Drug treatment of irritable bowel syndrome is appropriate for patients with disabling symptoms.
Few drugs have been adequately studied for treating the syndrome, however. In general, drugs do not work very well for patients with IBS, but several agents seem to help at least some patients.
Treatment should be tailored based on whether the IBS is diarrhea predominant or constipation predominant and whether the patient has anxiety-related symptoms, abdominal pain, or impaired social function.
Treatment should also include supportive care accompanied by patient education and recommendations for lifestyle and dietary changes. Over-the-counter treatments, including psyllium-based fiber therapy, should be tried before advancing to a prescription drug. Psychological treatment is also effective for many patients.
Misoprostol is contraindicated during pregnancy and dicyclomine is contraindicated for nursing women. No dose adjustment of the other listed drugs is specifically required for patients who are pregnant, breast-feeding, or elderly. But these drugs should be used with caution in these patients.
Editor's Note:
In February, the Food and Drug Administration approved the marketing of alosetron (Lotronex) for the treatment of women with diarrhea-predominant IBS. It is the first approved agent from a new class of IBS drugs, the 5-hydroxytryptamine-3 receptor antagonists. Also in advanced development are drugs from another new class, the 5-hydroxytryptamine-4 agonists, which appear to help women and men with constipation-predominant IBS.
(*.)Cost is based on the average wholesale price for a 100-unit container, or closest available size, of the generic formulation, unless otherwise indicated, in the 1999 Red Book.
(**.)Cost is based on the average wholesale price provided by the manufacturer of a 527-g container.
(+.)The comments reflect the viewpoints and expertise of the following sources:
Dr. Richard Birtwhistle, professor of family medicine, Queen's University, Kingston, Ont.
Dr. Douglas Drossman, professor of medicine and psychiatry; codirector, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill.
Dr. Cynthia Yoshida, internal medicine physician, division of gastroenterology and hepatology, University of Virginia, Charlottesville.
COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group