IBS treatment has historically been far from standard, with variations by region and from one healthcare provider to the next. In 2021, the American College of Gastroenterology (ACG) released guidelines aimed at standardizing IBS treatment based on the latest research. Those recommendations are mentioned below.

IBS-Specific Drugs: IBS-D

Two prescription medications (rifaximin and eluxadoline) have been approved by the Food and Drug Administration (FDA) for treating IBS-D. The ACG recommends both of them.

IBS-D (diarrhea-predominant) IBS-C (constipation-predominant) IBS-M (mixed diarrhea and constipation) IBS-U (unidentified bowel pattern)

Xifaxan

Xifaxan (rifaximin) is an antibiotic that was originally used to treat travelers’ diarrhea and small intestinal bacterial overgrowth (SIBO). Its FDA approval is for the treatment of “non-constipation IBS.”

Xifaxan works differently than most antibiotics. Rather than entering your bloodstream, it directly targets bacteria in your small and large intestines. It’s considered safe to use for up to three two-week courses.

Viberzi

Viberzi (eluxadoline) affects opioid receptors in your digestive system to relieve the symptoms of abdominal pain and diarrhea in IBS-D. Because Viberzi is an opioid medication, it is classified as a controlled substance, which causes some concern about a potential for addiction.

Not everyone can safely take Viberzi. Factors that make it dangerous for you include:

A history of pancreatitis Gallbladder removal Alcoholism or alcohol abuse/addiction Three or more servings of alcohol per day Severe liver impairment

Imodium

Imodium (loperamide) is an over-the-counter (OTC) medication that’s long been a standby for diarrhea and IBS-D. Benefits include that it’s inexpensive and easy to get.

However, the ACG guidelines recommend against loperamide as a first-line treatment for IBS because it addresses only diarrhea and not global symptoms.

Lotronex

Lotronex (alosetron) works by slowing down the movement of stool through your intestines. It’s used to treat several symptoms of IBS-D, including:

DiarrheaPainCrampsUrgent bowel movements

However, this drug is linked to some serious side effects, including:

Ischemic colitis Complicated constipation (associated with obstruction or perforation) Death

Because of these risks, the ACG recommends this medication only for women with severe IBS-D, and only when other treatments have failed to bring relief.

IBS-Specific Drugs: IBS-C

A few presciption medications are available and ACG-recommended for treating IBS-C. They include:

Amitiza (lubiprostone): Causes cells lining the intestines to release more fluid, which softens your stool. Nausea is a frequent side effect. Linzess (linaclotide): Increases the amount of fluid in your large intestine, which softens stool. Trulance (plecantide): Also increases fluid in the large intestines. Zelnorm (tegaserod): Improves muscle movement and fluid production in the bowels, which helps soften and move stool. It is only considered appropriate for women under 65 who haven’t been helped by other drugs.

Laxatives

Laxatives of all types are commonly used to relieve the symptom of constipation, especially Miralax (polyethylene glycol or PEG), which no longer requires a prescription.

One study found that PEG was helpful for easing constipation and softening stools, but not for relieving IBS pain. The ACG recommends against using laxatives containing PEG.

Antidepressants

Antidepressants are often used at low doses to treat IBS symptoms, since they have pain-relieving qualities and are safe for long-term use.

Your healthcare provider may recommend an antidepressant even if you are not depressed. If you do have depression or anxiety alongside your IBS, it is even more likely that your healthcare provider may choose this option.

In addition to relieving pain, antidepressants sometimes have side effects that involve digestion. As a result, your healthcare provider may make their choice of specific drugs based on whether you have IBS-C or IBS-D.

Available types include:

Tricyclic antidepressants (TCAs)Selective serotonin reuptake inhibitors (SSRIs)Serotonin-norepinephrine reuptake inhibitors (SNRIs)

The ACG recommends TCAs above the other types of antidepressants for all subtypes of IBS.

Antispasmodics

Antispasmodic medications are commonly prescribed for IBS, as they can help to relieve the abdominal pain and cramping that is characteristic of the condition.

However, they tend to have a constipating effect and thus might not be the best choice for IBS-C. As research regarding the safety of antispasmodics for long-term use is limited, these medications may be more appropriate for short-term use only.

While the ACG recommends against using these drugs, common antispasmodics prescribed for IBS include:

Bentyl (dicyclomine) Buscopan (hyoscine butylbromide) Anaspaz, Cystospaz, Levbid, Levsin (hyoscyamine)

Other Recommendations

Other IBS treatments recommended by the ACG guidelines include:

Adding soluble fiber to the diet Enteric-coated peppermint oil supplements A limited trial of a low-FODMAP diet Gut-directed psychotherapies including cognitive behavioral therapy (CBT) and hypnotherapy

The guidelines recommend against:

Probiotics Bile acid sequestrants Fecal transplant

Possible Future Drugs

New medications are currently going through safety trials and could eventually be used to treat IBS.

Asimadoline: In early clinical trials for treating IBS-D, it appears to ease abdominal pain and discomfort. Elobixibat: Under investigation for chronic idiopathic constipation (CIC), it increases levels of bile acids in your large intestine, which is believed to get fecal matter through the colon faster.

A Word From Verywell

While you have a variety of IBS medications to choose from, you may find that medication isn’t enough to totally eliminate your IBS symptoms. In some cases, the drugs cause unpleasant side effects that make you stop taking them.

Luckily, medication is not the only available treatment for IBS. Your other options include over-the-counter remedies, dietary modifications, and psychological therapies. Keep the lines of communication open with your healthcare provider to arrive at the best treatment plan for you.

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