Table of ContentsView AllTable of ContentsOver-the-Counter Medications for IBS-DPrescription Medications for IBS-D
Table of ContentsView All
View All
Table of Contents
Over-the-Counter Medications for IBS-D
Prescription Medications for IBS-D
You can usually relieve the symptoms ofdiarrhea-predominant irritable bowel syndrome (IBS-D)with over-the-counter (OTC)diarrhea medicationslike Pepto-Bismol and Imodium. However, these drugs are not meant to be used for more than a few days.
This article lists the OTC and prescription drugs commonly used for diarrhea-predominant IBS. These include some drugs that are frequently used off-label when other options fail to provide relief.
If you have IBS-D, OTC antidiarrheals may be effective in relieving youracute(sudden, severe)diarrhea. However, they can cause side effects if misused or overused. These drugs should only be used under the direction of a healthcare provider for a limited period.
Imodium (Loperamide)
Imodium should not be used for more than two days without your healthcare provider’s OK. Doing so can lead toconstipationand, on rare occasions, a potentially life-threatening complication calledtoxic megacolonin which the dilation (widening) of the large intestine can causebowel perforation, internal bleeding, and death.
Pepto-Bismol, Kaopectate (Bismuth Subsalicylate)
Taking bismuth subsalicylate for more than two days is not recommended because it can alter the balance of fluids andelectrolytesin the body. This can lead to dizziness, muscle spasms, heart palpitations, andtinnitus(ringing in the ears).
Can Probiotics Help IBS-D Symptoms?Probioticswill not stop an acute episode of IBS-associated diarrhea, and it is unclear how helpful they are in the long-term management of the disease. Some studies suggest thatprobiotic supplements may help ease IBS-D symptomsover time, while others found no such benefit.
Can Probiotics Help IBS-D Symptoms?
Probioticswill not stop an acute episode of IBS-associated diarrhea, and it is unclear how helpful they are in the long-term management of the disease. Some studies suggest thatprobiotic supplements may help ease IBS-D symptomsover time, while others found no such benefit.
There are a host of prescription drugs that can be used to relieve diarrhea in people with IBS. Some are specifically indicated for the treatment of IBS-D, while others are used off-label (meaning for purposes other than what they are licensed for).
Xifaxan (rifaximin)
Viberzi (Eluxadoline)
Viberzi (eluxadoline) is FDA-approved to treat diarrhea and stomach pain in people with IBS-D. It blocks signals from the brain to the intestines that regulateperistalsis(intestinal contractions). By doing so, it allows more water to be absorbed from stool.
Viberzi is taken twice daily with food but only for as long as your healthcare provider thinks you need it. It is listed as a controlled substance due to a risk of drug dependence (addiction).
Side effects include nausea, constipation, bloating, vomiting, runny or stuffy nose, and upper respiratory infection.
Lotronox (Alosetron)
Lotronox is only used when severe IBS-associated diarrhea persists for six months. The drug is used with such caution because it can lead to a potentially severe complication calledischemic colitisin which reduced blood flow to the colon can lead to tissue death, bowel perforation, orbowel obstruction.
Lotronox is not used in males because the concentration of the drug in the blood is typically lower than in females, Because of the reduced therapeutic effect, the benefits may not outweigh the risks.
Lomotil (Diphenoxylate/Atropine)
Side effects of Lomotil include drowsiness, dizziness, itchy skin, nausea, dry skin, restlessness, andmalaise(a general feeling of unwellness).
Antispasmodics
Antispasmodics prescribed off-label for IBS include:
Despite their frequent use, the American College of Gastroenterology (ACG) recently came out against the use of antispasmodics, citing the lack of evidence that the drugs help ease IBS symptoms.
Side effects include constipation, dry skin, dry mouth, dizziness, bloating, and decreased urination. Some antispasmodic are taken up to four times daily to treat acute IBS-D symptoms.
How Effective Are Antispasmodics for IBS?
Antidepressants
Although commonly prescribed for the treatment of depression and anxiety,antidepressantsmay have beneficial effects for people with IBS-D.
Antidepressants commonly used for IBS-D include:
Though the use of antidepressants to treat IBS-D is considered off-label, the drugs remain widely prescribed because they are often very effective and generally well tolerated. They can also ease anxiety and stress that can trigger IBS symptoms.
Side effects include nausea, drowsiness, dry mouth, insomnia, dizziness, and sexual problems like low sex drive and erectile dysfunction. Antidepressants are typically dosed on a once-daily schedule.
Bile Acid Sequestrants
Drugs classified asbile acid sequestrants(a.k.a. bile acid binders or bile acid resins) are sometimes prescribed to people with IBS who have evidence of BAD. These drugs are not recommended for the general treatment of IBS-D.
Bile acid binders sometimes used to treat IBS-D include:
Side effects of bile acid sequestrants include constipation, stomach pain, bloating, vomiting, heartburn, loss of appetite, indigestion, and upset stomach. The drugs are typically taken once daily until symptoms ease.
How Diarrhea-Predominant IBS (IBS-D) Is Treated
Summary
Diarrhea-predominant irritable bowel syndrome (IBS-D) can be treated with over-the-counter (OTC) and prescription medications. OTC options include antidiarrheals like Imodium (loperamide) and bismuth subsalicylate found in Pepto-Bismol and Kaopectate.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Moshiree B, Heidelbaugh JJ, Savuk GS.A narrative review of irritable bowel syndrome with diarrhea: a primer for primary care providers.Adv Ther.2022;39(9):4003–4020. doi:10.1007/s12325-022-02224-zCamilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med. 2017;6(11):101. doi:10.3390/jcm6110101U.S. Food and Drug Administration.Imodium label.Graham DY, Lee SY.How to effectively use bismuth quadruple therapy: The good, the bad, and the ugly.Gastroenterol Clin North Am. 2015;44(3):537-63. doi:10.1016/j.gtc.2015.05.003Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA.Probiotics in irritable bowel syndrome: an up-to-date systematic review.Nutrients. 2019;11(9):2048. doi:10.3390/nu11092048Salix Pharmaceuticals,.XIFAXAN® (rifaximin) tablets.Lacy, BE, Pimentel M, Brenner DM, et al.Clinical guideline: management of irritable bowel syndrome.Am J Gastroenterol.2021;116(1):17-44. doi:10.14309/ajg.0000000000001036Allergan USA.VIBERZI (eluxadoline) tablets, for oral use.U.S. Food and Drug Administration.Lotronex (alosetron hydrochloride) information.Canadian Society of Intestinal Research.Irritable bowel syndrome.Fritsch P, Kobler MR, Korownyk C.Antidepressants for irritable bowel syndrome.Can Fam Physician,2020 Apr;66(4):265.BouSaba J, Sanaa W, McKinzie S, et al.Impact of bile acid diarrhea in patients with diarrhea-predominant irritable bowel syndrome on symptoms and quality of life.Clin Gastroenterol Hepatol. 2022 Sep;20(9):2083–2090.e1. doi:10.1016/j.cgh.2021.11.035
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Moshiree B, Heidelbaugh JJ, Savuk GS.A narrative review of irritable bowel syndrome with diarrhea: a primer for primary care providers.Adv Ther.2022;39(9):4003–4020. doi:10.1007/s12325-022-02224-zCamilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med. 2017;6(11):101. doi:10.3390/jcm6110101U.S. Food and Drug Administration.Imodium label.Graham DY, Lee SY.How to effectively use bismuth quadruple therapy: The good, the bad, and the ugly.Gastroenterol Clin North Am. 2015;44(3):537-63. doi:10.1016/j.gtc.2015.05.003Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA.Probiotics in irritable bowel syndrome: an up-to-date systematic review.Nutrients. 2019;11(9):2048. doi:10.3390/nu11092048Salix Pharmaceuticals,.XIFAXAN® (rifaximin) tablets.Lacy, BE, Pimentel M, Brenner DM, et al.Clinical guideline: management of irritable bowel syndrome.Am J Gastroenterol.2021;116(1):17-44. doi:10.14309/ajg.0000000000001036Allergan USA.VIBERZI (eluxadoline) tablets, for oral use.U.S. Food and Drug Administration.Lotronex (alosetron hydrochloride) information.Canadian Society of Intestinal Research.Irritable bowel syndrome.Fritsch P, Kobler MR, Korownyk C.Antidepressants for irritable bowel syndrome.Can Fam Physician,2020 Apr;66(4):265.BouSaba J, Sanaa W, McKinzie S, et al.Impact of bile acid diarrhea in patients with diarrhea-predominant irritable bowel syndrome on symptoms and quality of life.Clin Gastroenterol Hepatol. 2022 Sep;20(9):2083–2090.e1. doi:10.1016/j.cgh.2021.11.035
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Moshiree B, Heidelbaugh JJ, Savuk GS.A narrative review of irritable bowel syndrome with diarrhea: a primer for primary care providers.Adv Ther.2022;39(9):4003–4020. doi:10.1007/s12325-022-02224-zCamilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med. 2017;6(11):101. doi:10.3390/jcm6110101U.S. Food and Drug Administration.Imodium label.Graham DY, Lee SY.How to effectively use bismuth quadruple therapy: The good, the bad, and the ugly.Gastroenterol Clin North Am. 2015;44(3):537-63. doi:10.1016/j.gtc.2015.05.003Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA.Probiotics in irritable bowel syndrome: an up-to-date systematic review.Nutrients. 2019;11(9):2048. doi:10.3390/nu11092048Salix Pharmaceuticals,.XIFAXAN® (rifaximin) tablets.Lacy, BE, Pimentel M, Brenner DM, et al.Clinical guideline: management of irritable bowel syndrome.Am J Gastroenterol.2021;116(1):17-44. doi:10.14309/ajg.0000000000001036Allergan USA.VIBERZI (eluxadoline) tablets, for oral use.U.S. Food and Drug Administration.Lotronex (alosetron hydrochloride) information.Canadian Society of Intestinal Research.Irritable bowel syndrome.Fritsch P, Kobler MR, Korownyk C.Antidepressants for irritable bowel syndrome.Can Fam Physician,2020 Apr;66(4):265.BouSaba J, Sanaa W, McKinzie S, et al.Impact of bile acid diarrhea in patients with diarrhea-predominant irritable bowel syndrome on symptoms and quality of life.Clin Gastroenterol Hepatol. 2022 Sep;20(9):2083–2090.e1. doi:10.1016/j.cgh.2021.11.035
Moshiree B, Heidelbaugh JJ, Savuk GS.A narrative review of irritable bowel syndrome with diarrhea: a primer for primary care providers.Adv Ther.2022;39(9):4003–4020. doi:10.1007/s12325-022-02224-z
Camilleri M, Ford AC.Pharmacotherapy for irritable bowel syndrome.J Clin Med. 2017;6(11):101. doi:10.3390/jcm6110101
U.S. Food and Drug Administration.Imodium label.
Graham DY, Lee SY.How to effectively use bismuth quadruple therapy: The good, the bad, and the ugly.Gastroenterol Clin North Am. 2015;44(3):537-63. doi:10.1016/j.gtc.2015.05.003
Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA.Probiotics in irritable bowel syndrome: an up-to-date systematic review.Nutrients. 2019;11(9):2048. doi:10.3390/nu11092048
Salix Pharmaceuticals,.XIFAXAN® (rifaximin) tablets.
Lacy, BE, Pimentel M, Brenner DM, et al.Clinical guideline: management of irritable bowel syndrome.Am J Gastroenterol.2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
Allergan USA.VIBERZI (eluxadoline) tablets, for oral use.
U.S. Food and Drug Administration.Lotronex (alosetron hydrochloride) information.
Canadian Society of Intestinal Research.Irritable bowel syndrome.
Fritsch P, Kobler MR, Korownyk C.Antidepressants for irritable bowel syndrome.Can Fam Physician,2020 Apr;66(4):265.
BouSaba J, Sanaa W, McKinzie S, et al.Impact of bile acid diarrhea in patients with diarrhea-predominant irritable bowel syndrome on symptoms and quality of life.Clin Gastroenterol Hepatol. 2022 Sep;20(9):2083–2090.e1. doi:10.1016/j.cgh.2021.11.035
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