Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Helpful for managing pain and maybe for constipation or diarrhea. Effective in treating pain like the TCA's but without the side effects of TCA's. | Link |
| Elavil® | amitriptyline | IBS-D | Prescription | Tricyclic antidepressant (TCA). Usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. Common side-effect of constipation can be helpful for IBS-D. | Link |
| Lexapro® | escitalopram | IBS-C | Prescription | Selective Serotonin Reuptake Inhibitor (SSRI). May alleviate the abdominal pain and associated symptoms of IBS. Side effect of diarrhea may be helpful for IBS-C. | Link |
| Lyrica® | pregabalin | IBS-A | Prescription | Treats pain caused by fibromyalgia and neuropathic pain. Also treats abdominal pain and potentially bloating and diarrhea in IBS. | Link |
| Norpramin® / Pertofrane® | desipramine | IBS-D | Prescription | Tricyclic antidepressant (TCA). Usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. Common side-effect of constipation can be helpful for IBS-D. Less unwanted side-effects than Elavil®. | Link |
| Pamelor® / Aventyl® | nortriptyline | IBS-D | Prescription | Tricyclic antidepressant (TCA). Usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. Common side-effect of constipation can be helpful for IBS-D. Less unwanted side-effects than Elavil®. | Link |
| Paxil® | paroxetine | IBS-C | Prescription | Selective Serotonin Reuptake Inhibitor (SSRI). May alleviate the abdominal pain and associated symptoms of IBS. Side effect of diarrhea may be helpful for IBS-C. | Link |
| Pristiq® | desvenlafaxine | IBS-A | Prescription | Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Helpful for managing pain and maybe for constipation or diarrhea. Effective in treating pain like the TCA's but without the side effects of TCA's. | Link |
| Prozac® | fluoxetine | IBS-C | Prescription | Selective Serotonin Reuptake Inhibitor (SSRI). May alleviate the abdominal pain and associated symptoms of IBS. Side effect of diarrhea may be helpful for IBS-C. | Link |
| Remeron® | mirtazapine | IBS-D | Prescription | Noradrenergic and specific serotonergic antidepressant (NaSSA). Can also be classified as a tetracyclic antidepressant (TeCA). | Link |
| Savella® | milnacipran | IBS-A | Prescription | Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). Helpful for managing pain and maybe for constipation or diarrhea. Effective in treating pain like the TCA's but without the side effects of TCA's. | Link |
| Silenor® | doxepin | IBS-D | Prescription | Tricyclic antidepressant (TCA). Also used as a sleep aid. | Link |
| Tofranil® | imipramine | IBS-D | Prescription | Tricyclic antidepressant (TCA). Usually recommended when antispasmodic medicines have not been able to control the symptoms of pain and cramping. Common side-effect of constipation can be helpful for IBS-D. | Link |
| Wellbutrin® / Zyban® | bupropion | IBS-D | Prescription | Norepinephrine-dopamine reuptake inhibitor (NDRI). | Link |
| Zoloft® | sertraline | IBS-C | Prescription | Selective Serotonin Reuptake Inhibitor (SSRI). May alleviate the abdominal pain and associated symptoms of IBS. Side effect of diarrhea may be helpful for IBS-C. | Link |
Probiotics and Antibiotics
Probiotics are good bacteria that are thought to provide a health benefit including healthy digestion. Probiotics are increasingly being used and evaluated in the management of digestive health. Some antibiotics may make probiotics less effective. Antibiotics are a new class of prescription treatment for IBS. It is thought to work by its anti-inflammatory and antibacterial properties and additionally, it is a nonabsorbable antibiotic that acts locally in the gut, and considered to have less side effects to the whole body. Also see FDA approved antibiotic medications here.| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Alflorex® | bifidobacterium infantis 35624 | All IBS types | Over-the-counter | Probiotic that delivers "good" bacteria to your digestive system to relieve abdominal pain, bloating, urgency, constipation or diarrhea. | Link |
| Align® | bifidobacterium infantis 35624 | All IBS types | Over-the-counter | Probiotic that delivers "good" bacteria to your digestive system to relieve abdominal pain, bloating, urgency, constipation or diarrhea. | Link |
| Bimuno® | galacto-oligosaccharides (B-GOS) | All IBS types | Supplement | Bimuno® is a prebiotic supplement and is the result of an on-going research and development programme conducted in collaboration with the University of Reading’s Food Microbial Sciences Unit and other globally recognised research institutes. Bimuno® contains a mixture of unique, patented galacto-oligosaccharides (B-GOS). B-GOS belongs to a special group of nutrient fibres (oligosaccharides) also found in maternal milk that naturally feed and stimulate the growth of friendly bacteria in the gut. | Link |
| Florastor® | saccharomyces boulardii | IBS-D | Over-the-counter | Probiotic derived from yeast. Normalizes intestinal flora and relieves diarrhea. | Link |
| TuZen® | lactobacillus plantarum 299v | All IBS types | Over-the-counter | TuZen increases the population of "good" lactobacillus plantarum 299v (Lp229v) bacteria, increases the concentration of carboxylic acids, an important energy source for the cells of the intestinal mucosa, inhibits the adhesion of a "bad" bacteria (Enterobacteria) on the intestinal mucosa and inhibits the growth of potential pathogenic agents (antibacterial activity). Additional relief may also be a result of TuZen's proven effectiveness as an anti-inflammatory. | Link |
| Visbiome® | 8 strains of lactic acid bacteria | All IBS types | Over-the-counter | Probiotic medical food is designated for the dietary management of IBS. It is a prescribable medicine and should not be confused with an over-the-counter probiotic. It must be used under medical supervision and may be dispensed by a pharmacist. | Link |
| Xifaxan® / Zaxine® / Xifaxnta® / Xifapil® / Ciboz® | rifaximin | IBS-D | Prescription | Antibiotic indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. | Link |
Antispasmodics
Antispasmodics relax abdominal muscle spasms where pain and cramps occur. They are usually taken before meals.| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Anaspaz® / Levsin®/ Levbid® / Nulev® | hyoscyamine sulfate | All IBS types | Prescription | antispasmodic medication for relieving abdominal discomfort and pain due to cramps and spasms. | Link |
| Bentyl® / Bentylol® | dicyclomine hydrochloride / dicycloverine hydrochloride | All IBS types | Prescription | antispasmodic which relieves smooth muscle spasm of the gastrointestinal tract (May be over the counter in some countries.) | Link |
| Buscopan® / Buscapina® | hyoscine butylbromide | All IBS types | Over-the-counter | antispasmodic medication for relieving abdominal discomfort and pain due to cramps and spasms. (May require a physician's prescription in some countries.) | Link |
| Colofac® | mebeverine | All IBS types | Prescription | musculotropic agent that reduces intestinal peristalsis | Link |
| Colpermin® | peppermint oil | All IBS types | Over-the-counter | Relives abdominal cramp, spasms and bloating of IBS. | Link |
| Donnatal® | phenobarbital, hyoscyamine sulfate, atropine sulfate, scopolamine hydrobromide | All IBS types | Prescription | Slows the natural movements of the gut by relaxing the muscles in the stomach and intestines and acts on the brain to produce a calming effect. | Link |
| Librax® | chlordiazepoxide, clidinium | IBS-A | Prescription | A benzodiazepine which reduces stomach acid and decreases intestinal spasms. | Link |
| Modulon® | trimebutine maleate | All IBS types | Prescription | Regulates abnormal intestinal activity. | Link |
| Normaxin® | clidinium, chlordiazepoxide, dicyclomine | All IBS types | Prescription | Helps relieve, prevent and lower the incidence of muscle spasms, particularly the smooth muscles of the bowel wall. | Link |
| Pamine® / Pamine Forte® | methscopolamine bromide | All IBS types | Prescription | Slows the natural movements of the gut and relaxes the muscles in the stomach/intestines. | Link |
| Pepogest® | peppermint essential oil | All IBS types | Over-the-counter | Relives abdominal cramp, spasms and bloating of IBS. | Link |
| Spasmonal® | alverine citrate | All IBS types | Prescription | An “anti-spasmodic” medicine. It relaxes the muscles in the intestine (gut). | Link |
Antidiarrheal Agents
Antidiarrheal agents work to help restore the digestive system to its normal pace. Some slow down the colon to allow for more liquid to be absorbed and/or slow down the contractions which move food materials. Some also work to bind to substances which might otherwise contribute to diarrhea.| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Colestid® | colestipol | IBS-D | Prescription | Bile acid sequestrant which binds bile in the gastrointestinal tract to prevent its reabsorption. Commonly used to treat diarrhea resulting from bile acid malabsorption. | Link |
| Imodium® | loperamide | IBS-D | Over-the-counter | Slows down the movement of fluid through the intestines. | Link |
| Lomotil® | diphenoxylate, atropine sulfate | IBS-D | Prescription | Decreases the motion of muscles in the intestines and prolonging the time it takes to move the contents through the body. May be habit forming. | Link |
| Motofen® | difenoxin hydrochloride, atropine sulfate | IBS-D | Prescription | Slows intestinal motility. May be habit forming. | Link |
| Questran® | cholestyramine | IBS-D | Prescription | Bile acid sequestrant which binds bile in the gastrointestinal tract to prevent its reabsorption. Commonly used to treat diarrhea resulting from bile acid malabsorption. | Link |
Laxatives and Constipation related
Laxatives are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. Certain osmotic, stimulant, lubricant and saline laxatives are used to evacuate the colon for rectal and bowel examinations, and may be supplemented by enemas under certain circumstances. Sufficiently high doses of laxatives may cause diarrhea. Also see FDA approved constipation medications here.| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Metamucil® | psyllium | IBS-C | Supplement | Psyllium is a bulk-forming fiber laxative. Psyllium works by absorbing liquid and swelling in the intestines to create a softer, bulky stool that is easier to pass. | Link |
| Miralax®, Glycolax® | polyethylene glycol | IBS-C | Over-the-counter | Polyethylene glycol is an osmotic laxative. Polyethylene glycol works by retaining water in the stool, resulting in softer stools and more frequent bowel movements. | Link |
| Cytotec® | misoprostal (prostaglandin analog) | CIC | Prescription | Works as a bowel stimulant. Should not be used if you are pregnant. | Link |
| Lactulose | synthetic sugar | CIC | Over-the-counter | Stool softener that pulls water into the bowel. | Link |
Medical Foods
While medical foods do not need approval in the same way as prescription medications, they do have the FDA designation as a Medical Food. A medical food is specially formulated to be consumed or administered enterally (orally) under the supervision of a physician. Medical foods are intended for specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.| Brand Name | Generic name | IBS type | Type | Comments | |
|---|---|---|---|---|---|
| Atrantil® | peppermint, quebracho, and horse chestnut extract | All IBS types | Over-the-counter | Patented combination of natural polyphenols which reduces bloating and supports digestive health. Active ingredients are peppermint, quebracho, and horse chestnut extract. | Link |
| Culturelle® IBS Complete Support | human milk oligosaccharides (HMOs) | All IBS types | Over-the-counter medical food | Medical food which is clinically shown to relieve abdominal pain, bloating, constipation and diarrhea due to IBS. | Link |
| EnteraGam® | serum-derived bovine immunoglobulin/protein isolate | IBS-D | Prescription | Medical food for chronic loose or frequent stools (IBS-D). | Link |
| Enterosgel® | polymethylsiloxane polyhydrate | IBS-D | Over-the-counter | Intestinal adsorbent which sequesters harmful molecules and is safe and effective in acute infective diarrhea. It improves stool consistency, frequency, and abdominal pain. (Clinical Research: https://gut.bmj.com/lookup/doi/10.1136/gutjnl-2022-327293) | Link |
| IBgard® | Ultramen®, an ultra-purified peppermint oil | All IBS types | Over-the-counter | Targeted technology to deliver peppermint oil directly to the small intestine | Link |
| Holigos® | human milk oligosaccharides (HMOs) | All IBS types | Over-the-counter medical food | Medical food which manages IBS symptoms like abdominal pain, bloating, constipation, and diarrhea. | Link |
Investigational Medications
There remains a significant unmet need for effective treatments particularly for the pain component of IBS and other functional gastrointestinal disorders (FGIDs). There is a promising pipeline of investigational medications for the future treatment of IBS and related FGIDs. These medications are being researched and may be available in clinical trials.| Brand Name | Generic name | IBS type | Comments | |
|---|---|---|---|---|
| Bekinda® | ondansetron | IBS-D | A patent-protected, extended-release (24 hours) oral pill formulation of ondansetron. Ondansetron is a 5-HT3 antagonist. | Link |
| Blautix | All IBS types | Single-strain bacteria that consumes gases which are known to cause bloating, abdominal pain and changes in bowel frequency. | Link | |
| IBset® / Nasea® / Nozia® / Irribow® | ramosetron | IBS-D | Improves abnormal bowel movement associated with the acceleration of intestinal transit by inhibiting 5-HT3 receptor selectively. It also improves visceral hypersensitivity by suppressing the transmission of intestinal nociception. | Link |
| Mytesi® | crofelemer | Chronic Idiopathic Diarrhea | Botanical (plant-based) drug extracted and purified from the red bark sap of the medicinal Croton lechleri tree in the Amazon rainforest. Currently approved for HIV-related diarrhea. | Link |
| ORP-101® | buprenorphine | IBS-D | A buprenorphine dimer therapeutic, is a peripherally active partial mu opioid receptor agonist and K opioid receptor antagonist designed to ease colonic hypersensitivity stemming from intestinal hyperalgesia and motility dysfunction in IBS-D. | Link |
| Pradigastat | ANJ908 | CIC | A first-in-class inhibitor of diacylglycerol acyl transferase 1 (DGAT1). Evaluated for improvements in constipation. | Link |
| Rifamycin-MMX® / Aemcolo® | rifamycin | IBS-D | A broad spectrum, semi-synthetic, orally non-absorbable antibiotic. | Link |
| SMP-100 | 5-HT3 agonist | IBS-D and IBS-A | SMP-100 is a selective serotonin receptor-3 (5-HT3) partial agonist that has a large therapeutic index, better side-effect profile, and the potential to treat a wider spectrum of IBS-D and IBS-A patients. | Link |
Be sure to talk to your doctor about the potential risks and side effects of these medications and weigh them against the potential benefits. We are not able to offer medical, pharmaceutical or nutritional advice. Please consult a healthcare professional.
Source:
National Institutes of Health (NIH)
PubMed – NCBI
Verywell.com
FDA.gov
Last updated on Aug 25, 2022