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Irritable bowel syndrome - Management
What drug treatment should I consider?

  • Use single drugs or a combination of drugs according to the predominant symptoms of the individual.
  • Consider an antispasmodic, alongside dietary and lifestyle advice, for all people with irritable bowel syndrome, and in particular those with pain occurring as spasm.
  • For people with constipation, consider treatment with a laxative.
    • Bulk-forming laxatives are preferred (e.g. ispaghula or sterculia).
    • For people who cannot tolerate a bulk-forming laxative, or who need an additional laxative, offer a macrogol (polyethylene glycol) or a stimulant laxative (for short-term use only).
    • Lactulose is not recommended.
  • For people with diarrhoea, consider treatment with an antimotility drug.
    • Loperamide is the antimotility drug of choice.
  • Advise people to adjust the dose of laxative or antimotility drug according to response. The aim is to produce a soft, well-formed stool.
  • If symptoms do not respond to first-line treatment, consider a trial of a low dose tricyclic antidepressant e.g. amitriptyline 10 mg at night (for pain relief).
    • Review 4 weeks after starting treatment and titrate the dose up if necessary (usual maximum 30 mg at night).
    • Continue to review every 6–12 months.
    • Consider a selective serotonin reuptake inhibitor if a tricyclic antidepressant has previously been shown to be ineffective.

In depth

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