IBS Pharmacotherapy

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Author:
pcspstudent
ID:
176888
Filename:
IBS Pharmacotherapy
Updated:
2012-10-10 19:51:34
Tags:
IBS
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Description:
Treatment guidelines for IBS
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  1. Clinical Presentation of IBS
    • 1. Diarrhea predominant in >3 stools per week
    • 2. Constipation predominant: <3 stools per week
    • 3. Lower abdominal pain
    • 4. Mucus passage
    • 5. Abdominal bloating/distension
  2. Most Common Etiology of IBS
    Women, caucasian, <50yo
  3. Mann Criteria
    • Chronic or recurrent abdominal pain for at least 6 months and two or more of the following:
    • 1. Abdominal pain relieved with defication
    • 2. Abdominal pain associated with looser stools or more frequent stools
    • 3. Abdominal distension
    • 4. Mucus in stools
  4. Rome III criteria for IBS
    • Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months and associated with 2 of the following:
    • 1. relieved with defecation
    • 2.Onset associated w. a change in frequency or form of stool
  5. Treatment of Constipation Predominant IBS
    • 1. Dietary modification
    • 2. Bulk forming laxatives
    • 3.Lubiprostone (amitiza)
    • 4. Linaclotide (Linzess)
    • 5. Tegaserod (Zelnorm)
  6. Dietary Modification/ lifestyle modifications in constipation predominant IBS
    • 1. Increased fluid intake (NONCAFFEINATED DRINKS)
    • 2. Increase dietary soluble fiber fiber (20-35mg/day)
    • 3. Be active
  7. Laxatives in the treatment of  constipation predominant IBS
    • 1. Bulk forming: Psyllium soluble fiber (takes a couple of days)
    • 2. Hyperosmotic agen: PEG (miralax) increases water in stool (17g in 8oz of water daily)
  8. Lupiprostone (Amitiza)
    • >Use after fiber/laxative tried
    • >It is a Cl- channel activater that increases intraluminal fluid that softens stool
    • >Approved for: IBS-C in WOMEN 18 YEARS AND OLDER
    • >dose: 8 mcg BID
    • >Side effects: Nausea, diarrhea, flatulence
  9. Linaclotide (Linzess)
    • >Guanylate Cyclase-C agonists (accelerates GI transit time and pain relief)
    • >APPROVED IN IBS-C IN ADULTS (MEN AND WOMEN)
    • >290mcg daily 30 min before food (works within one week)
    • >CONTRAINDICATED IN PEDS
  10. Tegaserod (Zelnorm)
    • >class: Serotonin (5-HT4) agonist
    • >relieves pain and increases bowel frequency
    • >6 mg BID
    • >REMOVED FROM THE MARKET: only available to women with emergency IND
  11. Treatment of Diarrhea Predominant IBS
    • 1. Dietary Modifications
    • 2. Loperamide
    • 3. Antispasmotic
    • 4. Alosetron
    • 5. Rifaximin (not currently indicated but being studied)
  12. Dietary Modifications for Diarrhead Predominant IBS
    • 1. Lactose and caffeine free diet
    • 2. Avoid: herbal teas continaing senna, artificial sweeteners
  13. Loperamide (Imodium)
    • >Class: opiod agonist
    • >Decreases GI motility
    • >4mg initially, then 2 mg after each loose stool
    • >DO NOT EXCEED 16MG/DAY)
    • >Side effects: dizziness, constipation, cramping, nausea
  14. Antispasmotic therapy in IBS
    • >Ex. Dicyclomine(Bentyl) or Hyoscyamine (Levsin)
    • short term relief of abdominal pain and discomfort
    • >side effects: blurry vision, dry mouth, urinary retention, constipation (anticholinergic effects)
  15. Alosetron (Lotronex) in IBS
    • >Class: Serotonin (5HT3) antagonist this class blocks pain, colonic transit, GI secretions
    • >APPROVED FOR USE IN WOMEN WITH SEVERE REFRACTORY IBS-D
    • >Dose: 0.5mg bid x 4 weeks
    • > Side effects: constipation (stop if this occurs), abdominal
    • >on the market WITH RESTRICTIONS (PROMETHEUS)
  16. Rifaximin (Xifaxan) in IBS
    • OFF LABLE FOR IBS W/OUT CONSTIPATION
    • Reduced symptoms and bloating for up to 3 months
    • In trials
  17. Adjunctive Treatment in IBS
    • 1. Probiotics
    • 2. Antidepressants (pain)
    • 3. Pyschotherapy
  18. Probiotics in IBS
    • Bifidobacterium (ADULTS) and lactobacillus (CHILDREN)
    • Take for 4 weeks
    • Normalizes the GI tract
  19. Antidepressants in IBS
    Indicated for PAIN associated with eatting

    • TCAs(diarrhea-predominant IBS with severe abdominal pain) AVOID IN CONSTIPATION (more evidence for this)
    • SSRIs (paroxetine) may improve well being and good if experiencing depression and pain

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