Issue link: https://eguideline.guidelinecentral.com/i/70970
Treatment Table 6. Treatment Options for IBS-C Drug (Brand) Bulk laxatives Psyllium (eg, Metamucil® Fiberall® ) , Perdiem® , Titrate up to ~ 20 g (2C) Recommended Dose Comments Natural fiber that undergoes bacterial degradation, which may contribute to bloating and flatus; should be taken with plenty of water to avoid intestinal obstruction; allergic reactions such as anaphylaxis and asthma are rare Methylcellulose (eg, Citrucel® ) Calcium polycarbophil (eg, Equalactin® ) Osmotic laxatives Saline laxatives Magnesium hydroxide (eg, Phillips' ® Magnesia) Magnesium citrate (eg, Evac-Q-Mag® Lactulose (Chronulac® Enulose® Kristalose® , Generlac® ) Milk of ) , Constulose® , , 15-30 mL once or twice a day 150-300 mL prn 15-30 mL once or twice a day A small percentage of magnesium is actively absorbed in the small intestines; hypermagnesemia can occur in patients with renal failure and in children Synthetic disaccharide consisting of galactose and fructose linked by bond resistant to disaccharidases; not absorbed by the small intestine; undergoes bacterial fermentation in the colon with formation of short- chain fatty acids; gas and bloating are common side effects Polyethylene glycol 3350 (eg, Miralax® ) Stimulant laxatives Anthraquinones Cascara sagrada (Colamin® Sagrada-lax® , Senna (Senokot® ) , Ex-Lax® ) 325 mg (or 5 mL) daily 187 mg daily Converted by colonic bacteria to their active form; may cause melanosis coli, a benign condition that is usually reversible within 12 months aſter the cessation of laxative use; no definitive association between anthraquinones and colon cancer or myenteric nerve damage has been established 17-36 g once or twice a day (2C) Does not include electrolytes and is packaged for more regular use Titrate up to ~ 20 g Titrate up to ~ 20 g Semisynthetic cellulose fiber that is relatively resistant to colonic bacterial degradation Synthetic fiber of polymer of acrylic acid, resistant to bacterial degradation