Irritable Bowel Syndrome Treatments- MPR

Irritable Bowel Syndrome Treatments

IRRITABLE BOWEL SYNDROME TREATMENTS
Generic	Brand		Strength	Form	Usual Dose
5-HT₃ RECEPTOR ANTAGONIST
alosetron HCl	Lotronex	Rx	0.5mg, 1mg	tabs	Adults: 0.5mg twice daily; may increase to 1mg twice daily after 4wks if needed. If constipation occurs, discontinue until constipation resolves, then restart at 0.5mg once daily. Discontinue if constipation recurs or inadequate symptom control after 4wks of treatment at 1mg twice daily. Children: Not recommended.
ANTICHOLINERGICS
dicyclomine HCl	—	Rx	10mg/5mL	syrup	Adults: Initially 20mg 4 times daily; may increase to 40mg 4 times daily after 1wk if tolerated. Discontinue if not effective within 2wks or daily doses ≥80mg are not tolerated. Inj: Give by IM route only. 10−20mg four times daily for max 1−2 days when oral therapy is not feasible. Children: <6mos: Contraindicated. ≥6mos: Consult manufacturer.
			10mg	caps
			20mg	tabs
	Bentyl Injection		10mg/mL	inj
BARBITURATE + ANTICHOLINERGICS
phenobarbital/ hyoscyamine sulfate/ atropine sulfate/ scopolamine HBr	Donnatal Elixir		Rx	16.2mg/ 0.1037mg/ 0.0194mg/ 0.0065mg per 5mL	liq^1,3	Adults: 5−10mL 3−4 times daily. Children: <10lb (4.5kg): Not recommended. 10lb (4.5kg): Initially 0.5mL every 4hrs or 0.75mL every 6hrs. 20lb (9.1kg):,1mL every 4hrs or 1.5mL every 6hrs. 30lb (13.6kg): 1.5mL every 4hrs or 2mL every 6hrs. 50lb (22.7kg): 2.5mL every 4hrs or 3.75mL every 6hrs 75lb (34kg): 3.75mL every 4hrs or 5mL every 6hrs. 100lb (45.4kg): 5mL every 4hrs or 7.5mL every 6hrs.
	Donnatal Tablets	Rx	16.2mg/ 0.1037mg/ 0.0194mg/ 0.0065mg	tabs	Adults: 1−2 tabs 3−4 times daily Children: Not recommended.
BENZODIAZEPINE + ANTICHOLINERGIC
chlordiazep– oxide HCl/ clidinium bromide	Librax	CIV	5mg/ 2.5mg	caps	Adults: Individualize. Usually 1−2 caps 3−4 times daily before meals and at bedtime. Elderly or debilitated: max 2 caps daily initially, then may increase gradually. Children: Not established.
GI MOTILITY ENHANCER (CHLORIDE CHANNEL ACTIVATOR)
lubiprostone	Amitiza	Rx	8mcg, 24mcg	caps	≥18yrs: Take with food and water. IBS-C (women only): 8mcg twice daily. Severe hepatic impairment (Child-Pugh Class C): initially 8mcg once daily; if tolerated and inadequate response, may escalate to full dose; monitor. <18yrs: Not established.
GUANLYATE CYCLASE-C AGONIST
linaclotide	Linzess	Rx	72mcg, 145mcg, 290mcg	caps	Adults: Take on empty stomach, at least 30mins before a meal, approx. same time each day. IBS-C: 290mcg once daily. Children: <2yrs: Contraindicated. 2–<18yrs: Not established.
plecanatide	Trulance	Rx	3mg	tabs	≥18yrs: IBS-C: 3mg once daily. <6yrs: Contraindicated. 6–<18yrs: Avoid.
MU-OPIOID RECEPTOR AGONIST
eluxadoline	Viberzi	CIV	75mg, 100mg	tabs	Adults: Take with food. IBS-D: 100mg twice daily. Mild or moderate hepatic impairment, moderate or severe renal impairment, ESRD (not on dialysis), concomitant OATP1B1 inhibitors, intolerance to 100mg: 75mg twice daily. Children: Not established.
RIFAMYCIN
rifaximin	Xifaxan	Rx	550mg	tabs	≥18yrs: IBS-D: 550mg three times daily for 14 days. Recurrent episodes: can retreat up to two times with the same dose. <18yrs: Not established.
SODIUM/HYDROGEN EXCHANGER 3 (NHE3) INHIBITOR
tenapanor	Ibsrela	Rx	50mg	tabs	≥18yrs: IBS-C: 50mg twice daily immediately prior to breakfast (or the first meal of the day) and prior to dinner. <6yrs: Contraindicated. 6–12yrs: Avoid. 13–18yrs: Not established.
NOTES
Key: IBS-C = irritable bowel syndrome with constipation; IBS-D = irritable bowel syndrome with diarrhea ¹ contains alcohol; ² dye-free, peppermint flavor; ³ grape flavor Not an inclusive list of medications and/or official indications. Please see drug monographs at www.eMPR.com and/or contact company for full drug labeling. (Rev. 10/2023)

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