IBS Medications [+ Future & Alternative Treatments]

Over-the-Counter & Prescription IBS Medications

Can IBS be treated with medication? Yes, several different medications can be for treating IBS. Even if more natural methods (like diet and lifestyle changes) avoid side effects and unnecessary man-made chemicals, there are over 100 IBS medications.

What type of medication is used for IBS? The types of medications doctors use to treat IBS include:

1. Promotility agents
2. Laxatives
3. Antidiarrheals
4. Anticholinergics
5. Antibiotics
6. Tricyclic antidepressants
7. SSRI antidepressants
8. Linaclotide
9. Pain-blocking medications

Let’s go over each type of medication in a little more detail. For each medication, we’ll discuss:

• How it treats IBS
• Whether it treats IBS-C or IBS-D
• Is it prescription or over-the-counter?
• Side effects

1. Prokinetic agents

Prokinetic (also known as promotility) agents like Motegrity (prucalopride) and low-dose naltrexone may be used to treat IBS-C and concurrent SIBO. These medications help to stimulate smooth muscle contractions.

Prokinetic agents are often used in the short term.

Prucalopride has been approved in most countries, including the US, as an effective, safe treatment for constipation with no known cause, also known as Chronic Idiopathic Constipation (CIC). 

Unlike earlier types of medication in this category, prucalopride does not seem to cause significant side effects (although it may cause diarrhea or mood changes in some cases). Mood can sometimes be affected because the medication functions by stimulating a particular serotonin receptor (5-HT4).

Randomized controlled trials have not proven it as an established IBS or SIBO treatment, but functional practitioners (including those at PrimeHealth) have seen notable success using this medication.

Low-dose naltrexone (LDN) affects the opioid receptors in the gut to support peristalsis. A 2007 clinical trial found that it improved symptoms in over 78% of patients who took it for IBS.

Common side effects of low-dose-naltrexone include:

• Nightmares or sleep disturbance
• Headache and/or migraine
• Nausea

2. Laxatives

Laxatives increase bowel function, relieving constipation. Laxatives are an IBS-C treatment because they accelerate the waste removal process.

You can get several laxatives over the counter without a prescription, but some laxatives require a doctor’s prescription. OTC laxatives should be taken in low doses and only after consulting your doctor.

These laxatives are used to treat IBS:

• Bisacodyl (Dulcolax)
• Lubiprostone (Amitiza)
• Magnesium hydroxide (Milk of Magnesia)
• Methylcellulose (Citrucel)
• Polyethylene glycol 3350 (MiraLAX)
• Psyllium (Metamucil)
• Senna (Senokot)

Common side effects of laxatives include:

• Diarrhea
• Bloating
• Flatulence
• Stomach cramping
• Dehydration

3. Antidiarrheal Medications

Antidiarrheal medications stop or slow diarrhea by slowing down intestinal contractions. This allows more time for water to be absorbed from the waste product, which stiffens your stool consistency.

Antidiarrheals treat IBS-D.

You can usually get antidiarrheals over-the-counter — no prescription needed.

These antidiarrheal meds are used to treat IBS:

• Atropine and diphenoxylate (Lomotil)
• Bismuth subsalicylate (Pepto-Bismol)
• Lactobacillus acidophilus (Acidophilus)
• Loperamide (Imodium)

Common side effects of antidiarrheal meds include:

• Constipation
• Nausea
• Vomiting
• Abdominal pain
• Dizziness
• Loss of appetite

4. Anticholinergic Medications

Anticholinergic medications (also called antispasmodics) are drugs that limit acetylcholine, which is a neurotransmitter which causes muscles  — such as bowel movement muscles — to contract. In a way, anticholinergics are a more targeted type of antidiarrheal.

Anticholinergic meds are an IBS treatment because anticholinergics regulate spasms of the colon.

Anticholinergics treat IBS-D. They are only available with a physician’s prescription.

These anticholinergic meds are used to treat IBS:

• Atropine (Atropen)
• Benztropine mesylate (Cogentin)
• Cyclopentolate (Cyclogyl)
• Darifenacin (Enablex)
• Dicyclomine (Bentyl)
• Fesoterodine (Toviaz)
• Flavoxate (Urispas)
• Hyoscyamine (Levsin)
• Ipratropium (Atrovent)
• Oxybutynin (Ditropan XL)
• Propantheline (Pro-banthine)
• Solifenacin (VESIcare)
• Tiotropium (Spiriva)
• Tolterodine (Detrol)

Common side effects of anticholinergic meds include:

• Constipation
• Dry mouth
• Dry eyes
• Dizziness
• Sexual dysfunction
• Heart arrhythmia
• Retention of fluids

5. Antibiotics

Antibacterial medications (also called antibiotics) are drugs that kill bacteria. The problem is, there are all sorts of beneficial bacteria in our gut. Antibiotics seldom make that distinction.

However, there are sometimes enough harmful bacteria in your small intestine that it’s necessary to flush them out with antibiotics.

When bacteria grow in your small intestine instead of your large intestine, where they’re supposed to, a condition called SIBO (small intestinal bacterial overgrowth) may develop. SIBO is often linked to IBS in our patients.

Different antibiotics can treat IBS-C or IBS-D.

You cannot buy antibiotics over the counter. Antibacterial meds are available by prescription only.

These antibiotics are used to treat IBS:

• Clarithromycin (Biaxin)
• Metronidazole (Flagyl)
• Rifaximin (Xifaxan)

Here at PrimeHealth, the IBS antibiotic we most often prescribe is rifaximin. We pair this with Neomycin or an antibiotic like Flagyl for methane-predominant SIBO.

Common side effects of antibiotics include:

• Diarrhea
• Indigestion
• Nausea
• Vomiting
• Bloating
• Abdominal pain
• Loss of appetite
• Destruction of the gut microbiome

6. Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) mainly treat depression. But they also reduce pain and stress and promote digestive health.

TCAs treat IBS-D by slowing down gut motility.

TCAs were the first antidepressant created. However, TCAs interact poorly with hundreds of other drugs. Your doctor will make sure TCAs don’t interact with any drugs you’re already taking.

Like most antidepressants, TCAs require a prescription. Because of many undesirable side effects, PrimeHealth practitioners rarely suggest or prescribe them.

These tricyclic antidepressants are used to treat IBS:

• Amitriptyline (Elavil)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Desipramine (Norpramin)
• Nortriptyline (Pamelor)

Common side effects of tricyclic antidepressants include:

• Constipation
• Drop in blood pressure
• Blurred vision
• Dry mouth
• Drowsiness
• Sexual dysfunction

7. SSRI Antidepressants

SSRI antidepressants are selective serotonin reuptake inhibitors. They are thought to treat depression by stopping the “reuptake” of serotonin (a mood-enhancing neurotransmitter), increasing serotonin levels.

SSRIs treat IBS-C.

SSRI antidepressants are used as an IBS treatment for four reasons:

1. SSRIs reduce stress and anxiety, common comorbid symptoms of IBS. Stress and anxiety can also cause or worsen IBS symptoms.
2. SSRIs seem to reduce pain, particularly in your central nervous system and digestive system.
3. SSRIs help you sleep. IBS often leads to insomnia.
4. SSRIs may regulate gut motor function that is messed up by IBS, according to preliminary evidence.

Like all antidepressants, SSRIs are prescription medications. The withdrawal symptoms of SSRIs can be very serious, so discuss this with your doctor before starting, weaning off, or stopping an SSRI. 

We help many of our patients come off of SSRI medications. They can be helpful in the short-term, but it’s ideal to stop prolonged use when possible.

These SSRI antidepressants are used to treat IBS:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Common side effects of SSRI antidepressants include:

• Diarrhea
• Constipation
• Indigestion
• Loss of appetite
• Agitation
• Dry mouth
• Blurred vision
• Headache
• Insomnia
• Dizziness
• Sexual performance issues
• Suicidal ideation, in rare cases

8. Linaclotide and Plecanatide

Linaclotide and plecanatide are relatively new drugs meant to treat IBS-C.

These are FDA-approved guanylate cyclase-C agonists, which means they increase fluid in the large intestine and decrease the activity of pain-sensing nerves.

Linaclotide and plecanatide require a prescription.

Linzess is the brand name of linaclotide in the United States and Mexico — Constella in other markets.

Trulance is the brand name of plecanatide.

Common side effects of linaclotide include:

• Diarrhea
• Abdominal pain
• Bloating
• Vomiting
• Headache
• Heartburn
• Cold-like symptoms

9. Pain-Blocking Medications

Pain medications (also called painkillers) are drugs meant to relieve pain. Painkillers are usually used to reduce abdominal pain associated with IBS.

Painkillers typically relieve symptoms of irritable bowel syndrome temporarily, and are not meant as a long-term fix. They don’t treat IBS-C or IBS-D, they simply offer short-term symptom relief.

Over-the-counter pain medications include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), like:

• Aspirin
• Naproxen (Aleve)
• Ibuprofen (Advil, Motrin)

Prescription pain medications used to treat IBS symptoms include:

• Hydrocodone (Vicodin)
• Oxycodone (Percocet)
• Meperidine (Demerol)
• Tramadol (Ultram)

Eluxadoline (Viberzi) is a painkiller used specifically to treat IBS-D. This prescription drug manages abdominal pain and diarrhea.

Common side effects of pain medications include:

• Constipation
• Nausea
• Weakened immune system
• Drowsiness
• Dizziness
• Depression
• Tolerance
• Addiction

Because opioids are highly addictive, the doctors at PrimeHealth never begin treatment with these medications.

Supplements for IBS Symptoms

Several dietary supplements can help relieve IBS symptoms, including:

• Fiber supplements
• Digestive enzymes
• Probiotics 
• Prebiotics
• Peppermint oil
• Oil of oregano
• Chamomile
• Chasteberry
• Ginger

Read more about supplements and other natural IBS remedies.

Future Treatments for IBS

Scientists are already investigating novel treatment options for IBS in ongoing clinical trials.

Bovine proteins and specially coated peppermint oil tablets are two promising new therapies.

What is the new medicine for IBS?

5-HT3 directed therapy is an IBS medication recently gaining traction.

5-HT3 directed therapy prevents the activation of 5-HT3 receptors, which may decrease abdominal pain and slow the motility of your bowels. This would be useful in IBS-D.

Alosetron (Lotronex) is a popular 5-HT3 drug approved by the FDA in 2000. In 2016, the drug was efficiently tested for safety to the point that the additional warning labels it previously carried were removed.

Alternative Treatments for IBS

Alternative treatments for IBS are growing in popularity, even if the science behind them is less thorough or controversial. This is partly because there is not one agreed-upon treatment for IBS.

Alternative therapies you may consider looking into include:

• Acupuncture
• Biofeedback
• Cognitive behavior therapy
• Hypnotherapy
• Meditation
• Psychotherapy
• Visceral manipulation
• Fecal Microbiota Transplant (FMT)

What is IBS? 

Irritable bowel syndrome (IBS) is a disorder of the large intestine characterized by abnormal bowel movements and abdominal discomfort.

The symptoms of IBS are:

• Abdominal pain
• Bloating
• Cramping
• Excess gas
• Blood in stool
• Fatigue
• Depression and anxiety
• Diarrhea or constipation

According to the Rome IV criteria for diagnosing IBS, there are 4 types of IBS based on their predominant symptoms:

1. IBS-D. Diarrhea-predominant IBS (IBS-D) is when your irritated bowel causes diarrhea.
2. IBS-C. Constipation-predominant IBS (IBS-C) is when your irritated bowel causes constipation.
3. IBS-M. IBS with mixed bowel habits (IBS-M) is when you go back and forth between diarrhea and constipation. Used to be called IBS-A.
4. IBS-U. IBS unclassified (IBS-U) is when your symptoms cannot be classified within the other three types.

Are IBS and IBD the same thing? No. IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) both occur in the intestines, but involve different symptoms. IBS causes altered bowel movements, while IBD is characterized by chronic inflammation. IBD is an autoimmune disorder, while IBS is not technically considered an autoimmune condition.

IBS medication isn’t the only way to treat IBS, but it can be beneficial. 

To avoid synthetic chemicals, adverse side effects, and masking an underlying cause of IBS, it’s best to treat IBS with a Functional and Integrative Medicine approach first. At PrimeHealth, we’ve helped hundreds of patients cure IBS permanently.

The approach includes dietary and lifestyle changes, supplement protocols, and sometimes medications.

What is the typical treatment for IBS? Typical treatment for IBS includes temporary use of medications while the patient and their healthcare provider work to determine the underlying cause(s) of symptoms.

A Functional Approach to Treating IBS

Functional treatment of IBS is effective because IBS is rooted in inflammation and dysbiosis of the gut. Dietary and lifestyle changes help to reset these issues and result in a more pronounced improvement than conventional treatment alone. 

Here at PrimeHealth, our patients often report that their IBS has been reversed as a result of our whole body approach to IBS.

Dietary changes to support healing the gut.  include removing common food allergens, like gluten or dairy, and considering a low-FODMAP diet for IBS. You can work with a dietitian to determine your specific needs.

Lifestyle changes also play a big role in reversing IBS, such as:

• Stress relief
• A full night’s sleep – to improve sleep through optimizing melatonin production, use code PRIMEHEALTH for 10% off our favorite blue-light blocking glasses from Ra Optics
• Meditation
• Yoga
• Going outside
• Focused breathing
• Exercise
• Keeping a food diary

When to Call Your Doctor

When you are undergoing treatment for IBS, there are some dangerous symptoms or side effects that should compel you to seek immediate medical attention.

Call your healthcare provider if you experience any of these signs that your IBS is worsening:

• Persistent diarrhea
• Persistent constipation
• Blood or mucus in stool
• Abdominal pain

Call a doctor immediately if you experience any of these adverse side effects to IBS medication:

• Vomiting
• Severe diarrhea
• Severe constipation
• Rash
• Constant dizziness
• Vaginal itching or discharge
• White patches on tongue
• Abnormal heartbeat
• Cognitive changes

Looking to the Future

Tens of millions of Americans suffer from IBS every year. Just because it’s common doesn’t mean it should be ignored.

There are more treatments for IBS than there ever have been, including IBS medications.

Here at PrimeHealth, we believe in a functional approach first when dealing with IBS. We prescribe IBS medication to some patients to support a whole-body approach to healing this condition.

Ready to take back your quality of life? Schedule a free phone consultation with PrimeHealth today. Don’t forget to follow us on Instagram for health updates straight to your feed!

— Medically reviewed by Soyona Rafatjah, MD. on June 28, 2023.

Sources

1. Omer, A., & Quigley, E. M. (2017). An update on prucalopride in the treatment of chronic constipation. Therapeutic advances in gastroenterology, 10(11), 877-887. 
2. Ford, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., … & Quigley, E. M. (2014). American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. American Journal of Gastroenterology, 109, S2-S26.
3. Generali, J., & Cada, D. J. (2007). Naltrexone: irritable bowel syndrome. Hospital Pharmacy, 42(8), 712-715.
4. Ploesser, J., Weinstock, L. B., & Thomas, E. (2010). Low dose naltrexone: side effects and efficacy in gastrointestinal disorders. International journal of pharmaceutical compounding, 14(2), 171. 
5. Thiwan, S. I., & Drossman, D. A. (2006). Treatment of functional GI disorders with psychotropic medicines: a review of evidence with a practical approach. Gastroenterology & hepatology, 2(9), 678. 
6. Talley, N. J. (2003). SSRIs in IBS: sensing a dash of disappointment. Clinical Gastroenterology and Hepatology, 1(3), 155-159. 
7. Axelrod, C. H., & Saps, M. (2018). The role of fiber in the treatment of functional gastrointestinal disorders in children. Nutrients, 10(11), 1650. 
8. Chen, Q., Ren, Y., Lu, J., Bartlett, M., Chen, L., Zhang, Y., … & Liu, C. (2017). A novel prebiotic blend product prevents irritable bowel syndrome in mice by improving gut microbiota and modulating immune response. Nutrients, 9(12), 1341. 
9. Alammar, N., Wang, L., Saberi, B., Nanavati, J., Holtmann, G., Shinohara, R. T., & Mullin, G. E. (2019). The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC complementary and alternative medicine, 19(1), 21. 
10. Miraj, S., & Alesaeidi, S. (2016). A systematic review study of therapeutic effects of Matricaria recuitta chamomile (chamomile). Electronic physician, 8(9), 3024. 
11. Spanier, J. A., Howden, C. W., & Jones, M. P. (2003). A systematic review of alternative therapies in the irritable bowel syndrome. Archives of internal medicine, 163(3), 265-274. 
12. Gonsalkorale, W. M., Miller, V., Afzal, A., & Whorwell, P. J. (2003). Long term benefits of hypnotherapy for irritable bowel syndrome. Gut, 52(11), 1623–1629.
13. Han, C. J., & Yang, G. S. (2016). Fatigue in irritable bowel syndrome: a systematic review and meta-analysis of pooled frequency and severity of fatigue. Asian nursing research, 10(1), 1-10.
14. Janssens, K. A., Zijlema, W. L., Joustra, M. L., & Rosmalen, J. G. (2015). Mood and anxiety disorders in chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome: results from the LifeLines cohort study. Psychosomatic medicine, 77(4), 449-457.
15. Magge, S., & Lembo, A. (2012). Low-FODMAP diet for treatment of irritable bowel syndrome. Gastroenterology & hepatology, 8(11), 739. 
16. Ewert, A., & Chang, Y. (2018). Levels of nature and stress response. Behavioral Sciences, 8(5), 49. 
17. Zhou, C., Zhao, E., Li, Y., Jia, Y., & Li, F. (2019). Exercise therapy of patients with irritable bowel syndrome: a systematic review of randomized controlled trials. Neurogastroenterology & Motility, 31(2), e13461.