Treating Irritable Bowel Syndrome (IBS) and Diarrhea
Prescription Drugs for IBS continued...
Common side effects of these antidepressants include dry mouth, blurred vision, and constipation.
Studies show that tricyclic antidepressants can improve abdominal pain, says Philip Schoenfeld, MD, MSEd, MSc. He is co-author of the American College of Gastroenterology's treatment guidelines.
When IBS patients come into her office, Beth Schorr-Lesnick, MD, FACG, a gastroenterologist at the Montefiore Medical Center in Bronx, New York, tries to review each individual's symptoms to determine the right treatment. Many times, she starts off patients with an antispasmodic drug such as Levbid or Bentyl.
Antispasmodics "relax the smooth muscle of the gut," says Schorr-Lesnick. She says muscle spasms and gas in the gut cause much of the pain IBS. Sometimes, she prescribes the antispasmodic and antidepressant together to relieve abdominal cramping.
Side effects of most antispasmodics include decreased sweating, constipation, and dryness of the mouth, nose, throat, or skin. The American College of Gastroenterology guidelines found that there isn't enough evidence to make a recommendation about antispasmodics.
On the other hand, the experts found that the prescription drug Lotronex to be effective for treatment of all symptoms associated with IBS with diarrhea, including abdominal pain and distress, urgency, and diarrhea. The finding, however, was only relevant to female patients.
Lotronex works to block the body chemical serotonin's effect on the digestive system. Serotonin's role in the development of IBS is uncertain, but researchers do know Lotronex somehow calms down the colon and slows down the frequency of bowel movements.
In 2001, the FDA pulled Lotronex from the market, due to its high risk of side effects. As of March 2002, the agency recorded at least 84 cases of ischemic colitis, and 113 cases of serious complications of constipation (needing hospitalization) in connection with the medication. The severe side effects resulted in four deaths.
Yet Lotronex had gained strong support among doctors and patients who saw its value in treating IBS with diarrhea. Because of this, in June 2002, the FDA brought back the drug with several restrictions.
Physicians now need to be enrolled in a special program to prescribe Lotronex. The drug is approved only for women with severe, diarrhea-predominant IBS who have not responded to other treatments.
Patients who are considering Lotronex need to seriously consider the benefit of the drug with its risks, says Schoenfeld.