Compared to the list of medications that are available for
diarrhea predominant irritable bowel syndrome (IBS-D), prescription medications for
constipation predominant irritable bowel syndrome (IBS-C) is a bit of a short story. Your doctor is more likely to recommend that you increase your intake of
fiber, either through your
diet or the use of a supplement, rather than to write out a prescription. If your symptom picture warrants further treatment, a few prescription options are available.
Amitiza (lubiprostone)
Amitiza is the only prescription medication approved by the
FDA for the treatment of IBS-C, as well as for
chronic idiopathic constipation (CIC). Amitiza works by increasing the amount of fluids in the intestines and therefore easing the passage of stools. The medication works on a cellular level as it targets (activates) proteins involved in transporting chloride, thus Amitiza is known as a chloride channel activator. Most people who take Amitiza will experience symptom relief within 24 hours. You should not take Amitiza if you have a bowel obstruction, experience severe diarrhea or are pregnant or breastfeeding.
Lactulose, sold under a variety of brand names, including Cephulac, Chronulac, Constilac, Cholac, Constulose, Duphalac, Enulose, Generlac and Kristalose, is indicated for the treatment of constipation. Lactulose is a manmade sugar that is broken down by bacteria in the intestines, a process that pulls more water into the colon. This increase in water softens, increases and normalizes the stool. The higher volume of stool helps to stimulate colon
motility and therefore encourages a bowel movement. Lactulose is generally recommended to be used on a short-term basis. Before taking lactulose, make sure that your doctor knows if you are scheduled for surgery, suffer from diabetes, or are pregnant or breastfeeding.
Zelnorm is a medication that was designed to treat IBS-C and
chronic idiopathic constipation (CIC), by increasing the amount of the
neurotransmitter serotonin (5-HT) in the cells of the gut’s own
nervous system. Unfortunately, due to identified serious health risks, the medication is now only available on an emergency basis and its prescription must be authorized directly by the FDA.
Antidepressants are not approved as a treatment for constipation. However, due to the high rate of depression in patients with
IBS and due to the fact that antidepressants can have effective anti-pain properties, a doctor may prescribe an antidepressant to an individual who suffers from IBS-C.
Tricyclic antidepressants are an older class of antidepressants with the unfortunate side effect of constipation and therefore would not be indicated for use by someone who suffers from chronic constipation. Examples of tricyclic antidepressants include
Elavil,
Norpramin,
Pamelor and
Tofranil. A better choice of antidepressant for a person who suffers from constipation would be from the class called
selective serotonin reuptake inhibitors (SSRIs), as they are less likely to be constipating. Examples of SSRIs include
Celexa,
Lexapro,
Prozac,
Paxil and
Zoloft.
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