Medications for IBS

About Medications for IBS
Constipation Medications
Diarrhea Medications
Other IBS Medications
Supplements for IBS

There's no one and done "IBS pill" that you can take and all your problems will be solved. But there are medications and supplements that can help you manage symptoms or address the underlying drivers of IBS. Research continues and new drugs are in development, so this is a space to watch.

Any product taken for a therapeutic effect should be considered a drug. Use of medications for IBS, whether prescription, over-the-counter, herbs or supplements should be considered carefully and in consultation with your healthcare provider. It may take some detective work to find the right drug and dose for you.

The following sections on IBS medications and supplements are meant as a general overview, to give you an understanding of the treatment options that may be available to you. Keep in mind that recommendations for the management of IBS usually begin with changes to lifestyle and diet.

Find out more about medications and supplements as treatment options for IBS...

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Video Transcript

About Medications for IBS

You may remember from the About IBS section that IBS has been classified as a disorder of the gut/brain axis, but the exact cause is still unknown. However, most people do agree that the cause of IBS is multifactorial, meaning there is more than one.

IBS likely involves an interaction between the GI tract, the nervous system, the immune system, hormones, bacteria in the gut and external factors like stress and diet.

Given that many factors could cause the onset of IBS, there is no one medication that will work for everyone with IBS. There is no "cure". But there are many types of medications available for treating IBS. Some of them only address a particular digestive symptom, while others address multiple symptoms or the overall dysfunction that underlies IBS.

Should You Take Meds for IBS?

Recommendations for the management of IBS usually begin with changes to lifestyle and diet. Medications do have a place in IBS management, but they shouldn't be your only strategy.

Meds can be useful when you are beginning your IBS recovery journey, for flare ups that may happen from time to time, if you're still suffering after trying lifestyle and diet changes or for treating the underlying drivers of IBS.

Ultimately, taking meds for IBS is a personal decision and one that should be made with your doctor. Keep in mind that there is no one fits all cure for IBS.

Talk to Your Doctor

It's a good idea to talk to your doctor about over-the-counter (OTC) or prescription drugs and supplements if you're thinking you'd like to go that route. Your doctor can tailor meds to your particular symptoms and help you weigh the pros and cons associated with particular meds.

Talking to your doctor before taking meds for IBS is particularly important if you also have another health condition and/or you're taking other medications.

There are many different medications that could be proscribed for IBS and everyone’s reaction to these medications will also be different. What works for some may not work at all for others. Finding meds that work for your particular case may involve some trial and error.

Track Your Symptoms

Because there is no one and done pill to cure IBS and some detective work might be necessary to find the right meds for you, it's important to track your IBS symptoms.

Create a before and after record of your symptoms, so you can see if or how well the medication is working. Information is power, so the more detailed and time sensitive you can be the better.

The following sections are for informational purposes only!

Talk to your doctor before you use any medications or supplements to manage your IBS, especially if you have another condition and/or are on other meds.

Make sure to follow instructions for dosage, frequency and duration.

Constipation Medications

Lifestyle and dietary changes are recommended as a first line treatment for IBS and are usually enough to manage mild to moderate IBS-C symptoms. But if your symptoms do not improve or even worsen, you may want to look into medications.

Over the counter (OTC) medications are usually recommended for short term/occasional use. They can be useful while you make your lifestyle changes and for flare ups.

If your symptoms are still unresolved, there are also a number of prescription drug options. Talk to your doctor and be prepared for a little detective work to find something that may work for you.

This section focuses on meds for constipation. Go to Other IBS Medications for more options.

OTC Meds for Constipation

A laxative is a drug that increases bowel function and helps you poop. Most laxatives are not a long-term solution for constipation. They're meant to be used for short-term relief and overuse can cause a number of issues. Some laxatives might be used longer-term, but this requires consultation with your doctor.

There are many laxatives available without a prescription. There may be generic brands that cost less. The following are commonly used types.

Osmotic Laxatives

If increasing fibre in the diet has not had the desired effects, this type of laxative is usually the starting point for most people. They work by pulling water into the intestines to bulk up stool and create movement. They can be helpful, but creating bulk may not be helpful for everyone e.g. pelvic floor dysfunction.

Osmotic laxatives could also interact with other meds. Side effects could include diarrhea, cramping, bloating or nausea. Be sure to stay hydrated. They could cause bloating, so it might be best to take before bed for a bowel movement in the morning.

Magnesium

Not all forms work as a laxative, must be poorly absorbed
E.g. milk of magnesia, magnesium oxide, magnesium citrate

Peg 3350

Has been evaluated in clinical trials for IBS-C and not everyone agrees on its effects
Does not improve abdominal pain of IBS
Good safety profile, good efficacy for longer term use
E.g. Clearlax, Laxaday, MiraLAX

Glycerin Suppositories

Work locally in the rectum and good for clearing out hard stool

Stool Softeners

These laxatives soften stool, but don't directly stimulate the bowels. Some patients report they're helpful, but they aren't proven very effective in the literature.

E.g. Docusate

Stimulant Laxatives

These laxatives increase contractions of muscles in the intestine and help stool pass through the colon more quickly. They can be found as OTC meds or herbal preparations.

There has been some controversy over the last few years that they may cause damage to the lining and the nerves of the intestines, but recent reviews of the literature are showing that this isn't the case (castor oil may be an exception so best to steer clear). Side effects could include cramping, pain and urgency to poop.

Bisacodyl

Stimulant and osmotic laxative
E.g. Dulcolax, Correctol

Senna

E.g. Senokot, Ex-Lax
Sometimes combined with stool soften e.g. Senokot-S

Cascara

Herbal remedy made from aged bark of buckthorn tree and sometimes combined with senna

Prescription Meds for Constipation

Prosecretory Agents

The following drugs help to increase fluid, and therefore movement, in the intestines. They are the result of newer research and are now being recommended instead of stimulant laxatives. They have a better long term safety profile and have been shown to be effective in the treatment of IBS, improving pain, discomfort and bloating in addition to constipation.

Lubiprostone (Amitiza)

Generally prescribed only for women with severe symptoms with no response to other treatments
Shown to be effective for men, although fewer participated in drug trials
Direct mechanism of pain relief unknown, it has been proven to relieve overall IBS symptoms in multiple trials
Side effects include nausea and diarrhea.

Linaclotide (Linzess) and Plecanatide (Trulance)

Work in similar way and have been shown to decrease overall IBS symptoms
Reduce abdominal pain by decreasing the activity of pain sensing nerves
Work mainly in GI tract so less risk of interactions with other drugs
Most common side effect is diarrhea

Retainagogues

This is a fancy way of saying that these drugs block the absorption of sodium from food and drink in the GI tract. This means that more water stays in the intestines, which can create softer stools and help speed up transit time. These drugs have also been shown to reduce pain and other abdominal symptoms like bloating.

Tenapanor (Ibsrela)

Multiple studies for IBS-C and recently approved by FDA
Shown to improve visceral hypersensitivity and pain
Most common side effects noted in clinical trials include diarrhea, abdominal distention and gas

Prokinetics

These drugs boost movement in your digestive system by strengthening muscle contractions and coordinating gut activity. They do this by mimicking the neurotransmitter serotonin. Serotonin is involved in gut secretions like mucus, motility and sensation (physical feelings or perceptions). Serotonin receptors in the GI tract appear to be a good target for treating IBS symptoms.

Currently, Tegaserod is the only one that has been studied specifically for IBS-C.

Tegaserod (Zelnorm)

Shown to improve pain and bloating and increase bowel movements
Only approved for women with IBS-C under the age of 65 and low cardiovascular risk
Side effects include headaches, dizziness, joint pain and abdominal symptoms

Prucalopride (Resotran)

Currently no completed trials for IBS-C
Long term safety unclear

Metaclopramide

Currently no completed trials for IBS-C
Used for stomach emptying and nausea

Diarrhea Medications

Lifestyle and dietary changes are recommended as a first line treatment for IBS and are usually enough to manage mild to moderate IBS-D symptoms. But if your symptoms do not improve or even worsen, you may want to look into medications.

Over the counter (OTC) medications are usually recommended for short term/occasional use. They can be useful while you make your lifestyle changes and for flare ups.

If your symptoms are still unresolved, there are also a number of prescription drug options. Talk to your doctor and be prepared for a little detective work to find something that may work for you.

This section focuses on meds for diarrhea. Go to Other IBS Medications for more options.

OTC Meds for Diarrhea

Loperamide (Imodium)

Opioid receptor agonist (stimulates opioid receptors)
A few studies have shown it solidifies loose stool and reduces frequency of diarrhea
Not shown to have beneficial effect on pain or bloating
Side effects include abdominal pain and constipation
Can use situationally for relief of IBS-D, but other meds may be more beneficial

Bismuth Subsalicylate (Pepto Bismol, Kaopectate)

Mechanism of action complex - antimicrobial and stimulates reabsorption of fluids
Primarily addresses loose stools
Not as effective for other IBS symptoms like chronic belly pain or severe bloating.
Recommended for short-term use (up to 2 days) to manage acute flares
Long-term use is not advised due to potential fluid/electrolyte imbalances and toxicity risks
Can use situationally for relief of IBS-D, but other meds may be more beneficial

Prescription Meds for Diarrhea

Serotonin Blockers

Alosetron (Lotronex)

Slows motility and the movement of stool through the colon
Generally proscribed for severe IBS-D that hasn't responded to other treatments
Pulled for association with injury to the colon and severe constipation, but now back on the market

Ondansetron (Zofran)

Generally used to treat nausea and vomiting, but also slows motility
Few clinical studies show it may help IBS-D

Dual Action Opioids

Eluxadoline (Viberzi)

Improves abdominal pain, diarrhea, bloating urgency, frequency and incontinence
Similar to loperamide, but better efficacy for IBS-D
Targets cells in the GI tract, unlike traditional opioid pain killers that affect central nervous system
Generally well tolerated, but has been linked to some serious side effects in certain people

Antibiotics

Rifaximin (Xifaxan)

How it works unknown, but may help balance gut bacteria and decrease bacterial overgrowth
Acts locally in gut, low risk of toxicity or side effects (could cause nausea)
Used to treat diarrhea, bloating, and abdominal pain
Best for people who have tested positive for SIBO

Bile Acid Binders

Cholestyramine (Prevalite), Colestipol (Colestid) and Colesevelam (Welchol)

Used to treat bile acid malabsorption (BAM) - also called bile acid diarrhea
Bile acids not absorbed properly in colon cause watery stool, urgency and fecal incontinence
You can have both IBS and BAM (BAM occurs in 25-33% of people with IBS-D)
Side effects include constipation and bloating

Other IBS Medications

Some medications are not type specific and target global symptoms of IBS, including abdominal pain.

The following prescription medications are more helpful for moderate to severe cases of IBS, when life style changes aren't enough and pain is the most distressing issue.

Be aware that the effectiveness of various medications is different for everyone and side effects must be considered. A medication regimen should be carefully chosen by you and your healthcare provider and it may take a bit of detective work to find the right drug and the right dose.

Neuromodulators

Neuromodulators change the activity of neurons (nerve cells). In the brain they affect how it communicates and functions and in the gut they work by regulating communication along the gut-brain axis to manage essential functions like motility, sensation, secretion, and immune responses.

There's a lot of stigma around these drugs because of the stigma around mental health issues, but there's evidence they could help with abdominal pain and general IBS symptoms.

These drugs often affect GI symptoms at lower dosages than what is usually used to treat depression or anxiety, so it's important to find the right dose. A lower than typical dose may be recommended for an IBS patient who doesn't have anxiety and/or depression

The following neuromodulators are the ones most commonly used to treat IBS symptoms:

SNRI (Serotonin and Norepinephrine Reuptake Inhibitor)

Can be considered primary treatment for painful functional GI disorders like IBS
Affects only serotonin and norepinephrine, so may have less side effects than TCAs
Less constipating than TCAs (better for IBS-D)
Venlafaxine, Duloxetine

TCA (Tricyclic Antidepressant)

Mechanism of action not completely understood in IBS, but some agreement across international guidelines that TCAs are effective for treating pain and multiple IBS symptoms
Imipramine, desipramine, nortriptyline, amitriptyline
Side effects can include drowsiness, blurred vision, dizziness, dry mouth, sexual dysfunction, weight gain

SSRI (Serotonin Reuptake Inhibitor)

May help manage pain, constipation and mood, but more likely to cause diarrhea
However, recommendations for using SSRIs aren't always in agreement
Fluoxetine, paroxetine citalopram, sertaline
The risk of side effects with these drugs are often milder than the TCAs.
Common side effects of SSRIs include drowsiness, dry mouth, diarrhea, headaches, blurred vision, reduced sexual desire.

Antispasmodics

An antispasmodic is a medication that relieves or prevents involuntary muscle contractions (spasms), especially in the smooth muscles of the digestive or urinary tract. They work by relaxing these internal muscles, reducing pain and discomfort from excessive tightening.

Buscopan (Hyosine), Dicetel (Pinaverium bromide) and Bentyl (Dicyclomine)

Some data to support use in IBS - overall symptom improvement and abdominal pain
Usually prescribed to take as needed, but most research based on 3x per day
Simethicone + Buscopan performs better for bloating
Side effects include dry mouth, nausea, constipation

Pain Medications

Gabapentin or Pregabalin

Normally used to manage neuropathic pain disorders
May help with IBS symptoms and abdominal pain, but more study is needed

The abdominal pain associated with IBS is different from other types of pain and requires special management. Certain conventional drugs for relieving pain, like NSAIDs, acetaminophen, aspirin, and various narcotics, have not been shown to significantly help with IBS pain.

Supplements for IBS

There are a number of over the counter supplements that may help you manage your IBS symptoms. Remember that what helps someone else may not help you, so some detective work is required here as well. Make sure you follow dosage instructions and don't hesitate to discuss supplements with your doctor, especially if you have another condition and/or you are taking other medications.

The brand names listed here are only for guidance. You will find them under many other names and they will vary, especially country to country.

Fibre Supplements

Fibre, especially soluble fibre, can help with both constipation and diarrhea. When starting a fibre supplement, it's important to start at a low dose, increase over time and stay hydrated.

For more on fibre go to Fibre and IBS in the Tips for Healthy Eating section.

There are many fibre supplements to choose from. The following fibre supplements are the most common and also low FODMAP.

Psyllium

Psyllium husk is a natural fibre from plantago ovata, a medicinal herb
Source of both soluble and insoluble fibre
Powder form - 1 slightly heaping tsp. in 1 cup water up to 3x daily (texture may be an issue)
Capsules - about 5 up to 4x daily (can be expensive)
Main ingredient in Metamucil (Gummies may contain inulin, which isn't low FODMAP)
Has been shown to be effective for diarrhea, but evidence not as strong as for constipation

Methylcellulose

Non fermentable soluble plant fibre
Good evidence for use in constipation
Main ingredient in Citrucel

Partially Hydrolyzed Guar Gum (PHGG)

Soluble fibre from guar beans
May be more helpful for diarrhea
Main ingredient in Fibre4, Sunfiber

Peppermint Oil

Several studies have found that peppermint oil is associated with a reduction in abdominal pain and overall IBS symptoms. Other studies found it was no more effective than a placebo. But used properly, it is low risk and worth a try for symptom management.

Peppermint oil is a smooth muscle relaxant and may also have antimicrobial and anti-inflammatory effects. It is thought to work by decreasing gut related spasms and cramping. The predominant side effect is reflux, although using enteric coated capsules (like IBguard) may help as this means the oil is not released until it reaches the small intestine.

Studies are usually done with 182 mg of enteric coated peppermint oil either once a day before a meal or 3 times per day before meals, although the exact dosage for maximum effect is still unclear. However, it's not meant to be taken like a "pain killer". There is no evidence that peppermint tea helps with IBS.

Probiotics

Overall there appears to be a positive signal for the benefit of probiotics, but more research is needed to make recommendations as to the most effective probiotic for each individual. For more info go to the Probiotics section.

Digestive Enzymes

There are a few types of digestive enzymes that may help your IBS symptoms. But keep in mind that these enzymes target particular short chain carbs that might be causing problems in your large intestine. Discovering if you have an issue with one or more of these particular carbs is actually the goal of the low FODMAP elimination diet.

Dietary enzymes can mean less food restrictions, but the following enzymes will only help if you have an issue with that particular carb (FODMAPs). More generalized enzymes that break down carbs, like lipase or amylase, are not recommended for IBS.

Lactase

For lactose intolerance (dairy products)

Alpha-Galactosidase

For galacto-oligosaccharide (GOS) intolerance (found in foods like beans and nuts)
Brand name Beano

Mixed Enzymes

For lactose, GOS and fructan intolerance (found in foods like onions and garlic).
Brand name FODZYME, Fodmate
FODZYME is currently working on an enzyme for polyols, so stay tuned!

Melatonin

A few studies have shown that melatonin may lessen abdominal and rectal pain, although results were mixed for reducing overall IBS symptoms. It's also possible that improving sleep may improve how IBS symptoms are perceived. For more info go to Sleep and IBS

Melatonin may be most helpful for shift workers, who are at a higher risk for IBS (possibly due to a disruption in circadian rhythm)

A dose of 3mg has been shown to be safe, with minimal possible side effects (sleepy during the day and nausea).

Cannabis

At this time more research is needed before recommendations can be made about cannabis and IBS. However, research is ongoing and it's a space to watch.

For more info go to Cannabis and IBS.

Glutamine

Glutamine is the most abundant naturally occurring amino acid in the human body and is considered to be "conditionally essential". Your body usually produces enough, but in times of stress, illness or injury the demand might be more than the supply. Glutamine is also the preferred fuel source for cells in the intestines and is necessary for the health of the gut walls.

However, the evidence is too limited at the present time to make recommendations about its use for IBS or gut health in general. Glutamine is considered to be low risk at recommended doses, but could cause digestive discomfort at high doses.

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Medications for IBS

About Medications for IBS
Constipation Medications
Diarrhea Medications
Other IBS Medications
Supplements for IBS