about alternatives for treating irritable bowel syndrome

Now that Lotronex is off the market, patients are asking about alternatives for treating irritable bowel syndrome.

Lotronex (alosetron) was introduced last March...for women with diarrhea- predominant irritable bowel syndrome (IBS).

Now it has been discontinued due to reports of ischemic colitis and severe constipation...including several deaths.

Recommend the usual standbys for IBS instead...

Fiber to help prevent constipation. Supplements (Citrucel, FiberCon, Metamucil) often cause less bloating than dietary fiber.

Loperamide for diarrhea. It causes fewer adverse effects than diphenoxylate (Lomotil, etc) and other opioids.

Antispasmodics...dicyclomine (Bentyl), hyoscyamine (Levsin)... sometimes reduce abdominal pain by decreasing intestinal contractions that are triggered by meals or stress.

Tricyclic antidepressants for pain or depression. Low-dose tricyclics have an analgesic effect...but they can be constipating.

SSRIs are used as an alternative to tricyclics for pain...or for anxiety or depression. SSRIs sometimes cause diarrhea.

Peppermint oil has antispasmodic effects that might reduce abdominal pain and bloating. Our Natural Medicines Comprehensive Database rates it as "possibly effective" for IBS. It's worth a try.

Suggest an enteric-coated formulation of peppermint oil...one capsule three times daily before meals.

We've created a patient handout on managing irritable bowel syndrome. Ask us for a copy...or go to www.pharmacistsletter.com.

• Patient Education: Irritable Bowel Syndrome (IBS)